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Lunde IG, Rypdal KB, Van Linthout S, Diez J, González A. Myocardial fibrosis from the perspective of the extracellular matrix: mechanisms to clinical impact. Matrix Biol 2024:S0945-053X(24)00110-0. [PMID: 39214156 DOI: 10.1016/j.matbio.2024.08.008] [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: 05/07/2024] [Revised: 08/08/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Fibrosis is defined by the excessive accumulation of extracellular matrix (ECM) and constitutes a central pathophysiological process that underlies tissue dysfunction, across organs, in multiple chronic diseases and during aging. Myocardial fibrosis is a key contributor to dysfunction and failure in numerous diseases of the heart and is a strong predictor of poor clinical outcome and mortality. The excess structural and matricellular ECM proteins deposited by cardiac fibroblasts, is found between cardiomyocytes (interstitial fibrosis), in focal areas where cardiomyocytes have died (replacement fibrosis), and around vessels (perivascular fibrosis). Although myocardial fibrosis has important clinical prognostic value, access to cardiac tissue biopsies for histological evaluation is limited. Despite challenges with sensitivity and specificity, cardiac magnetic resonance imaging (CMR) is the most applicable diagnostic tool in the clinic, and the scientific community is currently actively searching for blood biomarkers reflecting myocardial fibrosis, to complement the imaging techniques. The lack of mechanistic insights into specific pro- and anti-fibrotic molecular pathways has hampered the development of effective treatments to prevent or reverse myocardial fibrosis. Development and implementation of anti-fibrotic therapies is expected to improve patient outcomes and is an urgent medical need. Here, we discuss the importance of the ECM in the heart, the central role of fibrosis in heart disease, and mechanistic pathways likely to impact clinical practice with regards to diagnostics of myocardial fibrosis, risk stratification of patients, and anti-fibrotic therapy.
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Affiliation(s)
- Ida G Lunde
- Oslo Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway; KG Jebsen Center for Cardiac Biomarkers, Campus Ahus, University of Oslo, Oslo, Norway.
| | - Karoline B Rypdal
- Oslo Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway; KG Jebsen Center for Cardiac Biomarkers, Campus Ahus, University of Oslo, Oslo, Norway
| | - Sophie Van Linthout
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | - Javier Diez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, Department of Cardiology, Clínica Universidad de Navarra and IdiSNA Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, Department of Cardiology, Clínica Universidad de Navarra and IdiSNA Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
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2
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Brás PG, Cunha PS, Timóteo AT, Portugal G, Galrinho A, Laranjo S, Cruz MC, Valente B, Rio P, Delgado AS, Paulo M, Brás M, Ferreira RC, Oliveira MM, Branco LM. Evaluation of left atrial strain imaging and integrated backscatter as predictors of recurrence in patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation undergoing catheter ablation. J Interv Card Electrophysiol 2024; 67:479-492. [PMID: 37414922 DOI: 10.1007/s10840-023-01602-z] [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: 04/12/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Impaired left atrial (LA) strain predicts atrial fibrillation (AF) recurrence after catheter ablation (CA), but currently there is no cut-off to guide patient selection for CA. Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis. The aim of this study was to compare LA strain and IBS between paroxysmal, persistent, and long-standing persistent AF and evaluate their association with AF recurrence after CA. METHODS Analysis of consecutive patients with symptomatic paroxysmal and persistent AF who underwent CA. LA phasic strain, strain rate and IBS were assessed by two-dimensional speckle-tracking at baseline. RESULTS We analyzed 78 patients, 31% with persistent AF (46% long-standing AF), 65% male, mean age 59 ± 14 years, who underwent CA and were followed-up for 12 months. AF recurrence occurred in 22 (28%) patients. LA phasic strain parameters were significantly impaired in patients with AF recurrence and were independent predictors of AF recurrence in a multivariable analysis. LA reservoir strain (LASr) < 18% predicted AF recurrence with 86% sensitivity and 71% specificity, with a higher predictive power compared to LA volume index (LAVI). LASr < 22% in paroxysmal AF and LASr < 12% in persistent AF correlated with AF recurrence. Increased IBS was a predictor of AF recurrence in patients with paroxysmal AF. CONCLUSION LA phasic strain parameters were predictors of AF recurrence after CA, independently of LAVI and AF subtype. LASr < 18% showed a higher predictive power compared to LAVI. Further studies are needed to investigate the role of IBS as a predictor of AF recurrence.
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Affiliation(s)
- Pedro Garcia Brás
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal.
| | - Pedro Silva Cunha
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Lisbon, Portugal
| | - Guilherme Portugal
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Ana Galrinho
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Sérgio Laranjo
- Department of Physiology, NOVA Medical School|Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Madalena Coutinho Cruz
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Bruno Valente
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Ana Sofia Delgado
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Margarida Paulo
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Manuel Brás
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
| | - Mário Martins Oliveira
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
- Department of Physiology, NOVA Medical School|Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Luísa Moura Branco
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal
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Li F, Chen L, Zhong S, Chen J, Cao Y, Yu H, Ran H, Yin Y, Reutelingsperger C, Shu S, Ling Z. Collagen-Targeting Self-Assembled Nanoprobes for Multimodal Molecular Imaging and Quantification of Myocardial Fibrosis in a Rat Model of Myocardial Infarction. ACS NANO 2024; 18:4886-4902. [PMID: 38295159 DOI: 10.1021/acsnano.3c09801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Currently, inadequate early diagnostic methods hinder the prompt treatment of patients with heart failure and myocardial fibrosis. Magnetic resonance imaging is the gold standard noninvasive diagnostic method; however, its effectiveness is constrained by low resolution and challenges posed by certain patients who cannot undergo the procedure. Although enhanced computed tomography (CT) offers high resolution, challenges arise owing to the unclear differentiation between fibrotic and normal myocardial tissue. Furthermore, although echocardiography is real-time and convenient, it lacks the necessary resolution for detecting fibrotic myocardium, thus limiting its value in fibrosis detection. Inspired by the postinfarction accumulation of collagen types I and III, we developed a collagen-targeted multimodal imaging nanoplatform, CNA35-GP@NPs, comprising lipid nanoparticles (NPs), encapsulating gold nanorods (GNRs) and perfluoropentane (PFP). This platform facilitated ultrasound/photoacoustic/CT imaging of postinfarction cardiac fibrosis in a rat model of myocardial infarction (MI). The surface-modified peptide CNA35 exhibited excellent collagen fiber targeting. The strong near-infrared light absorption and substantial X-ray attenuation of the nanoplatform rendered it suitable for photoacoustic and CT imaging. In the rat model of MI, our study demonstrated that CNA35-GNR/PFP@NPs (CNA35-GP@NPs) achieved photoacoustic, ultrasound, and enhanced CT imaging of the fibrotic myocardium. Notably, the photoacoustic signal intensity positively correlated with the severity of myocardial fibrosis. Thus, this study presents a promising approach for accurately detecting and treating the fibrotic myocardium.
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Affiliation(s)
- Fang Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Lihua Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Shigeng Zhong
- Department of Ultrasound, Chongqing People's Hospital, Chongqing 400010, P. R. China
| | - Jinhua Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Yang Cao
- Department of Ultrasound Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Han Yu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Haitao Ran
- Department of Ultrasound Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Chris Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Shiyu Shu
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
| | - Zhiyu Ling
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China
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Ravassa S, López B, Treibel TA, San José G, Losada-Fuentenebro B, Tapia L, Bayés-Genís A, Díez J, González A. Cardiac Fibrosis in heart failure: Focus on non-invasive diagnosis and emerging therapeutic strategies. Mol Aspects Med 2023; 93:101194. [PMID: 37384998 DOI: 10.1016/j.mam.2023.101194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
Heart failure is a leading cause of mortality and hospitalization worldwide. Cardiac fibrosis, resulting from the excessive deposition of collagen fibers, is a common feature across the spectrum of conditions converging in heart failure. Eventually, either reparative or reactive in nature, in the long-term cardiac fibrosis contributes to heart failure development and progression and is associated with poor clinical outcomes. Despite this, specific cardiac antifibrotic therapies are lacking, making cardiac fibrosis an urgent unmet medical need. In this context, a better patient phenotyping is needed to characterize the heterogenous features of cardiac fibrosis to advance toward its personalized management. In this review, we will describe the different phenotypes associated with cardiac fibrosis in heart failure and we will focus on the potential usefulness of imaging techniques and circulating biomarkers for the non-invasive characterization and phenotyping of this condition and for tracking its clinical impact. We will also recapitulate the cardiac antifibrotic effects of existing heart failure and non-heart failure drugs and we will discuss potential strategies under preclinical development targeting the activation of cardiac fibroblasts at different levels, as well as targeting additional extracardiac processes.
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Affiliation(s)
- Susana Ravassa
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Begoña López
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Gorka San José
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Blanca Losada-Fuentenebro
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Leire Tapia
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBERCV, Carlos III Institute of Health, Madrid, Spain; Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain.
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain.
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Lima MR, Abecasis J, Santos RR, Maltês S, Lopes P, Ferreira A, Ribeiras R, Andrade MJ, Abecasis M, Gil V, Ramos S, Cardim N. Is myocardial fibrosis appropriately assessed by calibrated and 2D strain derived integrated backscatter? Cardiovasc Ultrasound 2023; 21:14. [PMID: 37568167 PMCID: PMC10422833 DOI: 10.1186/s12947-023-00311-x] [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: 05/04/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
AIMS Increased collagen content of the myocardium modifies tissue reflectivity and integrated backscatter (IBS) indexes are suggested as markers of myocardial fibrosis (MF). We sought to assess the correlation between calibrated (c) IBS and bidimensional (2D) strain derived IBS with left ventricular (LV) MF in patients with severe aortic stenosis (AS). METHODS AND RESULTS We made a prospective observational cohort study including 157 patients with severe AS referred for surgical aortic valve replacement (AVR), with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of surgery. Two groups of 30 patients were specifically evaluated, with and without late gadolinium enhancement (LGE) at CMR. IBS was obtained at QRS peak from both parasternal long axis (PLAX) and apical-three-chamber (AP3C) views and measured in decibels (dB). Whole-cardiac cycle IBS at basal anterior septum was obtained from 2D longitudinal strain. Correlation analysis of reflectivity indexes was performed with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) (Masson´s Trichrome). IBS values were compared in both group of patients (LGE + vs. LGE -). 60 patients (74 [36-74] years, 45% male) with high gradient (mean gradient: 63 ± 20mmHg), normal flow (45 ± 10mL/m2) AS and preserved left ventricular ejection fraction (60 ± 9%) were included. Basal septum cIBS was - 17.45 (-31.2-10.95) and - 9.17 ± 9.45dB from PLAX and A3C views, respectively. No significant correlations were found between IBS and both non-invasive CMR tissue characterization and CVF: median MF of 9.7(2.1-79.9)%. Acoustic indexes were not significantly different according to the presence of pre-operative LGE. CONCLUSION In this group of patients with classical severe AS, IBS reflectivity indexes are of no added value to discriminate the presence of MF.
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Affiliation(s)
- Maria Rita Lima
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
| | - João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Rita Reis Santos
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Sérgio Maltês
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - António Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Abecasis
- Cardiac Surgery Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Sância Ramos
- Pathology Anatomy Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Saeed S, Wasim D, Mohamed Ali A, Bleie Ø, Chambers JB. The electrocardiogram: Still a useful marker for LV fibrosis in aortic stenosis. J Electrocardiol 2021; 65:82-87. [PMID: 33556740 DOI: 10.1016/j.jelectrocard.2021.01.008] [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: 11/21/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 11/19/2022]
Abstract
Left ventricular (LV) strain on the electrocardiogram (ECG) (down-sloping, convex ST-segment depression with asymmetric T-wave inversion in leads V5 and V6) reflects fibrosis as a result of subendocardial ischemia. It is associated with a significantly increased risk of cardiovascular events independent of the presence of LV hypertrophy on the echocardiogram or cardiac magnetic resonance (CMR) scan. Ongoing studies of early aortic valve replacement in asymptomatic patients with severe aortic stenosis are using ECG changes as a marker of possible fibrosis shown by midwall late gadolinium enhancement on CMR. However, until these studies report, it is still reasonable to respond to LV strain on the ECG by tightening control of systemic hypertension and consider intervention in cases where indications are otherwise in borderline.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Daanyaal Wasim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John B Chambers
- Cardiothoracic Centre, Guy's and Saint Thomas' Hospital, London, UK
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7
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Abecasis J, Gomes Pinto D, Ramos S, Masci PG, Cardim N, Gil V, Félix A. Left Ventricular Remodeling in Degenerative Aortic Valve Stenosis. Curr Probl Cardiol 2021; 46:100801. [PMID: 33588124 DOI: 10.1016/j.cpcardiol.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 01/15/2023]
Abstract
Aortic stenosis was once considered a pure isolated valve obstacle challenging left ventricle driving force of contraction and flow generation. Left ventricular (LV) adaptation was merely interpreted as a uniform hypertrophic response to increased afterload. However, in these last 2 decades cardiac imaging research and some histopathology correlation studies brought insight towards the complex interaction between the vasculature, the valve and the myocardium. Verily, LV remodeling in this setting is a complex multidetermined process that goes further beyond myocardial hypertrophy. Ultrastructural changes involving both diffuse and replacement fibrosis of the myocardium take part and might explain the transition of clinical phenotypes with distinct prognosis, from compensated hypertrophy to LV maladaptive dysfunction and heart failure. Presently, the combined appropriate use of echocardiography and cardiac magnetic resonance may better assess the global LV afterload, hypertrophy and geometric remodeling, global and regional LV function, beyond ejection fraction, and structural changes that include the fibrotic burden of the myocardium. As a whole these may not only better stratify individual risk of disease progression but also identify patients benefiting from earlier valve intervention. In this paper, we review the maladaptive response of the LV to chronic pressure overload, describing the different signaling pathways and mechanisms that underly both hypertrophy and remodeling. Histomorphology changes in this setting are described and we try to make sense of the use of new imaging tools for LV characterization.
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Affiliation(s)
- João Abecasis
- Nova Medical School, Lisboa, Portugal; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Cardiology Department, Hospital dos Lusíadas, Lisboa, Portugal.
| | - Daniel Gomes Pinto
- Nova Medical School, Lisboa, Portugal; Pathology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Sância Ramos
- Pathology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Faculdade Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | | | - Nuno Cardim
- Nova Medical School, Lisboa, Portugal; Hospital da Luz, Lisboa, Portugal
| | - Victor Gil
- Cardiology Department, Hospital dos Lusíadas, Lisboa, Portugal; Faculdade de Medicina de Lisboa, Portugal
| | - Ana Félix
- Nova Medical School, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Merdler I, Loewenstein I, Hochstadt A, Morgan S, Schwarzbard S, Sadeh B, Peri Y, Shacham Y, Finkelstein A, Steinvil A. Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis and Variable Ejection Fractions (<40%, 40%-49%, and >50%). Am J Cardiol 2020; 125:583-588. [PMID: 31843234 DOI: 10.1016/j.amjcard.2019.10.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
We evaluated the safety and efficacy of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients with mid-range ejection fraction (ASmrEF) and compared it to aortic stenosis patients with reduced ejection fraction (ASrEF) and preserved ejection fraction (ASpEF). TAVI cases were stratified by baseline ejection fraction (ASrEF, ASmrEF, ASpEF) and compared for characteristics, procedural outcomes, and change in echocardiographic parameters at 1 year and mortality over a 5-year follow-up. The final study population included 708 patients who underwent TAVI. ASmrEF patients presented with improved EF at 1-year after procedure (49.0 ± 9.8 at 1 year vs 43.0 ± 2.5 at baseline, p <0.001) and showed improvements in left ventricular (LV) diameters (LV end-diastolic diameter: 50.4 ± 6.0 at 1 year vs 53.0 ± 5.5 at baseline and LV end-systolic diameter 34.7 ± 7.8 at 1 year vs 39.5 ± 5.9 at baseline, p <0.001 for both). LVEF improved for patients with ASrEF but not in ASpEF patients. LV diameters did not improve for patients in either group. Procedural safety and success rates were similar between all heart failure groups. Survival rates over a 5-year follow-up post-TAVI were not different between patients with ASmrEF, ASrEF, and ASpEF (ASrEF 78.4%, ASmrEF 81.9%, ASpEF 78.3%, p = 0.327). TAVI for patients with ASmrEF is safe and effective and results in marked improvement of LV function and structure.
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Affiliation(s)
- Ilan Merdler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itamar Loewenstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Samuel Morgan
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Schwarzbard
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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9
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Coisne A, Ninni S, Pontana F, Aghezzaf S, Janvier F, Mouton S, Ridon H, Ortmans S, Seunes C, Wautier M, Coppin A, Madika AL, Boutie B, Koussa M, Bical A, Vincentelli A, Juthier F, Loobuyck V, Sudre A, Marchetta S, Martinez C, Staels B, Lancellotti P, Modine T, Montaigne D. Clinical significance of electrocardiographic markers of myocardial damage prior to aortic valve replacement. Int J Cardiol 2020; 307:130-135. [PMID: 32067832 DOI: 10.1016/j.ijcard.2020.01.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pre-operative myocardial fibrosis and remodeling impact on outcomes after aortic valve replacement (AVR). We aimed at investigating the prognostic impact of preoperative electrocardiographic (ECG) markers of left ventricular (LV) myocardial damage, i.e. bundle branch block (BBB) and ECG strain pattern after (surgical or transcatheter) AVR for severe aortic stenosis (AS). METHODS Between April 2008 and October 2017, we explored consecutive patients referred to our Heart Valve Clinic for first AVR for severe AS. Detailed pre-operative phenotyping and ECG analysis were performed. Patients were followed-up after AVR for major cardiac events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke. RESULTS BBB and ECG strain were respectively observed in 13.5 and 21% of the 1122 patients included. These ECG markers identified a subgroup of older patients, with higher NYHA class and more advanced myocardial disease as detected by echocardiography, i.e. higher LV mass and lower LV ejection fraction, global longitudinal strain and integrated backscatter, than patients without ECG strain or BBB. ME occurred in 212 (18.6%) patients during a mean follow-up of 4.4 ± 1.5 years with higher incidence in case of ECG strain or BBB (HR 1.56, 95%CI 1.13-2.14, p = 0.006; HR 1.47, 95%CI 1.02-2.13, p = 0.04 respectively). The prognostic value of ECG strain remained significant after adjustment for age, diabetes and pre-operative LVEF. CONCLUSIONS Pre-operative ECG markers of myocardial damage identify a subgroup of AS patients at high risk of post-AVR cardiovascular complications irrespective of other prognostic factors and should help the multiparametric staging of cardiac damage to guide AVR.
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Affiliation(s)
- Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, France; Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France.
| | - Sandro Ninni
- Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France; CHU Lille, Department of Cardiovascular Medicine, France
| | - François Pontana
- Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France; CHU Lille, Department of Cardiovascular Radiology, France
| | - Samy Aghezzaf
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Florent Janvier
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Stéphanie Mouton
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Hélène Ridon
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Staniel Ortmans
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Claire Seunes
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Marine Wautier
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Amandine Coppin
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Anne-Laure Madika
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | - Bertrand Boutie
- CHU Lille, Department of Clinical Physiology and Echocardiography, France
| | | | - Antoine Bical
- CHU Lille, Department of Cardiovascular Surgery, France
| | | | | | | | - Arnaud Sudre
- CHU Lille, Department of Cardiovascular Medicine, France
| | - Stella Marchetta
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Christophe Martinez
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Bart Staels
- Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France; CHU Lille, Department of Biology, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Thomas Modine
- CHU Lille, Department of Cardiovascular Surgery, France
| | - David Montaigne
- CHU Lille, Department of Clinical Physiology and Echocardiography, France; Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France
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10
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Moharram MA, Lamberts RR, Whalley G, Williams MJA, Coffey S. Myocardial tissue characterisation using echocardiographic deformation imaging. Cardiovasc Ultrasound 2019; 17:27. [PMID: 31730467 PMCID: PMC6858720 DOI: 10.1186/s12947-019-0176-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022] Open
Abstract
Myocardial pathology results in significant morbidity and mortality, whether due to primary cardiomyopathic processes or secondary to other conditions such as ischemic heart disease. Cardiac imaging techniques characterise the underlying tissue directly, by assessing a signal from the tissue itself, or indirectly, by inferring tissue characteristics from global or regional function. Cardiac magnetic resonance imaging is currently the most investigated imaging modality for tissue characterisation, but, due to its accessibility, advanced echocardiography represents an attractive alternative. Speckle tracking echocardiography (STE) is a reproducible technique used to assess myocardial deformation at both segmental and global levels. Since distinct myocardial pathologies affect deformation differently, information about the underlying tissue can be inferred by STE. In this review, the current available studies correlating STE deformation parameters with underlying tissue characteristics in humans are examined, with separate emphasis on global and segmental analysis. The current knowledge is placed in the context of integrated backscatter and the future of echocardiographic based tissue characterisation is discussed. The use of these imaging techniques to more precisely phenotype myocardial pathology more precisely will allow the design of translational cardiac research studies and, potentially, tailored management strategies.
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Affiliation(s)
- Mohammed A. Moharram
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Regis R. Lamberts
- Department of Physiology – HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Gillian Whalley
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Michael J. A. Williams
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
| | - Sean Coffey
- Department of Medicine – HeartOtago, Dunedin School of Medicine, University of Otago, Box 56, Dunedin, PO 9054 New Zealand
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11
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Cowling RT, Kupsky D, Kahn AM, Daniels LB, Greenberg BH. Mechanisms of cardiac collagen deposition in experimental models and human disease. Transl Res 2019; 209:138-155. [PMID: 30986384 PMCID: PMC6996650 DOI: 10.1016/j.trsl.2019.03.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/19/2022]
Abstract
The inappropriate deposition of extracellular matrix within the heart (termed cardiac fibrosis) is associated with nearly all types of heart disease, including ischemic, hypertensive, diabetic, and valvular. This alteration in the composition of the myocardium can physically limit cardiomyocyte contractility and relaxation, impede electrical conductivity, and hamper regional nutrient diffusion. Fibrosis can be grossly divided into 2 types, namely reparative (where collagen deposition replaces damaged myocardium) and reactive (where typically diffuse collagen deposition occurs without myocardial damage). Despite the widespread association of fibrosis with heart disease and general understanding of its negative impact on heart physiology, it is still not clear when collagen deposition becomes pathologic and translates into disease symptoms. In this review, we have summarized the current knowledge of cardiac fibrosis in human patients and experimental animal models, discussing the mechanisms that have been deduced from the latter in relation to the former. Because assessment of the extent of fibrosis is paramount both as a research tool to further understanding and as a clinical tool to assess patients, we have also summarized the current state of noninvasive/minimally invasive detection systems for cardiac fibrosis. Albeit not exhaustive, our aim is to provide an overview of the current understanding of cardiac fibrosis, both clinically and experimentally.
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Affiliation(s)
- Randy T Cowling
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California.
| | - Daniel Kupsky
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
| | - Lori B Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
| | - Barry H Greenberg
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
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12
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Fabiani I, Conte L, Pugliese NR, Calogero E, Barletta V, Di Stefano R, Santoni T, Scatena C, Bortolotti U, Naccarato AG, Petronio AS, Di Bello V. The integrated value of sST2 and global longitudinal strain in the early stratification of patients with severe aortic valve stenosis: a translational imaging approach. Int J Cardiovasc Imaging 2017; 33:1915-1920. [PMID: 28664478 DOI: 10.1007/s10554-017-1203-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Abstract
Aortic valve stenosis (AVS) is associated with significant myocardial fibrosis (MF). Global longitudinal strain (GLS) is a sensible indicator of systolic dysfunction. ST2 is a member of the interleukin (IL)-1 receptor family and a modulator of hypertrophic and fibrotic responses. We aimed at assessing: (a) the association between adverse LV remodeling, LV functional parameters (including GLS) and sST2 level. (b) The association between MF (detected by endo-myocardial biopsy) and sST2 in patients with AVS undergoing surgical valve replacement. Twenty-two patients with severe AVS and preserved EF underwent aortic valve replacement. They performed laboratory analysis, including serum ST2 (sST2), echocardiography and inter-ventricular septum biopsy to assess MF (%). We included ten controls for comparison. Compared to controls, patients showed higher sST2 levels (p < 0.0001). sST2 showed correlation with Age (r = 0.58; p = 0.0004), E/e' average (r = 0.58; p = 0.0007), GLS (r = 0.61; p = 0.0002), LAVi (r = 0.51; p = 0.003), LVMi (r = 0.43; p = 0.01), sPAP (r = 0.36; p = 0.04) and SVi (r = -0.47; p < 0.005). No correlation was found between MF and sST2. At ROC analysis, a sST2 ≥ 284 ng/mL had the best accuracy to discriminate controls from patients with impaired GLS, i.e. GLS ≤ 17% (AUC 0.80; p = 0.003; sensitivity 95%; specificity 83%) and increased E/e' average (AUC 0.87; p = 0.0001; sensitivity 96%; specificity 74%). At multivariate regression analysis GLS resulted the only independent predictor of sST2 levels (R2 = 0.35; p = 0.0004). Patients with severe AVS present elevated sST2 levels. LV GLS resulted the only independent predictor of sST2 levels.
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Affiliation(s)
- Iacopo Fabiani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Lorenzo Conte
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Enrico Calogero
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy.
| | - Valentina Barletta
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Rossella Di Stefano
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Tatiana Santoni
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Cristian Scatena
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100, Pisa, Italy
| | - Uberto Bortolotti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Antonio Giuseppe Naccarato
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100, Pisa, Italy
| | - Anna Sonia Petronio
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Vitantonio Di Bello
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
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13
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Fabiani I, Scatena C, Mazzanti CM, Conte L, Pugliese NR, Franceschi S, Lessi F, Menicagli M, De Martino A, Pratali S, Bortolotti U, Naccarato AG, La Carrubba S, Di Bello V. Micro-RNA-21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study. J Transl Med 2016; 14:248. [PMID: 27567668 PMCID: PMC5002330 DOI: 10.1186/s12967-016-1011-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/16/2016] [Indexed: 01/19/2023] Open
Abstract
Aims Myocardial fibrosis (MF) is a deleterious consequence of aortic valve stenosis (AVS). Global longitudinal strain (GLS) is a novel left ventricular (LV) functional parameter potentially useful to non-invasively estimate MF. MicroRNAs (miRNAs) are non-coding small ribonucleic acids (RNA) modulating genes function, mainly through RNA degradation. miRNA-21 is a biomarker associated with MF in pressure overload. The aim of the present study was to find an integrated algorithm for detection of MF using a combined approach with both bio- and functional markers. Methods Thirty-six patients (75.2 ± 8 y.o.; 63 % Female) with severe AVS and preserved LV ejection fraction (EF), candidate to surgical aortic valve replacement (sAVR) were enrolled. Clinical, bio-humoral evaluation (including plasmatic miRNA-21 collected using specific tubes, PAXgene, for stabilization of peripheral RNA) and a complete echocardiographic study, including GLS and septal strain, were performed before sAVR. Twenty-eight of those patients underwent sAVR and, in 23 of them, an inter-ventricular septum biopsy was performed. Tissues were fixed in formalin and embedded in paraffin. Sections were stained with Hematoxylin and Eosin for histological evaluation and with histochemical Masson trichrome for collagen fibers. The different components were calculated and expressed as micrometers2. To evaluate tissue miRNA components, sections 2-μm thick were cut using a microtome blade for each slide. Regression analysis was performed to test association between dependent variable and various predictors included in the model. Results Despite a preserved EF (66 ± 11 %), patients presented altered myocardial deformation parameters (GLS −14,02 ± 3.8 %; septal longitudinal strain, SSL −9.63 ± 2.9 %; septal longitudinal strain rate, SL-Sr −0.58 ± 0.17 1/s; Septal Longitudinal early-diastolic strain rate, SL-SrE 0.62 ± 0.32 1/s). The extent of MF showed an inverse association with both GLS and septal longitudinal deformation indices (GLS: R2 = 0.30; p = 0.02; SSL: R2 = 0.36; p = 0.01; SL-Sr: R2 = 0.39; p < 0.001; SL-SrE: R2 = 0.35; p = 0.001). miRNA-21 was mainly expressed in fibrous tissue (p < 0.0001). A significant association between MF and plasmatic miRNA-21, alone and weighted for measures of structural (LVMi R2 = 0.50; p = 0.0005) and functional (SSL R2 = 0.35; p = 0.006) remodeling, was found. Conclusions In AVS, MF is associated with alterations of regional and global strain. Plasmatic miRNA-21 is directly related to MF and associated with LV structural and functional impairment.
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Affiliation(s)
- Iacopo Fabiani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, Via Paradisa, 2, 56100, Pisa, PI, Italy.
| | - Cristian Scatena
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100, Pisa, Italy
| | | | - Lorenzo Conte
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, Via Paradisa, 2, 56100, Pisa, PI, Italy
| | - Nicola Riccardo Pugliese
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, Via Paradisa, 2, 56100, Pisa, PI, Italy
| | | | | | | | - Andrea De Martino
- Division of Cardiac Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Stefano Pratali
- Division of Cardiac Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Uberto Bortolotti
- Division of Cardiac Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, 56100, Pisa, Italy
| | - Antonio Giuseppe Naccarato
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56100, Pisa, Italy
| | | | - Vitantonio Di Bello
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa/A.O.U.P, Via Paradisa, 2, 56100, Pisa, PI, Italy
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14
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Agabiti-Rosei E, Muiesan ML, Salvetti M. Review: New approaches to the assessment of left ventricular hypertrophy. Ther Adv Cardiovasc Dis 2016; 1:119-28. [DOI: 10.1177/1753944707086350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In hypertension, Left ventricular hypertrophy is initially a useful compensatory process that represents an adaptation to increased ventricular wall stress; however, it is also the first step toward the development of overt clinical disease. For this reason most international guidelines recommend the assessment of cardiac target organ damage in hypertensive patients for cardiovascular risk stratification. It is therefore of great importance to keep in mind the strengths and weakness of the different available methods for LVH assessment. Several methods are currently available for the assessment of LVH; however the various techniques differ in cost, availability, sensitivity and specificity. Due to its wide availability and its low cost, eLectrocardiography should be part of all routine assessment of subjects with high blood pressure; however, despite its good specificity, the sensitivity for LVH detection is low. Several other methods have been proposed for LVH detection. Cardiac magnetic resonance imaging allows 3D reconstruction of the heart with high spatial resolution; however its main limitation is represented by the relatively low availability and by its costs. Echocardiography certainly represents a valuable method for the detection of LVH in hypertensive patients, due to its wide availability and its relatively low cost. The main limitations of the technique are represented by the lower spatial resolution and reproducibility in comparison with magnetic resonance. The development of new matrix-array transducers and new software for 3D reconstruction with echocardiography make this approach particularly promising for the future; in the meantime, standard echocardiography, widely available and with low cost, will probably remain the most used tool for the evaluation of left ventricular structure and function in hypertension.
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Affiliation(s)
- Enrico Agabiti-Rosei
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia,
| | - Maria Lorenza Muiesan
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia
| | - Massimo Salvetti
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia
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15
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Prior DL, Somaratne JB, Jenkins AJ, Yii M, Newcomb AE, Schalkwijk CG, Black MJ, Kelly DJ, Campbell DJ. Calibrated integrated backscatter and myocardial fibrosis in patients undergoing cardiac surgery. Open Heart 2015; 2:e000278. [PMID: 26339497 PMCID: PMC4555070 DOI: 10.1136/openhrt-2015-000278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/16/2015] [Accepted: 07/31/2015] [Indexed: 12/29/2022] Open
Abstract
Objective The reported association between calibrated integrated backscatter (cIB) and myocardial fibrosis is based on study of patients with dilated or hypertrophic cardiomyopathy and extensive (mean 15–34%) fibrosis. Its association with lesser degrees of fibrosis is unknown. We examined the relationship between cIB and myocardial fibrosis in patients with coronary artery disease. Methods Myocardial histology was examined in left ventricular epicardial biopsies from 40 patients (29 men and 11 women) undergoing coronary artery bypass graft surgery, who had preoperative echocardiography with cIB measurement. Results Total fibrosis (picrosirius red staining) varied from 0.7% to 4%, and in contrast to previous reports, cIB showed weak inverse associations with total fibrosis (r=−0.32, p=0.047) and interstitial fibrosis (r=−0.34, p=0.03). However, cIB was not significantly associated with other histological parameters, including immunostaining for collagens I and III, the advanced glycation end product (AGE) Nε-(carboxymethyl)lysine (CML) and the receptor for AGEs (RAGE). When biomarkers were examined, cIB was weakly associated with log plasma levels of amino-terminal pro-B-type natriuretic peptide (r=0.34, p=0.03), creatinine (r=0.33, p=0.04) and glomerular filtration rate (r=−0.33, p=0.04), and was more strongly associated with log plasma levels of soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) (r=0.44, p=0.01) and soluble RAGE (r=0.53, p=0.002). Conclusions Higher cIB was not a marker of increased myocardial fibrosis in patients with coronary artery disease, but was associated with higher plasma levels of sVEGFR-1 and soluble RAGE. The role of cIB as a non-invasive index of fibrosis in clinical studies of patients without extensive fibrosis is, therefore, questionable.
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Affiliation(s)
- David L Prior
- Department of Cardiology , St. Vincent's Hospital Melbourne , Fitzroy , Australia ; Department of Medicine , University of Melbourne, St. Vincent's Hospital Melbourne , Fitzroy , Australia ; St. Vincent's Institute of Medical Research , Fitzroy , Australia
| | | | - Alicia J Jenkins
- Department of Medicine , University of Melbourne, St. Vincent's Hospital Melbourne , Fitzroy , Australia
| | - Michael Yii
- Department of Cardiothoracic Surgery , St. Vincent's Hospital Melbourne , Fitzroy , Australia ; Department of Surgery , University of Melbourne, St. Vincent's Hospital Melbourne , Fitzroy , Australia
| | - Andrew E Newcomb
- Department of Cardiothoracic Surgery , St. Vincent's Hospital Melbourne , Fitzroy , Australia ; Department of Surgery , University of Melbourne, St. Vincent's Hospital Melbourne , Fitzroy , Australia
| | - Casper G Schalkwijk
- Department of Internal Medicine , University of Maastricht , Maastricht , The Netherlands
| | - Mary J Black
- Department of Anatomy and Developmental Biology , Monash University , Clayton , Australia
| | - Darren J Kelly
- Department of Medicine , University of Melbourne, St. Vincent's Hospital Melbourne , Fitzroy , Australia
| | - Duncan J Campbell
- Department of Medicine , University of Melbourne, St. Vincent's Hospital Melbourne , Fitzroy , Australia ; St. Vincent's Institute of Medical Research , Fitzroy , Australia
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16
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Kritzer MD, Li J, Passariello CL, Gayanilo M, Thakur H, Dayan J, Dodge-Kafka K, Kapiloff MS. The scaffold protein muscle A-kinase anchoring protein β orchestrates cardiac myocyte hypertrophic signaling required for the development of heart failure. Circ Heart Fail 2014; 7:663-72. [PMID: 24812305 DOI: 10.1161/circheartfailure.114.001266] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cardiac myocyte hypertrophy is regulated by an extensive intracellular signal transduction network. In vitro evidence suggests that the scaffold protein muscle A-kinase anchoring protein β (mAKAPβ) serves as a nodal organizer of hypertrophic signaling. However, the relevance of mAKAPβ signalosomes to pathological remodeling and heart failure in vivo remains unknown. METHODS AND RESULTS Using conditional, cardiac myocyte-specific gene deletion, we now demonstrate that mAKAPβ expression in mice is important for the cardiac hypertrophy induced by pressure overload and catecholamine toxicity. mAKAPβ targeting prevented the development of heart failure associated with long-term transverse aortic constriction, conferring a survival benefit. In contrast to 29% of control mice (n=24), only 6% of mAKAPβ knockout mice (n=31) died in the 16 weeks of pressure overload (P=0.02). Accordingly, mAKAPβ knockout inhibited myocardial apoptosis and the development of interstitial fibrosis, left atrial hypertrophy, and pulmonary edema. This improvement in cardiac status correlated with the attenuated activation of signaling pathways coordinated by the mAKAPβ scaffold, including the decreased phosphorylation of protein kinase D1 and histone deacetylase 4 that we reveal to participate in a new mAKAP signaling module. Furthermore, mAKAPβ knockout inhibited pathological gene expression directed by myocyte-enhancer factor-2 and nuclear factor of activated T-cell transcription factors that associate with the scaffold. CONCLUSIONS mAKAPβ orchestrates signaling that regulates pathological cardiac remodeling in mice. Targeting of the underlying physical architecture of signaling networks, including mAKAPβ signalosome formation, may constitute an effective therapeutic strategy for the prevention and treatment of pathological remodeling and heart failure.
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Affiliation(s)
- Michael D Kritzer
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.).
| | - Jinliang Li
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
| | - Catherine L Passariello
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
| | - Marjorie Gayanilo
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
| | - Hrishikesh Thakur
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
| | - Joseph Dayan
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
| | - Kimberly Dodge-Kafka
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
| | - Michael S Kapiloff
- From the Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, FL (M.D.K., J.L., C.L.P., M.G., H.T., J.D., M.S.K.); and Calhoun Center for Cardiology, University of Connecticut Health Center, Farmington (K.D.-K.)
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Katayama M, Jiamsripong P, McMahon EM, Lombari TR, Bukatina AE, Wu Q, Marler RJ, Belohlavek M. Detection of progressive myocardial tissue injury by ultrasonic integrated backscatter immediately after coronary reperfusion. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1662-1669. [PMID: 22763007 DOI: 10.1016/j.ultrasmedbio.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/02/2012] [Accepted: 03/02/2012] [Indexed: 06/01/2023]
Abstract
Myocardial reperfusion following ischemia may paradoxically cause additional injury, including microvascular damage and edema. These structural alterations augment tissue echogenicity, which is measurable by ultrasonic integrated backscatter (IB). We sought to characterize alterations in myocardial IB in an ischemic and reperfused region of the rat heart. Myocardial IB of the regions of interest in 12 adult male Sprague-Dawley rats was studied at baseline, during ischemia, and chronologically after coronary reopening, using an ultrasound frequency of 8 MHz. IB did not significantly change between baseline and ischemia. However, within 1 min of reperfusion, IB significantly increased and continued to increase until 10 min of reperfusion, when a plateau was reached. Areas of high echogenicity were comparable to infarcted areas on gross pathologic slices and had edema with extravasation of red blood cells. Myocardial reperfusion following ischemia significantly augments tissue echogenicity. A continuing increase of IB suggests a rapid progression of reperfusion injury.
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Affiliation(s)
- Minako Katayama
- Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
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18
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Sado DM, Flett AS, Moon JC. Novel imaging techniques for diffuse myocardial fibrosis. Future Cardiol 2012; 7:643-50. [PMID: 21929344 DOI: 10.2217/fca.11.45] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diffuse myocardial fibrosis (DMF) is an important marker in many cardiac diseases, but its utility has been limited by the need for biopsy for its assessment. An accurate noninvasive method for DMF assessment could transform cardiology. This review explores the basic biology of DMF and then discusses the ability of various cardiac imaging modalities to evaluate this variable, speculating on how this area of research may develop over the next few years.
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Affiliation(s)
- Daniel M Sado
- Department of Inherited Cardiac Disease, The Heart Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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19
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Lin YH, Lee HH, Liu KL, Lee JK, Shih SR, Chueh SC, Lin WC, Lin LC, Lin LY, Chung SD, Wu VC, Kuo CC, Ho YL, Chen MF, Wu KD. Reversal of myocardial fibrosis in patients with unilateral hyperaldosteronism receiving adrenalectomy. Surgery 2011; 150:526-33. [DOI: 10.1016/j.surg.2011.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 02/10/2011] [Indexed: 11/25/2022]
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21
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Roosens B, Droogmans S, Hostens J, Somja J, Delvenne E, Hernot S, Bala G, Degaillier C, Caveliers V, Delvenne P, Lahoutte T, Van Camp G, Cosyns B. Integrated Backscatter for the In Vivo Quantification of Supraphysiological Vitamin D3-Induced Cardiovascular Calcifications in Rats. Cardiovasc Toxicol 2011; 11:244-52. [DOI: 10.1007/s12012-011-9118-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Di Bello V, Cucco C, Giannini C, Delle Donne MG. Myocardial tissue characterization and aortic stenosis. J Am Soc Echocardiogr 2011; 23:1067-70. [PMID: 20868956 DOI: 10.1016/j.echo.2010.08.025] [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] [Indexed: 10/19/2022]
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23
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Fijalkowski M, Koprowski A, Galaska R, Gruchala M, Pawlaczyk R, Brzezinski M, Rogowski J, Rynkiewicz A. Improvement of Ultrasonic Myocardial Properties after Aortic Valve Replacement for Pure Severe Aortic Stenosis: The Predictive Value of Ultrasonic Tissue Characterization for Left Ventricle Reverse Remodeling. J Am Soc Echocardiogr 2010; 23:1060-6. [DOI: 10.1016/j.echo.2010.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 10/19/2022]
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24
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Kawasaki T, Yamano M, Kuribayashi T, Kaimoto S, Miki S, Kamitani T, Matsubara H, Sugihara H. Three-layer ultrasonic tissue characterization of the ventricular septum is predictive of prognosis in patients with non-obstructive hypertrophic cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:90-7. [DOI: 10.1093/ejechocard/jeq108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Zhu H, Zhang W, Zhong M, Zhang G, Zhang Y. Myocardial ultrasonic integrated backscatter analysis in patients with chronic atrial fibrillation. Int J Cardiovasc Imaging 2010; 26:861-5. [DOI: 10.1007/s10554-010-9637-9] [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: 12/22/2009] [Accepted: 04/24/2010] [Indexed: 11/25/2022]
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26
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Losi MA, Memoli B, Contaldi C, Barbati G, Del Prete M, Betocchi S, Cavallaro M, Carpinella G, Fundaliotis A, Parrella LS, Parisi V, Guida B, Chiariello M. Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis. Nephrol Dial Transplant 2010; 25:1950-4. [PMID: 20075436 DOI: 10.1093/ndt/gfp747] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is linked to myocardial collagen content in many cardiac diseases. There are no data regarding such relationship in patients with end-stage renal disease (ESRD) undergoing haemodialysis. METHODS Twenty-five patients with ESRD undergoing haemodialysis were studied by echocardiography. LV diastolic function was investigated by Doppler echocardiography, by analysing LV filling velocities at rest and during loading manoeuvres, which represent an estimate of LV filling pressure. According to the Doppler pattern, LV filling pressure in a given patient was judged to be normal or slightly increased or to be moderately or severely increased. The presence of myocardial fibrosis was estimated by ultrasound tissue characterization with integrated backscatter, which in diastole correlates with the collagen content of the myocardium. RESULTS Integrated backscatter was higher in patients with moderate or severely increased than in patients with normal or slightly increased LV filling pressure (integrated backscatter: 51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008). Integrated backscatter was a strong and independent determinant of diastolic dysfunction (odds ratio = 1.212; P = 0.040). CONCLUSION Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial properties.
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Affiliation(s)
- Maria Angela Losi
- Department of Clinical Medicine, Cardiovascular & Immunological Sciences, Federico II University School of Medicine, Naples, Italy.
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Di Cori A, Bongiorni MG, Zucchelli G, Soldati E, Falorni M, Segreti L, Gemignani C, Siciliano A, Bovenzi FM, Di Bello V. Early Left Ventricular Structural Myocardial Alterations and Their Relationship with Functional and Electrical Properties of the Heart in Myotonic Dystrophy Type 1. J Am Soc Echocardiogr 2009; 22:1173-9. [DOI: 10.1016/j.echo.2009.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Indexed: 10/20/2022]
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28
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Weidemann F, Herrmann S, Störk S, Niemann M, Frantz S, Lange V, Beer M, Gattenlöhner S, Voelker W, Ertl G, Strotmann JM. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation 2009; 120:577-84. [PMID: 19652094 DOI: 10.1161/circulationaha.108.847772] [Citation(s) in RCA: 548] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In this prospective follow-up study, the effect of myocardial fibrosis on myocardial performance in symptomatic severe aortic stenosis was investigated, and the impact of fibrosis on clinical outcome after aortic valve replacement (AVR) was estimated. METHODS AND RESULTS Fifty-eight consecutive patients with isolated symptomatic severe aortic stenosis underwent extensive baseline characterization before AVR. Standard and tissue Doppler echocardiography and cardiac magnetic resonance imaging (late-enhancement imaging for replacement fibrosis) were performed at baseline and 9 months after AVR. Endomyocardial biopsies were obtained intraoperatively to determine the degree of myocardial fibrosis. Patients were analyzed according to the severity of interstitial fibrosis in cardiac biopsies (severe, n=21; mild, n=15; none, n=22). The extent of histologically determined cardiac fibrosis at baseline correlated closely with New York Heart Association functional class and markers of longitudinal systolic function (all P<0.001) but not global ejection fraction or aortic valve area. Nine months after AVR, the degree of late enhancement remained unchanged, implying that AVR failed to reduce the degree of replacement fibrosis. Patients with no fibrosis experienced a marked improvement in New York Heart Association class from 2.8+/-0.4 to 1.4+/-0.5 (P<0.001). Only parameters of longitudinal systolic function predicted this functional improvement. Four patients with severe fibrosis died during follow-up, but no patient from the other groups died. CONCLUSIONS Myocardial fibrosis is an important morphological substrate of postoperative clinical outcome in patients with severe aortic stenosis and was not reversible after AVR over the 9 months of follow-up examined in this study. Because markers of longitudinal systolic function appear to indicate sensitively both the severity of myocardial fibrosis and the clinical outcome, they may prove valuable for preoperative risk assessment in patients with aortic stenosis.
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Affiliation(s)
- Frank Weidemann
- University Clinic of Internal Medicine I/Center for Cardiovascular Disease, University of Würzburg, 97080 Würzburg, Germany.
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Di Bello V, Talini E, Donne MGD, Aghini-Lombardi F, Monzani F, La Carrubba S, Antonini-Canterin F, Dini FL, Di Salvo G, Carerj S, Marzilli M. New Echocardiographic Techniques in the Evaluation of Left Ventricular Mechanics in Subclinical Thyroid Dysfunction. Echocardiography 2009; 26:711-9. [DOI: 10.1111/j.1540-8175.2008.00875.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Dimitrow PP, Hlawaty M, Undas A, Śnieżek-Maciejewska M, Sobień B, Stępień E, Tracz W. Effect of aortic valve stenosis on haemostasis is independent from vascular atherosclerotic burden. Atherosclerosis 2009; 204:e103-8. [DOI: 10.1016/j.atherosclerosis.2008.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 12/21/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
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31
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Bauer F, Bénigno S, Lemercier M, Tapiéro S, Eltchaninoff H, Tron C, Baala B, Brunet D, Cribier A. Early improvement of left ventricular function after implantation of a transcutaneous aortic valve: A tissue Doppler ultrasound study. Arch Cardiovasc Dis 2009; 102:311-8. [DOI: 10.1016/j.acvd.2009.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 02/04/2009] [Accepted: 02/05/2009] [Indexed: 11/16/2022]
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32
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Guo CY, Shen LH, Li HW, Teng YX, Zhao SM. Relation of Hemoglobin A1c to myocardial acoustic densitometry and left ventricular diastolic function in patients with Type 2 diabetes mellitus and without evident heart disease. Diabetes Res Clin Pract 2009; 83:365-70. [PMID: 19187999 DOI: 10.1016/j.diabres.2009.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 12/27/2008] [Accepted: 01/05/2009] [Indexed: 11/24/2022]
Abstract
AIM The aim of the study was to detect the echocardiographic sensitive indexes for prediction of the subclinical cardiac dysfunction and to evaluate the relation between Hemoglobin A1c (HbA1c) and myocardial acoustic densitometry as well as cardiac function. METHODS Fifty DM2 patients (48.5+/-8.6 years) without evident heart disease and 50 age- and sex-matched normal controls (47.6+/-8.8 years) were enrolled. Conventional echocardiography, tissue Doppler imaging and acoustic densitometry of both groups were measured. HbA1c of DM2 patients were determined. RESULTS There were no significant differences in systolic indexes between the two groups. Mean LV myocardial early diastolic velocity Em and Em/Am were lower in DM group than control group. Mean LV myocardial late diastolic velocity Am and E/Em were higher in DM group than control group. IVS-IBS% and LVPW-IBS% were higher in DM group than control group. IVS-CVIB and LVPW-CVIB were lower in DM group than control group. HbA1c was negatively correlated with E/A (gamma=-0.310, P<0.05), Em (gamma=-0.409, P<0.01), Em/Am (gamma=-0.380, P<0.01) and positively correlated with E/Em (gamma=0.488, P<0.01). Significant positive correlation was present between HbA1c and IVS-IBS% (gamma=0.679, P<0.01), LVPW-IBS% (gamma=0.666, P<0.01). CONCLUSIONS The diastolic dysfunction and abnormal myocardial acoustic densitometry exist before the systolic function damage in DM2 patients. Tissue Doppler imaging and ultrasonic integrated backscatter can be used as sensitive means for early assessing myocardial histological changes in DM2 patients. HbA1c is related with both diastolic dysfunction and acoustic densitometry.
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Affiliation(s)
- Chun-Yan Guo
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, PR China
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Ichihashi K, Yada Y, Takahashi N, Honma Y, Momoi M. Analysis of the intensity of radio-frequency signals in intracranial ultrasonography of preterm infants. J Med Ultrason (2001) 2008; 35:57. [PMID: 27278692 DOI: 10.1007/s10396-007-0171-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 11/05/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of analysis of the intensity of radio-frequency (RF) signals in intracranial ultrasonography of preterm infants. METHODS Twenty neonatal infants admitted to the neonatal intensive care unit of our hospital were included in this study. Their gestational age was 33-35 weeks. The studies were performed with a System 5 ultrasound system with 3.0-and 5.0-MHz transducers. The transducer was placed on the anterior fontanel to obtain images. Regions of interest were determined based on B-mode images and were positioned at the thalamus, caudate nucleus, cerebral white matter, cerebellum, brain stem, and lateral ventricle. The software used for analysis of the RF signals was EchoMAT (Vingmed Ultrasound). RESULTS The RF signals of the ventricle and the choroid plexus showed the lowest and the highest intensities, respectively. The intensities of the brain stem and vermis signals were the same, and were higher than the intensity of the cerebellar hemisphere. The thalamus and caudate nucleus showed macroscopically identical brightness levels; however, the intensity of the thalamus was lower than that of the caudate nucleus. The intensity of subependymal hemorrhage was lower than that of the caudothalamic groove. The intensity of subependymal cyst was the same as that of the lateral ventricle. The RF signal frequencies and intensities were distinctive in each tissue. CONCLUSION The results of this study suggest that measurement of RF signal intensity may be useful to differentiate macroscopically similar lesions.
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Affiliation(s)
- Ko Ichihashi
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, 330-8503, Japan.
| | - Yukari Yada
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, 330-8503, Japan
| | - Naoto Takahashi
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, 330-8503, Japan
| | - Yoko Honma
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, 330-8503, Japan
| | - Mariko Momoi
- Department of Pediatrics, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Omiya, 330-8503, Japan
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Talini E, Di Bello V, Bianchi C, Palagi C, Delle Donne MG, Penno G, Nardi C, Canale ML, Del Prato S, Mariani M, Miccoli R. Early impairment of left ventricular function in hypercholesterolemia and its reversibility after short term treatment with rosuvastatin. Atherosclerosis 2008; 197:346-54. [PMID: 17631295 DOI: 10.1016/j.atherosclerosis.2007.05.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 05/25/2007] [Accepted: 05/25/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypercholesterolemia contributes to coronary heart disease but little is known about its direct effect on myocardial function. We evaluated left ventricular function using echocardiography and the effect of treatment with rosuvastatin in a group of patients with primary hypercholesterolemia. METHODS AND RESULTS Thirty-three patients with primary hypercholesterolemia (HC) and without evidence of coronary heart disease and 25 aged matched healthy volunteers (C) were submitted to conventional echocardiography, pulsed wave tissue Doppler imaging (PWTDI), color Doppler myocardial imaging (CDMI) and integrated backscatter (IBS). Echocardiographic evaluation was repeated after 6 months of treatment with rosuvastatin (10mg/day) in 17 patients. Compared with C, patients with HC showed lower E/A ratio (p<0.0001) and higher Tei index mit (p<0.0001), as well as lower PW TDI E/A both at septum (p<0.0001) and at lateral level (p<0.0001) and higher modified Tei index both at septal annulus (p<0.0001) and lateral annulus (p<0.0001). Integrated backscatter parameters were significantly reduced in patients with HC (CVIsept p<0.0001 and CVI post wall p<0.05). CDMI derived indices in the two groups were not different. After 6 months of Rosuvastatin treatment a significant reduction of LDL cholesterol levels (51%, p<0.0001) was registered in HC patients together with a significant improvement of longitudinal global systolic and diastolic function (Tei index) and myocardial intrinsic contractility (CVI). CONCLUSIONS These data suggest that in patients with hypercholesterolemia exists an early cardiomyopathy characterized by systolic and diastolic dysfunction. That could produce a substratum for an "impaired preconditioning". Rosuvastatin seems able to revert systolic abnormalities.
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Affiliation(s)
- Enrica Talini
- Cardiac Thoracic and Vascular Department, University of Pisa, Italy.
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Di Bello V, Santini F, Di Cori A, Pucci A, Talini E, Palagi C, Delle Donne MG, Marsili A, Fierabracci P, Valeriano R, Scartabelli G, Giannetti M, Anselmino M, Pinchera A, Mariani M. Effects of Bariatric Surgery on Early Myocardial Alterations in Adult Severely Obese Subjects. Cardiology 2007; 109:241-8. [PMID: 17873488 DOI: 10.1159/000107787] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 01/12/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aim of this study was to investigate the effect of weight loss on structural and functional myocardial alterations in severely obese subjects treated with bariatric surgery. PATIENTS AND METHODS Thirteen severely obese patients (2 males and 11 females) were enrolled in the study. All subjects underwent conventional 2D color Doppler echocardiography. The new ultrasonic techniques used were: (a) integrated backscatter for the analysis of myocardial reflectivity, referred to pericardial interface as expression of myocardial structure (increase in collagen content) and of cyclic variation index as expression of intrinsic myocardial contractility and (b) color Doppler myocardial imaging (CDMI) for the analysis of strain and strain rate (myocardial deformability). All subjects underwent bariatric surgery and were resubmitted to echocardiographic and biochemical examination 6-24 months after surgery. RESULTS The main finding of the present study was a quite complete normalization of myocardial functional and structural alterations after weight loss. In particular, the cyclic variation index at septum level improved from 14.6 +/- 7.0 before to 25.7 +/- 11.2 (means +/- SD) after surgery (controls: 36.2 +/- 9.1). Mean reflectivity at septum level significantly decreased from 55.8 +/- 9.5 to 46.5 +/- 8.8 (controls: 43.0 +/- 8.0). Also, the strain at septum level significantly improved after surgery (from -11.9 +/- 3.2 to -20.4 +/- 5.3; controls: -23.4 +/- 9). CONCLUSION This study establishes: (a) the utility of new ultrasonic techniques to detect very early structural and functional myocardial alterations in severely obese patients, and (b) the regression of these subclinical abnormalities after weight loss achieved by bariatric surgery.
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Vitarelli A, Morichetti MC, Conde Y, Cimino E, D'Orazio S, Stellato S, Padella V, Caranci F, Battaglia D. Assessment of severity in aortic stenosis-incremental value of endocardial function parameters compared with standard indexes. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1224-35. [PMID: 17466445 DOI: 10.1016/j.ultrasmedbio.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Revised: 02/01/2007] [Accepted: 02/13/2007] [Indexed: 05/15/2023]
Abstract
Several studies have reported that patients (pts) with severe aortic stenosis and similar pressure gradients or even similar aortic valve areas may have quite different symptomatic status and clinical outcomes suggesting that other factors might have a significant impact on the pathophysiology of this disease. Our purpose was to assess the severity of subendocardial wall dysfunction in symptomatic and asymptomatic pts with aortic stenosis using tissue Doppler imaging (TDI), strain rate imaging (SRI) and cyclic variation of integrated backscatter (IB). We studied 68 pts with aortic valvar stenosis and 46 subjects with no signs of heart disease. SRI/IB indexes were calculated in the apical four chambers views at endocardial level. Early diastolic endocardial strain rate showed the best correlation with transvalvar pressure gradients and valve areas. Compared with controls, symptomatic pts showed a more marked decrease in endocardial strain, strain rate and cyclic variation of IB. Receiver operating characteristic (ROC) curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the prediction of symptoms were >/=60 mm Hg for the pressure gradient, less than 0.60 cm(2)/m(2) for aortic valve area, less than 20% for strain, less than 2.0 s(-1) for strain rate and less than 3.0 dB for cyclic variation. The combination of pressure gradient, aortic valve area and SRI/IB parameters resulted in an improvement of the overall performance for predicting the symptomatic state. Thus, SRI/IB parameters have an incremental value in differentiating symptomatic and asymptomatic pts with aortic stenosis compared with conventional hemodynamic parameters.
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Di Bello V, Aghini-Lombardi F, Monzani F, Talini E, Antonangeli L, Palagi C, Di Cori A, Caraccio N, Delle Donne MG, Dardano A, Pinchera A, Mariani M. Early abnormalities of left ventricular myocardial characteristics associated with subclinical hyperthyroidism. J Endocrinol Invest 2007; 30:564-71. [PMID: 17848839 DOI: 10.1007/bf03346350] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of the present study was to analyze heart function in subclinical hyperthyroidism (sHT) in otherwise healthy subjects by new methods using intramyocardial ultrasonic techniques. Twenty-four newly diagnosed and untreated sHT patients (20 women, 4 men; mean age: 42+/-4 yr) and 24 sex- and age-matched healthy volunteers were studied. All subjects were submitted to conventional 2D color-Doppler echocardiography, pulsed wave tissue Doppler imaging (PWTDI) for the analysis of diastolic function, color Doppler myocardial imaging (CDMI) for the analysis of regional strain and strain rate (SR) expression of regional myocardial deformability, and to integrated backscatter (IBS) for the evaluation of intrinsic contractility and tissue characterization. Regional myocardial systolic strain findings were significantly higher in sHT patients when compared with controls (p<0.001). Considering diastolic SR, the early phase of diastolic SR was compromised in sHT subjects as compared with controls (p<0.001). Cyclic variation index (CVI), expression of intrinsic contractility, was significantly higher in sHT subjects in comparison with controls (p<0.0001). IBS values were comparable between the 2 study groups. In conclusion, the present study suggests that in patients with sHT early systolic hyperdeformability and hypercontractility are present, together with impairment of both active and passive phases of diastole. On the contrary, no left ventricular hypertrophy or other structural alterations are documented.
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Affiliation(s)
- V Di Bello
- Cardiac Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy.
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38
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Salvetti M, Muiesan ML, Paini A, Monteduro C, Bonzi B, Galbassini G, Belotti E, Movilli E, Cancarini G, Agabiti-Rosei E. Myocardial ultrasound tissue characterization in patients with chronic renal failure. J Am Soc Nephrol 2007; 18:1953-8. [PMID: 17442790 DOI: 10.1681/asn.2006050462] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The objective of this study was to detect ultrastructural changes in myocardium related to collagen content by ultrasound tissue characterization in patients with chronic kidney disease (CKD) and in uncomplicated hypertensive control subjects. In 25 hemodialysis (HD) patients, in 25 patients with moderate to severe chronic renal failure (CRF), and in 10 patients with essential hypertension (EH) and normal renal function matched for age, BP, and left ventricular mass index, left ventricular anatomy and function were evaluated by conventional echocardiography, and integrated backscatter signal (IBS) was analyzed by acoustic densitometry. IBS mean reflectivity increased from 48% in patients with EH to 56% in patients with CRF to 62% in HD patients (ANOVA P < 0.01). IBS mean cyclic variation was progressively increased from 4.35 +/- 1.2 dB in HD patients to 5.27 +/- 0.90 in patients with CRF to 6.50 +/- 1.6 dB in patients with EH (ANOVA P < 0.01). At multivariate analysis, IBS mean reflectivity was positively related to age and serum creatinine (beta 0.351, P = 0.036; and beta = 0.408, P = 0.016, respectively). IBS mean cyclic variation was inversely related to age and serum creatinine (beta = -0.274, P = 0.025; and beta = -0.262, P = 0.025, respectively) and positively related to left ventricular midwall fractional shortening and transmitral E/A ratio (beta = 0.269, P < 0.05; and beta = 0.314, P < 0.001, respectively). The data support the hypothesis that interstitial collagen deposition may appear early in the course of CKD and suggest that acoustic densitometry may represent a useful tool for the assessment of myocardial tissue changes in patients with CKD.
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Affiliation(s)
- Massimo Salvetti
- Department of Medical and Surgical Sciences, University of Brescia, c/o Spedali Civili, 2a Medicina, Brescia 25100, Italy.
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39
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Di Cori A, Di Bello V, Miccoli R, Talini E, Palagi C, Delle Donne MG, Penno G, Nardi C, Bianchi C, Mariani M, Del Prato S, Balbarini A. Left ventricular function in normotensive young adults with well-controlled type 1 diabetes mellitus. Am J Cardiol 2007; 99:84-90. [PMID: 17196468 DOI: 10.1016/j.amjcard.2006.07.063] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 07/17/2006] [Accepted: 07/25/2006] [Indexed: 11/23/2022]
Abstract
The aim of this study was to determine whether early myocardial structural and functional systolic and diastolic alterations in asymptomatic and uncomplicated patients with type 1 diabetes mellitus (DM) could be detected using the new highly sensitive echocardiographic techniques of integrated backscatter and color Doppler myocardial imaging. Forty asymptomatic and uncomplicated patients with type 1 DM and 40 gender- and age-matched normal controls were studied. All patients were analyzed by conventional and new echocardiographic techniques (integrated backscatter and color Doppler myocardial imaging). Patients with DM showed reduced systolic function compared with controls, evidenced by significantly lower peak strain, strain rates, and cyclic variation indexes at the septum (p <0.0001, <0.01, and <0.001, respectively) and at the posterior wall level (p <0.0001, <0.0001, and <0.001, respectively). On receiver-operating characteristic curve analysis, systolic strain and the cyclic variation index showed the highest discriminating power for separating patients with DM and control subjects. Neither structural or ultrastructural nor diastolic functional abnormalities were detected. On univariate regression analysis, a significant inverse correlation was found for DM duration with conventional (E/A ratio) and unconventional (tissue Doppler imaging E/A ratio) indexes of diastolic function, in the absence of any correlation for systolic function. In conclusion, highly sensitive ultrasonic techniques demonstrate evidence of left ventricular systolic dysfunction in the early stage of type 1 DM, in the absence of ultrastructural and left ventricular diastolic functional abnormalities.
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Affiliation(s)
- Andrea Di Cori
- Cardiac and Thoracic Department, University of Pisa, Pisa, Italy.
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40
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Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne MG, Fierabracci P, Marsili A, Talini E, Giannetti M, Biadi O, Balbarini A, Mariani M, Pinchera A. Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr 2006; 19:1063-71. [PMID: 16880104 DOI: 10.1016/j.echo.2006.03.033] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Indexed: 12/26/2022]
Abstract
Obesity is a well-established risk factor for congestive heart failure. Evidence has been provided indicating that insulin resistance could be the mediator between obesity and congestive heart failure, but the pathogenic mechanisms leading to myocardial alterations remain unclear. The aim of this study was to investigate, by ultrasonic integrated backscatter (IBS) analysis, subclinical alterations of left ventricular (LV) structure and function in severe obesity. Sixty consecutive, severely obese people, who were otherwise healthy (15 men, 45 women; mean age +/- SD = 31.8 +/- 7 years), were enrolled. A total of 48 sex- and age-matched nonobese healthy participants were recruited as control subjects. All participants underwent conventional 2-dimensional color Doppler echocardiography, pulsed wave Doppler tissue imaging at mitral annulus level, and IBS. The homeostasis model assessment insulin resistance index was used to assess insulin resistance; the index values in the obese group were significantly higher (mean +/- SD = 4.9 +/- 1.4) than in the control group (0.92 +/- 0.5, P < .0001). Obese patients had a greater LV mass index by height (58.5 +/- 14 g/m(2.7)) than did control subjects (37 +/- 8 g/m(2.7), P < .0001) because of compensation response to volume overload caused by a greater cardiac output (P < .02). Preload reserve was increased in obese patients, as demonstrated by the significant increase in left atrial dimension (P < .0001). This volumetric increase activated the Frank-Starling mechanism, and determined a significantly higher LV ejection fraction (P < .03) in obese patients as compared with control subjects. A slightly reduced LV diastolic function was demonstrated in obese patients (transmitral early to late peak diastolic transmitral flow velocities ratio = 1.1 +/- 0.7) as compared with control subjects (1.5 +/- 0.5, P < .02). Pulsed wave Doppler tissue imaging showed an impairment of diastolic LV longitudinal function and increased LV diastolic filling pressure. The IBS values at septum level, indexed by pericardium interface, were significantly higher for septum in the obese group (57.8 +/- 8%) than in the control group (42.3 +/- 9%, P < .0001). Additional IBS alterations were observed in the obese group, with a significantly lower cyclic variation index both at septum (P < .0001) and at posterior wall (P < .001) levels. A significant association was found between insulin resistance index and both the IBS index of myocardial reflectivity at septum level (expression of increased myocardial collagen content) or LV mass. In conclusion, this study demonstrates that obese patients exhibit myocardial structural and functional alterations related to insulin resistance and to LV volume overload, which could be considered the very early stage of incipient obesity cardiomyopathy.
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41
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Abstract
Aortic valve stenosis has already reached endemic proportions in Western countries. As the prognosis of low-flow aortic valve stenosis under medical treatment is dismal, surgery is recommended in most patients. Preoperative dobutamine stress testing may help to assess surgical risk, but there is no strong scientific evidence to deny surgery based exclusively on the results of this test. The problems associated with clinical decision making in this condition are reviewed.
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Affiliation(s)
- J Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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42
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Quere JP, Monin JL, Levy F, Petit H, Baleynaud S, Chauvel C, Pop C, Ohlmann P, Lelguen C, Dehant P, Gueret P, Tribouilloy C. Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic Stenosis. Circulation 2006; 113:1738-44. [PMID: 16585393 DOI: 10.1161/circulationaha.105.568824] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Dobutamine stress hemodynamics (DSH) has the potential to stratify operative risk in low-gradient aortic stenosis (AS), but little is known about the relation between left ventricle contractile reserve and postoperative left ventricular ejection fraction (LVEF). We sought to assess the value of DSH to predict postoperative improvement in LVEF.
Methods and Results—
Sixty-six consecutive patients with symptomatic severe AS (aortic valve area ≤1 cm
2
), LVEF ≤40%, and mean pressure gradient ≤40 mm Hg prospectively enrolled in the French multicenter study on low-gradient AS and who survived to aortic valvular replacement (AVR) were included. Preoperative contractile reserve was present in 46 patients (group I; 70%) and absent in 20 patients (group II; 30%). In the overall sample, 58% of patients improved by 2 New York Heart Association (NYHA) classes after AVR. Mean LVEF improved from 29±6% to 47±11% (
P
<0.0001). LVEF improved by ≥10 EF units in 38 patients (83%) in group I and in 13 patients (65%) in group II. Mean LVEF improvement was similar in the 2 groups (19±10% versus 17±11%;
P
=0.54). On multivariable analysis, multivessel coronary artery disease (
P
=0.05) and baseline mean transaortic pressure gradient (
P
=0.01) were related to LVEF improvement, whereas contractile reserve was not.
Conclusions—
LVEF increases in the majority of patients with low-gradient AS who survive after AVR. Although the absence of contractile reserve on DSH is related to high operative mortality, it does not predict the absence of LVEF recovery in patients surviving to AVR. These data further support the concept that surgery should not be contraindicated on the basis of absence of contractile reserve alone.
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Affiliation(s)
- Jean-Paul Quere
- Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France
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43
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Galetta F, Franzoni F. Reply to Finsterer and Stöllberger. Neuromuscul Disord 2006. [DOI: 10.1016/j.nmd.2005.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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