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Abraham JD, Shavik SM, Mitchell TR, Lee LC, Ray B, Leonardi CR. Computational investigation of the role of ventricular remodelling in HFpEF: The key to phenotype dissection. Comput Biol Med 2024; 180:109019. [PMID: 39153393 DOI: 10.1016/j.compbiomed.2024.109019] [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: 03/15/2024] [Revised: 07/30/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
Recent clinical studies have reported that heart failure with preserved ejection fraction (HFpEF) can be divided into two phenotypes based on the range of ejection fraction (EF), namely HFpEF with higher EF and HFpEF with lower EF. These phenotypes exhibit distinct left ventricle (LV) remodelling patterns and dynamics. However, the influence of LV remodelling on various LV functional indices and the underlying mechanics for these two phenotypes are not well understood. To address these issues, this study employs a coupled finite element analysis (FEA) framework to analyse the impact of various ventricular remodelling patterns, specifically concentric remodelling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH), with and without LV wall thickening on LV functional indices. Further, the geometries with a moderate level of remodelling from each pattern are subjected to fibre stiffening and contractile impairment to examine their effect in replicating the different features of HFpEF. The results show that with severe CR, LV could exhibit the characteristics of HFpEF with higher EF, as observed in recent clinical studies. Controlled fibre stiffening can simultaneously increase the end-diastolic pressure (EDP) and reduce the peak longitudinal strain (ell) without significant reduction in EF, facilitating the moderate CR geometries to fit into this phenotype. Similarly, fibre stiffening can assist the CH and 'EH with wall thickening' cases to replicate HFpEF with lower EF. These findings suggest that potential treatment for these two phenotypes should target the bio-origins of their distinct ventricular remodelling patterns and the extent of myocardial stiffening.
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Affiliation(s)
- Jijo Derick Abraham
- University of Queensland - IIT Delhi Academy of Research (UQIDAR), Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India; School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India.
| | - Sheikh Mohammad Shavik
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Travis R Mitchell
- School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, East Lansing, MI, 48824, USA
| | - Bahni Ray
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Christopher R Leonardi
- School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia
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2
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Goetz WA, Yao J, Brener M, Puri R, Swaans M, Schopka S, Wiesner S, Creutzenberg M, Sievert H, Kassab GS. Inversion of Left Ventricular Axial Shortening: In Silico Proof of Concept for Treatment of HFpEF. Bioengineering (Basel) 2024; 11:676. [PMID: 39061758 PMCID: PMC11274197 DOI: 10.3390/bioengineering11070676] [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: 05/13/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Left ventricular (LV) longitudinal function is mechanically coupled to the elasticity of the ascending aorta (AA). The pathophysiologic link between a stiff AA and reduced longitudinal strain and the subsequent deterioration in longitudinal LV systolic function is likely relevant in heart failure with preserved ejection fraction (HFpEF). The proposed therapeutic effect of freeing the LV apex and allowing for LV inverse longitudinal shortening was studied in silico utilizing the Living Left Heart Human Model (Dassault Systémes Simulia Corporation). LV function was evaluated in a model with (A) an elastic AA, (B) a stiff AA, and (C) a stiff AA with a free LV apex. The cardiac model simulation demonstrated that freeing the apex caused inverse LV longitudinal shortening that could abolish the deleterious mechanical effect of a stiff AA on LV function. A stiff AA and impairment of the LV longitudinal strain are common in patients with HFpEF. The hypothesis-generating model strongly suggests that freeing the apex and inverse longitudinal shortening may improve LV function in HFpEF patients with a stiff AA.
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Affiliation(s)
- Wolfgang A. Goetz
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (S.S.)
| | - Jiang Yao
- Dassault Systémes, Johnston, RI 02919, USA;
| | - Michael Brener
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10027, USA
| | - Rishi Puri
- Cleveland Clinic, Cleveland, OH 44195, USA
| | - Martin Swaans
- St. Antonius Ziekenhuis, 3435 Nieuwegein, The Netherlands
| | - Simon Schopka
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (S.S.)
| | - Sigrid Wiesner
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (S.S.)
| | - Marcus Creutzenberg
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (S.S.)
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3
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Goetz WA, Yao J, Brener M, Puri R, Swaans M, Schopka S, Wiesner S, Creutzenberg M, Sievert H, Kassab GS. The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model. Bioengineering (Basel) 2024; 11:603. [PMID: 38927839 PMCID: PMC11200724 DOI: 10.3390/bioengineering11060603] [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: 04/12/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
During systole, longitudinal shortening of the left ventricle (LV) displaces the aortic root toward the apex of the heart and stretches the ascending aorta (AA). An in silico study (Living Left Heart Human Model, Dassault Systèmes Simulia Corporation) demonstrated that stiffening of the AA affects myocardial stress and LV strain patterns. With AA stiffening, myofiber stress increased overall in the LV, with particularly high-stress areas at the septum. The most pronounced reduction in strain was noted along the septal longitudinal region. The pressure-volume loops showed that AA stiffening caused a deterioration in LV function, with increased end-systolic volume, reduced systolic LV pressure, decreased stroke volume and effective stroke work, but elevated end-diastolic pressure. An increase in myofiber contractility indicated that stroke volume and effective stroke work could be recovered, with an increase in LV end-systolic pressure and a decrease in end-diastolic pressure. Longitudinal and radial strains remained reduced, but circumferential strains increased over baseline, compensating for lost longitudinal LV function. Myofiber stress increased overall, with the most dramatic increase in the septal region and the LV apex. We demonstrate a direct mechanical pathophysiologic link between stiff AA and reduced longitudinal left ventricular strain which are common in patients with HFpEF.
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Affiliation(s)
- Wolfgang Anton Goetz
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (M.C.)
| | - Jiang Yao
- Dassault Systèmes, Johnston, RI 02919, USA
| | - Michael Brener
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10027, USA;
| | - Rishi Puri
- Cleveland Clinic, Cleveland, OH 44195, USA
| | - Martin Swaans
- St. Antonius Ziekenhuis, 3435 Nieuwegein, The Netherlands;
| | - Simon Schopka
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (M.C.)
| | - Sigrid Wiesner
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (M.C.)
| | - Marcus Creutzenberg
- Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (W.A.G.); (M.C.)
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4
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He J, Yang W, Wu W, Yin G, Zhuang B, Xu J, Zhou D, Zhang J, Wang Y, Zhu L, Sun X, Sirajuddin A, Teng Z, Kureshi F, Arai AE, Zhao S, Lu M. Heart Failure with Normal Natriuretic Peptide Levels and Preserved Ejection Fraction: A Prospective Clinical and Cardiac MRI Study. Radiol Cardiothorac Imaging 2024; 6:e230281. [PMID: 38695743 PMCID: PMC11211949 DOI: 10.1148/ryct.230281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 06/16/2024]
Abstract
Purpose To describe the clinical presentation, comprehensive cardiac MRI characteristics, and prognosis of individuals with predisposed heart failure with preserved ejection fraction (HFpEF). Materials and Methods This prospective cohort study (part of MISSION-HFpEF [Multimodality Imaging in the Screening, Diagnosis, and Risk Stratification of HFpEF]; NCT04603404) was conducted from January 1, 2019, to September 30, 2021, and included individuals with suspected HFpEF who underwent cardiac MRI. Participants who had primary cardiomyopathy and primary valvular heart disease were excluded. Participants were split into a predisposed HFpEF group, defined as HFpEF with normal natriuretic peptide levels based on an HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, and Final Etiology) score of 4 from the latest European Society of Cardiology guidelines, and an HFpEF group (HFA-PEFF score of ≥ 5). An asymptomatic control group without heart failure was also included. Clinical and cardiac MRI-based characteristics and outcomes were compared between groups. The primary end points were death, heart failure hospitalization, or stroke. Results A total of 213 participants with HFpEF, 151 participants with predisposed HFpEF, and 100 participants in the control group were analyzed. Compared with the control group, participants with predisposed HFpEF had worse left ventricular remodeling and function and higher systemic inflammation. Compared with participants with HFpEF, those with predisposed HFpEF, whether obese or not, were younger and had higher plasma volume, lower prevalence of atrial fibrillation, lower left atrial volume index, and less impaired left ventricular global longitudinal strain (-12.2% ± 2.8 vs -13.9% ± 3.1; P < .001) and early-diastolic global longitudinal strain rate (eGLSR, 0.52/sec ± 0.20 vs 0.57/sec ± 0.15; P = .03) but similar prognosis. Atrial fibrillation occurrence (hazard ratio [HR] = 3.90; P = .009), hemoglobin level (HR = 0.94; P = .001), and eGLSR (per 0.2-per-second increase, HR = 0.28; P = .002) were independently associated with occurrence of primary end points in participants with predisposed HFpEF. Conclusion Participants with predisposed HFpEF showed relatively unique clinical and cardiac MRI features, warranting greater clinical attention. eGLSR should be considered as a prognostic factor in participants with predisposed HFpEF. Keywords: Heart Failure with Preserved Ejection Fraction, Normal Natriuretic Peptide Levels, Cardiovascular Magnetic Resonance, Myocardial Strain, Prognosis Clinical trial registration no. NCT04603404 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Jian He
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Wenjing Yang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Weichun Wu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Gang Yin
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Baiyan Zhuang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Jing Xu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Di Zhou
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Jian Zhang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Yining Wang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Leyi Zhu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Xiaoxin Sun
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Arlene Sirajuddin
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Zhongzhao Teng
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Faraz Kureshi
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Andrew E. Arai
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Minjie Lu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
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5
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Hao Y, Zhang R, Chen L, Fan G, Liu B, Jiang K, Zhu Y, Zhang M, Guo J. Distinguishing heart failure subtypes: the diagnostic power of different cardiac magnetic resonance imaging parameters. Front Cardiovasc Med 2024; 11:1291735. [PMID: 38385138 PMCID: PMC10879269 DOI: 10.3389/fcvm.2024.1291735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives The aim of this retrospective study was to explore the diagnostic potential of various cardiac parameters in differentiating between heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-ranged and reduced ejection fraction (HFm + rEF), and to discern their relationship with normal cardiac function. Methods This research encompassed a comparative analysis of heart failure subtypes based on multiple indicators. Participants were categorized into HFm + rEF, HFpEF, and control groups. For each participant, we investigated indicators of left ventricular function (LVEDVi, LVESVi, and LVEF) and myocardial strain parameters (GLS, GCS, GRS). Additionally, quantitative tissue evaluation parameters including native T1, enhanced T1, and extracellular volume (ECV) were examined.For comprehensive diagnostic performance analysis, receiver operating characteristic (ROC) curve evaluations for each parameters were conducted. Results HFm + rEF patients exhibited elevated LVEDVi and LVESVi and decreased LVEF compared to both HFpEF and control groups. Myocardial strain revealed significant reductions in GLS, GCS, and GRS for HFm + rEF patients compared to the other groups. HFpEF patients showed strain reductions relative to the control group. In cardiac magnetic resonance imaging (CMR) evaluations, HFm + rEF patients demonstrated heightened native T1 times and ECV fractions. Native T1 was particularly effective in distinguishing HFpEF from healthy subjects. Conclusion Native T1, ECV, and myocardial strain parameters have substantial diagnostic value in identifying HFpEF. Among them, native T1 displayed superior diagnostic efficiency relative to ECV, offering critical insights into early-stage HFpEF. These findings can play a pivotal role in refining clinical management and treatment strategies for heart failure patients.
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Affiliation(s)
- Yanhui Hao
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Rui Zhang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lihong Chen
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ganglian Fan
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bing Liu
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ke Jiang
- Clinical & Technical Support, Philips Healthcare, Beijing, China
| | - Yi Zhu
- Clinical & Technical Support, Philips Healthcare, Beijing, China
| | - Ming Zhang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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6
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Mandoli GE, Cameli M, Pastore MC, Benfari G, Malagoli A, D'Andrea A, Sperlongano S, Bandera F, Esposito R, Santoro C, Pedrinelli R, Mercuro G, Indolfi C. Speckle tracking echocardiography in early disease stages: a therapy modifier? J Cardiovasc Med (Hagerstown) 2023; 24:e55-e66. [PMID: 37052222 DOI: 10.2459/jcm.0000000000001422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Echocardiography has been included as a first-line tool in several international guidelines for the management of patients with various cardiac diseases. Beyond diagnosis, echocardiographic examination helps in characterizing the severity of the condition since the very first stages. In particular, the application of second-level techniques, speckle tracking echocardiography in particular, can also reveal a subclinical dysfunction, while the standard parameters are in the normality range. The present review describes the potentialities of advanced echocardiography in different settings, including arterial hypertension, atrial fibrillation, diastolic dysfunction, and oncological patients, thus opening up potential starting points for its application as a clinical routine changer.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena
| | | | - Simona Sperlongano
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, Naples
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milano
- Cardiology University Department, IRCCS Policlinico San Donato, Milan
| | | | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples
| | - Roberto Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
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7
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Meucci MC, Stassen J, Tomsic A, Palmen M, Crea F, Bax JJ, Ajmone Marsan N, Delgado V. Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation. Heart 2023; 109:478-484. [PMID: 36270784 DOI: 10.1136/heartjnl-2022-321698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Left atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR. METHODS A total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis. RESULTS Impaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients' outcome. CONCLUSIONS In patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Anton Tomsic
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands .,Hospital University Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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8
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Lin Y, Cai Z, Yuan J, Liu H, Pang X, Chen Q, Tang X, Geng Q, Dong S. Effect of pharmacological treatment on outcomes of heart failure with preserved ejection fraction: an updated systematic review and network meta-analysis of randomized controlled trials. Cardiovasc Diabetol 2022; 21:237. [PMID: 36348348 PMCID: PMC9644566 DOI: 10.1186/s12933-022-01679-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Optimal treatment strategies for patients with heart failure with preserved ejection fraction (HFpEF) remain uncertain. The goal of this study was to compare the treatment effects of different therapeutic agents for patients with HFpEF. Methods Randomized controlled trials (RCTs) published before June 2022 were searched from PubMed, Clinical Trials gov, and the Cochrane Central Register databases. Combined odds ratios (ORs) with 95% confidence intervals (CI) were calculated for the primary and secondary outcomes. All-cause death was the primary endpoint and cardiac death, hospitalization for HF, and worsening HF (WHF) events were secondary endpoints in this meta-analysis. Results Fifteen RCTs including 31,608 patients were included in this meta-analysis. All-cause and cardiac death were not significantly correlated between drug treatments and placebo. Compared with placebo, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor neprilysin inhibitors (ARNIs), and sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly reduced HF hospitalizations [odds ratio (OR) = 0.64, (95% confidence interval (95%CI 0.43 − 0.96), OR = 0.73, (95%CI 0.61 − 0.86), and OR = 0.74, (95%CI 0.66 − 0.83), respectively] without heterogeneity among studies. Only SGLT2 inhibitors significantly reduced WHF events [OR = 0.75, (95%CI 0.67 − 0.83)]. Conclusions No treatments were effective in reducing mortality, but ARNIs, ACEIs or SGLT2 inhibitors reduced HF hospitalizations and only SGLT2 inhibitors reduced WHF events for patients with HFpEF. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01679-2.
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9
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Sturgill SL, Shettigar V, Ziolo MT. Antiquated ejection fraction: Basic research applications for speckle tracking echocardiography. Front Physiol 2022; 13:969314. [PMID: 36353373 PMCID: PMC9637923 DOI: 10.3389/fphys.2022.969314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/05/2022] [Indexed: 03/24/2024] Open
Abstract
For years, ejection fraction has been an essentially ubiquitous measurement for assessing the cardiovascular function of animal models in research labs. Despite technological advances, it remains the top choice among research labs for reporting heart function to this day, and is often overstated in applications. This unfortunately may lead to misinterpretation of data. Clinical approaches have now surpassed research methods, allowing for deeper analysis of the tiers of cardiovascular performance (cardiovascular performance, heart performance, systolic and diastolic function, and contractility). Analysis of each tier is crucial for understanding heart performance, mechanism of action, and disease diagnosis, classification, and progression. This review will elucidate the differences between the tiers of cardiovascular function and discuss the benefits of measuring each tier via speckle tracking echocardiography for basic scientists.
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Affiliation(s)
| | | | - Mark T. Ziolo
- Frick Center for Heart Failure and Arrhythmia, Department of Physiology and Cell Biology, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
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10
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Kim K, Seo J, Cho I, Choi EY, Hong GR, Ha JW, Rim SJ, Shim CY. Associations between Subclinical Myocardial Dysfunction and Premature Fusion of Early and Late Diastolic Filling with Uncertain Cause. Yonsei Med J 2022; 63:817-824. [PMID: 36031781 PMCID: PMC9424778 DOI: 10.3349/ymj.2022.63.9.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is often found during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A fusion of uncertain cause in the absence of tachycardia. MATERIALS AND METHODS We identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between January 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion. RESULTS The premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msec vs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%, p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002). CONCLUSION Premature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.
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Affiliation(s)
- Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jiwon Seo
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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11
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Marra AM, Bencivenga L, D'Assante R, Rengo G, Cittadini A. Heart failure with preserved ejection fraction: Squaring the circle between comorbidities and cardiovascular abnormalities. Eur J Intern Med 2022; 99:1-6. [PMID: 35033395 DOI: 10.1016/j.ejim.2022.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/23/2022]
Abstract
Heart Failure with preserved Ejection Fraction (HFpEF) is nowadays considered a major healthcare issue. According to forecasts two third of all Heart Failure patients will belong to this phenotype by year 2050, overwhelming those affected by Heart Failure with reduced Ejection Fraction (HFrEF). Both epidemiological and mechanistic studies support the concept that HFpEF represents true HF although aggravated by a collection of comorbidities. There is urgent need of improving its phenotyping due to the high degree of disease heterogeneity within HFpEF that lead to the failure of randomized clinical trials in demonstrating a remarkable impact of drugs in improving its morbidity and mortality.
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Affiliation(s)
- Alberto Maria Marra
- Department of Translational Medical Sciences, University of Naples "Federico II", Napoli, Italy; Interdisciplinary Research Centre on Biomaterials (CRIB), Federico II University, Naples, Italy; Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Leonardo Bencivenga
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, France; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Napoli, Italy; Istituti Clinici Scientifici Maugeri SpA Società Benefit, Telese, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples "Federico II", Napoli, Italy; Interdisciplinary Research Centre on Biomaterials (CRIB), Federico II University, Naples, Italy.
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12
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Del Torto A, Guaricci AI, Pomarico F, Guglielmo M, Fusini L, Monitillo F, Santoro D, Vannini M, Rossi A, Muscogiuri G, Baggiano A, Pontone G. Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:758975. [PMID: 35355965 PMCID: PMC8959466 DOI: 10.3389/fcvm.2022.758975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome defined by the presence of heart failure symptoms and increased levels of circulating natriuretic peptide (NP) in patients with preserved left ventricular ejection fraction and various degrees of diastolic dysfunction (DD). HFpEF is a complex condition that encompasses a wide range of different etiologies. Cardiovascular imaging plays a pivotal role in diagnosing HFpEF, in identifying specific underlying etiologies, in prognostic stratification, and in therapeutic individualization. Echocardiography is the first line imaging modality with its wide availability; it has high spatial and temporal resolution and can reliably assess systolic and diastolic function. Cardiovascular magnetic resonance (CMR) is the gold standard for cardiac morphology and function assessment, and has superior contrast resolution to look in depth into tissue changes and help to identify specific HFpEF etiologies. Differently, the most important role of nuclear imaging [i.e., planar scintigraphy and/or single photon emission CT (SPECT)] consists in the screening and diagnosis of cardiac transthyretin amyloidosis (ATTR) in patients with HFpEF. Cardiac CT can accurately evaluate coronary artery disease both from an anatomical and functional point of view, but tissue characterization methods have also been developed. The aim of this review is to critically summarize the current uses and future perspectives of echocardiography, nuclear imaging, CT, and CMR in patients with HFpEF.
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Affiliation(s)
- Alberico Del Torto
- Department of Emergency and Acute Cardiac Care, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Daniela Santoro
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Monica Vannini
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- University Milano Bicocca, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- *Correspondence: Gianluca Pontone
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13
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Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application. Diagnostics (Basel) 2021; 11:diagnostics11050892. [PMID: 34067703 PMCID: PMC8156791 DOI: 10.3390/diagnostics11050892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.
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14
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Effects of Left Ventricular Hypertrophy and Myocardial Stiffness on Myocardial Strain Under Preserved Ejection Fraction. Ann Biomed Eng 2021; 49:1670-1687. [PMID: 33575930 DOI: 10.1007/s10439-020-02706-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Despite numerous experimental observations regarding heart failure with preserved ejection fraction (HFpEF), which is characterized mainly by left ventricular hypertrophy and a left ventricular ejection fraction over 50%, myocardial dynamics under HFpEF have not yet been fully clarified, particularly regarding the relationship between myocardial strain distribution and myocardial work. To address this issue, we numerically investigated radial distribution of myocardial strain during a cardiac cycle with fixed internal volume at the end of the systolic and diastolic phases under different mechanical conditions, such as those involving myocardial thickness and elasticity of myocardial fibers. The myocardium was a modeled as a visco-hyperelastic continuous material. This model was taken into account that active contractile stress along the myocardial fiber direction depends on membrane potential change. Our numerical results showed that both radial and circumferential strains decreased as wall thickness increased, which reflected cardiac hypertrophy, but that myocardial work became larger than that observed with thin ventricular walls. Further, the change in left ventricular diastolic internal pressure caused circumferential strain, while fiber stiffness contributed to radial strain. Since peak circumferential strain was well estimated by the maximum difference between total internal and myocardial volumes, measuring the epicardial contraction rate should be helpful in understanding patients with HFpEF.
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15
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Mathis MR, Duggal NM, Janda AM, Fennema JL, Yang B, Pagani FD, Maile MD, Hofer RE, Jewell ES, Engoren MC. Reduced Echocardiographic Inotropy Index after Cardiopulmonary Bypass Is Associated With Complications After Cardiac Surgery: An Institutional Outcomes Study. J Cardiothorac Vasc Anesth 2021; 35:2732-2742. [PMID: 33593647 DOI: 10.1053/j.jvca.2021.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Despite advances in echocardiography and hemodynamic monitoring, limited progress has been made to effectively quantify left ventricular function during cardiac surgery. Traditional measures, including left ventricular ejection fraction (LVEF) and cardiac index, remain dependent on loading conditions; more complex measures remain impractical in a dynamic surgical setting. However, the Smith-Madigan Inotropy Index (SMII) and potential-to-kinetic energy ratio (PKR) offer promise as measures calculable during cardiac surgery and potentially predictive of outcomes. Using echocardiographic and hemodynamic monitoring data, the authors aimed to calculate SMII and PKR values after cardiopulmonary bypass and understand associations with postoperative outcomes, adjusting for previously identified risk factors. DESIGN Observational cohort study. SETTING Tertiary care academic hospital. PATIENTS The study comprised 189 elective adult cardiac surgical procedures from 2015-2016. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS The primary outcome was postoperative mortality or organ system complication (stroke, prolonged ventilation, reintubation, cardiac arrest, acute kidney injury, new-onset atrial fibrillation). After adjustment, SMII <0.83 W/m2 independently predicted the primary outcome (adjusted odds ratio 2.19, 95% confidence interval 1.08-4.42); whereas PKR, LVEF, and cardiac index demonstrated no associations. When SMII and PKR were incorporated into a EuroSCORE II risk model, predictive performance improved (net reclassification index improvement 0.457; p = 0.001); whereas a model incorporating LVEF and cardiac index demonstrated no improvement (0.130; p = 0.318). CONCLUSION The present study demonstrated that SMII, but not PKR, as a measure of cardiac function was associated with major complications. The study's data may guide investigations of more suitable perioperative goal-directed therapies to reduce complications after cardiac surgery.
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Affiliation(s)
- Michael R Mathis
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI; Department of Computational Medicine and Bioinformatics, University of Michigan Health System, Ann Arbor, MI.
| | - Neal M Duggal
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI
| | - Jordan L Fennema
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Michael D Maile
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI
| | - Ryan E Hofer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Elizabeth S Jewell
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI
| | - Milo C Engoren
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI
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16
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The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients-Is There More Than Just Left Ventricle Global Longitudinal Strain? J Clin Med 2021; 10:jcm10010154. [PMID: 33466260 PMCID: PMC7795612 DOI: 10.3390/jcm10010154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
With the improvement in survival rate, cardiotoxicity has emerged as a significant adverse effect of cancer therapy. Early diagnosis of subclinical cardiac injury may allow the initiation of cardioprotective therapy and preventing the interruption of optimal cancer therapy and the development of irreversible cardiac dysfunction. In this article, we review the role of two-dimensional speckle tracking echocardiography (2D-STE), beyond the common left ventricle global longitudinal strain in the diagnosis of early subclinical cardiac injury in patients treated with cancer therapies.
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17
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2020; 40:3297-3317. [PMID: 31504452 DOI: 10.1093/eurheartj/ehz641] [Citation(s) in RCA: 834] [Impact Index Per Article: 208.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), left ventricular (LV) filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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18
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Usefulness and clinical relevance of left ventricular global longitudinal systolic strain in patients with heart failure with preserved ejection fraction. Heart Fail Rev 2020; 25:67-73. [PMID: 31489515 DOI: 10.1007/s10741-019-09853-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, several studies have shown the usefulness and clinical relevance of left ventricular global longitudinal systolic strain (GLS) in different cardiovascular diseases. In line with this, the role of GLS in patients with heart failure with preserved ejection fraction (HFpEF) has achieved great importance in this predominant form of heart failure in the last years. In this regard, GLS has shown to be not only a sensitive parameter to detect subtle myocardial abnormalities but also a parameter of clinical and prognostic relevance in patients with HFpEF. In this review, we analyze the current evidence concerning the clinical relevance of GLS in patients with HFpEF and we discuss the potential usefulness of GLS in this complex and heterogeneous condition for which so far no effective therapy exists.
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19
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Hochstadt A, Arnold J, Rosen R, Sherez C, Sherez J, Mor L, Derakhshesh M, Moshkovits Y, Merdler I, Arbel Y, Kapusta L, Rozenbaum Z, Topilsky Y, Laufer-Perl M. Diastolic strain time as predictor for systolic dysfunction among patients with active breast cancer. Echocardiography 2020; 37:1890-1896. [PMID: 32686871 DOI: 10.1111/echo.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of diastolic strain time (Dst) with the routine echocardiography diastolic parameters and estimated its role in the early detection of cardiotoxicity among patients with active breast cancer. METHODS Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy, were included. Echocardiography, including global longitudinal systolic strain (GLS) and Dst, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity was determined by GLS relative reduction of ≥15%. Dst was assessed as the time measured (ms) of the myocardium lengthening during diastole. RESULTS Among 69 patients, 67 (97.1%) were females with a mean age of 52 ± 13 years. Dst was significantly associated with the routine diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3. Both in a univariate and a multivariate analyses, the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (P < .04). CONCLUSIONS Among breast cancer patients, Dst showed high correlation to the routine diastolic echocardiography parameters. Change in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.
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Affiliation(s)
- Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Arnold
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Rosen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Sherez
- University of Naples, Federico ll, Naples, Italy
| | - Jack Sherez
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Livia Kapusta
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pediatrics Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Dogdus M, Diker S, Yenercag M, Gurgun C. Evaluation of left atrial and ventricular myocardial functions by three-dimensional speckle tracking echocardiography in patients with euthyroid Hashimoto's thyroiditis. Int J Cardiovasc Imaging 2020; 37:459-465. [PMID: 32897525 DOI: 10.1007/s10554-020-02011-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Hashimoto's Thyroiditis (HsT) is one of the most frequently occurring autoimmune diseases, characterized by lymphocytic infiltration, destruction and fibrosis of thyroid tissue and the presence of antibodies to thyroid peroxidase and thyroglobulin. The effects of euthyroid Hashimoto's thyroiditis (eHsT) on cardiovascular system are unclear. We aimed to identify if any deteriorations in LA and LV myocardial functions in patients with eHsT by 3D-STE in the current study. Fifty eight patients with eHsT and 60 age- and gender-matched controls were enrolled into the study. All participants underwent laboratory analyses which included thyroid hormones and thyroid autoantibody levels; and conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the study patients was 34.5 ± 9 years, and 68.6% were female. Left ventricular global longitudinal strain (LV-GLS) was significantly depressed in the eHsT (+) group than in the control group (- 15.3 ± 3.6 vs. - 22.8 ± 3.8, p < 0.001). The LV-GLS was found to be disrupted linearly as thyroid autoantibodies increased (r = 0.684 for anti-TPO-ab and LV-GLS; r = 0.649 for anti-Tg-ab and LV-GLS). The present study demonstrated that 3D-STE is useful in the early detection of LV myocardial dysfunction in patients with eHsT. We found that eHsT had a negative effect on LV myocardial dynamics. According to these findings, these myocardial alterations that are present early in the disease process may be considered as a reason to start medical treatment earlier, even at the euthyroid stage to prevent LV myocardial impairment.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Training and Research Hospital, Usak University, 64100, Usak, Turkey.
| | - Suleyman Diker
- Department of Internal Medicine, Training and Research Hospital, Usak University, 64100, Usak, Turkey
| | - Mustafa Yenercag
- Department of Cardiology, Faculty of Medicine, Ordu University, 52200, Ordu, Turkey
| | - Cemil Gurgun
- Department of Cardiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
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21
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Dzhioeva O, Belyavskiy E. Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations. Ther Clin Risk Manag 2020; 16:769-785. [PMID: 32904123 PMCID: PMC7450524 DOI: 10.2147/tcrm.s207117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major global public health problem. Diagnosis of HFpEF is still challenging and built based on the comprehensive echocardiographic analysis. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. This review attempts to summarize the current advances in the diagnosis of HFpEF and provide future directions of the patients´ management with this very widespread, heterogeneous clinical syndrome.
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Affiliation(s)
- Olga Dzhioeva
- Department of Fundamental and Applied Aspects of Obesity, National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Prediction of cardiac events using fully automated GLS and BNP titers in patients with known or suspected heart failure. PLoS One 2020; 15:e0234294. [PMID: 32542005 PMCID: PMC7295200 DOI: 10.1371/journal.pone.0234294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/24/2020] [Indexed: 12/28/2022] Open
Abstract
Background Although global longitudinal strain (GLS) measurements provide useful predictive information, measurement variability is still a major concern. We sought to determine whether fully automated GLS measurements could predict future cardiac events in patients with known or suspected heart failure (HF). Methods GLS was measured using fully automated 2D speckle tracking analysis software (AutoStrain, TomTec) in 3,150 subjects who had undergone clinically indicated brain natriuretic peptide (BNP) assays and echocardiographic examinations. Among 1,514 patients in the derivation cohort, optimal cut-off values of BNP and GLS for cardiac death (CD) and major adverse cardiovascular events (MACEs) were determined using survival classification and regression tree (CART) analysis. The remaining 1,636 patients, comprising the validation cohort, were stratified into subgroups according to predefined cut-off values, and survival curves were compared. Results Survival CART analysis selected GLS with cut-off values of 6.2% and 14.0% for predicting CD. GLS of 6.9% and 13.9% and BNP of 83.2 pg/mL and 206.3 pg/mL were selected for predicting MACEs. For simplicity, we defined GLS of 7% and 14% and BNP of 100 pg/mL and 200 pg/mL as cut-off values. These cut-off values stratify high-risk patients in the validation cohort with known or suspected HF for both CD and MACEs. Conclusions In addition to BNP, fully automated GLS measurements provide prognostic information for patients with known or suspected HF, and this approach facilitates clinical work flow.
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23
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Drapkina OM, Dzhioeva ON. Modern echocardiographic criteria for heart failure with preserved ejection fraction: not only diastolic dysfunction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. N. Dzhioeva
- National Medical Research Center for Therapy and Preventive Medicine
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24
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Abstract
OBJECTIVE To define the prevalence of early cardiac dysfunction in children and young adults with perinatally acquired HIV and predictors of cardiac function. DESIGN Cross-sectional design. METHODS Early cardiac dysfunction was defined as left ventricular (LV) global longitudinal strain z-score less than -2 or myocardial performance index at least 0.5 with normal LV ejection fraction. Regression models were fitted to assess the relationship between measures of cardiac function and HIV RNA levels, clinical variables, and markers of inflammation. RESULTS Six hundred and forty-three individuals (mean age 14.1 ± 5.2 years) were enrolled. The average time on combination antiretroviral treatment was 6.8 ± 3.6 years. Nearly 28% of individuals met criteria for early cardiac dysfunction. Individuals with early cardiac dysfunction were older (15.3 vs. 13.5 years, P < 0.001), had more frequently detectable HIV RNA (52.5 vs. 41.7%, P = 0.018), were more likely exposed to azidothymidine or zidovudine (ZDV) (55.6 vs. 41.2%, P = 0.002), and had higher median level of plasma IL-6 concentrations (1.00 vs. 0.88 pg/ml, P = 0.011). Multivariable models show LV ejection fraction negatively associated with HIV RNA levels [β -0.18; 95% confidence interval (CI) -0.33, -0.03] and ZDV exposure (β -1.75; 95% CI -2.62, -0.88) and positively associated with proportion of life on combination antiretroviral treatment (β 2.65; 95% CI 0.90, 4.41). Higher myocardial performance index was positively associated with serum inflammation marker (IL-6 β 0.01; 95% CI 0.0001, 0.001). Left ventricular global longitudinal strain was not significantly associated with clinical and laboratory variables of interest. CONCLUSION Over one-quarter of children and young adults living with HIV demonstrated evidence of cardiac dysfunction, which may be associated with increasing levels of systemic inflammation.
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25
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2020; 22:391-412. [PMID: 32133741 DOI: 10.1002/ejhf.1741] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), LV filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1 : Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2 : Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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26
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Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance. Eur Radiol 2020; 30:3672-3683. [PMID: 32107604 DOI: 10.1007/s00330-020-06744-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches. METHODS The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASRs), early diastole (FLASRe), and atrial contraction (FLASRa) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance. RESULTS FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASRe (0.96, 90%, and 94%). CONCLUSIONS The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis. KEY POINTS • Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
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27
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Parameters of repolarization heterogeneity are associated with myocardial recovery in acute heart failure. Int J Cardiol 2020; 301:147-151. [DOI: 10.1016/j.ijcard.2019.08.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/11/2019] [Accepted: 08/23/2019] [Indexed: 11/21/2022]
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28
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Azak E, Uçaktürk SA, Çetin İİ, Gürsu HA, Mengen E, Pamuk U. Subclinical Myocardial Dysfunction Demonstrated by Speckle Tracking Echocardiography in Children with Euthyroid Hashimoto’s Thyroiditis. J Clin Res Pediatr Endocrinol 2019; 11:410-418. [PMID: 31218876 PMCID: PMC6878337 DOI: 10.4274/jcrpe.galenos.2019.2018.0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
Objective Thyroid hormones have an important role in the regulation of the cardiovascular system. The aim of this study was to investigate the presence of subclinical myocardial dysfunction in children with euthyroid Hashimoto’s thyroiditis (eHT) without evident heart disease using tissue doppler imaging (TDI) and speckle tracking echocardiography (STE) methods. Methods TDI and STE were peformed in 50 children with eHT and in 35 healthy children. To assess myocardial velocities and time intervals, including peak systolic velocity (Sm), peak early diastolic velocity (Em), peak late diastolic velocity (Am), isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT) and ejection time (ET), TDI was performed at the base of the interventricular septum (IVS) and in the left and right ventricles (LV and RV, respectively). Analysis of myocardial deformation by STE including strain (S) and strain rate (SR) was performed globally in two planes, longitudinal (L) and mid-circumferential (C) in LV [LV global longitudinal strain (LVGLS), LV global longitudinal strain rate (LVGLSR), LV global circumferential strain (LVGCS), LV global circumferential strain rate (LVGCSR)] and RV [(RV global longitudinal strain (RVGLS), RV global longitudinal strain rate (RVGLSR)]. Results Among TDI parameters, ET at LV and IVS were significantly lower, IVRT and myocardial performance index at LV and IVS were significantly higher in the eHT group compared to controls (p=0.001). There were no significant differences in Sm, Em, Am and IVCT values between patients and controls. LVGLS, LVGLSR, LVGCS and LVGCSR values were significantly lower in patients than controls (p=0.01). There was a negative correlation between thyroid antibody levels and LV global longitudinal and circumferential strain and strain rate values (TPO-Ab and Tg-Ab between LVGLS, LVGLSR, LVGCS and LVGCSR; r=-411, p<0.001; r=-541, p<0.001; r=-430, p<.0.001; r=-502, r<0.01 and r=-397, p<0.001; r=-473, p<0.001; r=-519, p<0.001; r=-421, p<0.00, respectively). Conclusion The results show that myocardial function in children with eHT is impaired in the absence of any clinical symptoms and that conventional echocardiography is inadequate to determine these changes.
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Affiliation(s)
- Emine Azak
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Seyit Ahmet Uçaktürk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - İbrahim İlker Çetin
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Hazım Alper Gürsu
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
| | - Eda Mengen
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Utku Pamuk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Clinic of Pediatric Cardiology, Ankara, Turkey
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Swat SA, Cohen D, Shah SJ, Lloyd-Jones DM, Baldridge AS, Freed BH, Vorovich EE, Yancy CW, Jonnalagadda SR, Prenner S, Kim D, Wilcox JE. Baseline Longitudinal Strain Predicts Recovery of Left Ventricular Ejection Fraction in Hospitalized Patients With Nonischemic Cardiomyopathy. J Am Heart Assoc 2019; 7:e09841. [PMID: 30371257 PMCID: PMC6474980 DOI: 10.1161/jaha.118.009841] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Heart failure (HF) with “recovered” ejection fraction (HFrecEF) is an emerging phenotype, but no tools exist to predict ejection fraction (EF) recovery in acute HF. We hypothesized that indices of baseline cardiac structure and function predict HFrecEF in nonischemic cardiomyopathy and reduced EF. Methods and Results We identified a nonischemic cardiomyopathy cohort with EF<40% during the first HF hospitalization (n=166). We performed speckle‐tracking echocardiography to measure longitudinal, circumferential, and radial strain, and the average of these measures (myocardial systolic performance). HFrecEF was defined as follow‐up EF ≥40% and ≥10% improvement from baseline EF. Fifty‐nine patients (36%) achieved HFrecEF (baseline EF 26±7%; follow‐up EF 51±7%) within a median of 135 (interquartile range 58‐239) days after the first HF hospitalization. Baseline demographics, biomarker profiles, and comorbid conditions (except lower chronic kidney disease in HFrecEF) were similar between HFrecEF and persistent reduced‐EF groups. HFrecEF patients had smaller baseline left ventricular end‐systolic dimension (3.6 versus 4.8 cm; P<0.01), higher baseline myocardial systolic performance (9.2% versus 8.1%; P=0.02), and improved survival (adjusted hazard ratio 0.27, 95% confidence interval 0.11, 0.62). We found a significant interaction between baseline left ventricular end‐systolic dimension and absolute longitudinal strain. Among patients with left ventricular end‐systolic dimension >4.35 cm, higher absolute longitudinal strain (≥8%) was associated with HFrecEF (unadjusted odds ratio=3.9, 95% CI)confidence interval 1.2, 12.8). Incorporation of baseline indices of cardiac mechanics with clinical variables resulted in a predictive model for HFrecEF with c‐statistic=0.85. Conclusions Factors associated with achieving HFrecEF were specific to cardiac structure and indices of cardiac mechanics. Higher baseline absolute longitudinal strain is associated with HFrecEF among nonischemic cardiomyopathy patients with reduced EF and larger left ventricular dimensions.
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Affiliation(s)
- Stanley A Swat
- 1 Department of Medicine Northwestern University Chicago IL
| | - David Cohen
- 5 Division of Cardiology University of Michigan Ann Arbor MI
| | - Sanjiv J Shah
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Donald M Lloyd-Jones
- 2 Department of Preventative Medicine Northwestern University Chicago IL.,4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Benjamin H Freed
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Esther E Vorovich
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Clyde W Yancy
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Stuart Prenner
- 6 Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Daniel Kim
- 3 Department of Radiology Northwestern University Chicago IL
| | - Jane E Wilcox
- 2 Department of Preventative Medicine Northwestern University Chicago IL.,4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
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30
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Guan Z, Liu S, Wang Y, Meng P, Zheng X, Jia D, Yang J, Ma C. Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction. Echocardiography 2019; 36:1825-1833. [PMID: 31573711 DOI: 10.1111/echo.14496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS Left ventricular diastolic dysfunction (LVDD) is considered a key factor associated with heart failure (HF) symptoms in patients with preserved ejection fraction (HFpEF). However, LV systolic performance, including LV systolic function and synchrony, has not been well characterized in these patients. The aims of this study were to assess to investigate the underlying relationship and differences between subclinical LVDD and HFpEF. METHODS Eighty-six patients with LVDD were recruited (58 with HFpEF and 28 with subclinical LVDD). Systolic left ventricular (LV) longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te-SD and Ts-SD) were calculated. Forty age- and sex-matched healthy individuals were enrolled as a control group. RESULTS LV global LS and LSrS were decreased in patients with HFpEF than in normal controls and subclinical LVDD patients (P < .05). Te-SD and Ts-SD were significantly more prolonged in subclinical LVDD and HFpEF patients than in the control group (P < .05). Reduced LS was associated with HF symptoms in LVDD patients, and a cutoff value of -18% for LS could differentiate HFpEF from subclinical LVDD with 73% sensitivity and 69% specificity. CONCLUSION LV systolic function and mechanical dyssynchrony were impaired in HFpEF patients. Deteriorated LV longitudinal systolic function was likely correlated with the symptoms of HFpEF.
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Affiliation(s)
- Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pingping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xianfeng Zheng
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Dalin Jia
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
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31
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Olver TD, Edwards JC, Jurrissen TJ, Veteto AB, Jones JL, Gao C, Rau C, Warren CM, Klutho PJ, Alex L, Ferreira-Nichols SC, Ivey JR, Thorne PK, McDonald KS, Krenz M, Baines CP, Solaro RJ, Wang Y, Ford DA, Domeier TL, Padilla J, Rector RS, Emter CA. Western Diet-Fed, Aortic-Banded Ossabaw Swine: A Preclinical Model of Cardio-Metabolic Heart Failure. JACC Basic Transl Sci 2019; 4:404-421. [PMID: 31312763 PMCID: PMC6610000 DOI: 10.1016/j.jacbts.2019.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
The development of new treatments for heart failure lack animal models that encompass the increasingly heterogeneous disease profile of this patient population. This report provides evidence supporting the hypothesis that Western Diet-fed, aortic-banded Ossabaw swine display an integrated physiological, morphological, and genetic phenotype evocative of cardio-metabolic heart failure. This new preclinical animal model displays a distinctive constellation of findings that are conceivably useful to extending the understanding of how pre-existing cardio-metabolic syndrome can contribute to developing HF.
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Key Words
- AB, aortic-banded
- CON, control
- EDPVR, end-diastolic pressure−volume relationship
- EF, ejection fraction
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IL1RL1, interleukin 1 receptor-like 1
- LV, left ventricle
- NF, nuclear factor
- PTX3, pentraxin-3
- WD, Western Diet
- cardio-metabolic disease
- heart failure
- integrative pathophysiology
- preclinical model of cardiovascular disease
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Affiliation(s)
- T. Dylan Olver
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Jenna C. Edwards
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Thomas J. Jurrissen
- Department of Nutrition and Exercise Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Adam B. Veteto
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - John L. Jones
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Chen Gao
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Christoph Rau
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Chad M. Warren
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, Illinois
| | - Paula J. Klutho
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Linda Alex
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | | | - Jan R. Ivey
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Pamela K. Thorne
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
| | - Kerry S. McDonald
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Maike Krenz
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Christopher P. Baines
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - R. John Solaro
- Department of Physiology and Biophysics, Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, Illinois
| | - Yibin Wang
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David A. Ford
- Department of Biochemistry and Molecular Biology and Center for Cardiovascular Research, Saint Louis University- School of Medicine, St. Louis, Missouri
| | - Timothy L. Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, Missouri
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri-Columbia, Columbia, Missouri
- Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
- Department of Child Health, University of Missouri-Columbia, Columbia, Missouri
| | - R. Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri-Columbia, Columbia, Missouri
- Department of Medicine – University of Missouri-Columbia, Columbia, Missouri
- Research Service, Harry S Truman Memorial VA Hospital, University of Missouri-Columbia, Columbia, Missouri
| | - Craig A. Emter
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, Missouri
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Graham-Brown M, Gulsin G, Parke K, Wormleighton J, Lai F, Athithan L, Arnold J, Burton J, McCann G, Singh A. A comparison of the reproducibility of two cine-derived strain software programmes in disease states. Eur J Radiol 2019; 113:51-58. [DOI: 10.1016/j.ejrad.2019.01.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
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Vdovenko DV, Libis RA. Assessment of the functional state of left heart in patients with chronic heart failure with preserved ejection fraction. ACTA ACUST UNITED AC 2019. [DOI: 10.15829/1560-4071-2019-2-26-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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34
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White RD, Kirsch J, Bolen MA, Batlle JC, Brown RK, Eberhardt RT, Hurwitz LM, Inacio JR, Jin JO, Krishnamurthy R, Leipsic JA, Rajiah P, Shah AB, Singh SP, Villines TC, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure. J Am Coll Radiol 2018; 15:S418-S431. [DOI: 10.1016/j.jacr.2018.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/21/2022]
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35
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Liu S, Guan Z, Jin X, Meng P, Wang Y, Zheng X, Jia D, Ma C, Yang J. Left ventricular diastolic and systolic dyssynchrony and dysfunction in heart failure with preserved ejection fraction and a narrow QRS complex. Int J Med Sci 2018; 15:108-114. [PMID: 29333094 PMCID: PMC5765723 DOI: 10.7150/ijms.21956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/12/2017] [Indexed: 12/17/2022] Open
Abstract
Aims: Mechanical dyssynchrony has been reported in heart failure with preserved ejection fraction (HFpEF), with a majority of patients having a narrow QRS complex; however, whether any benefit is observed with restoration of dyssynchrony remains unclear. We sought to assess left ventricular (LV) dyssynchrony and function in HFpEF and elucidate the underlying mechanisms that may account for HFpEF. Methods: Seventy-eighty patients with a narrow QRS complex including 47 with HFpEF, 31 with heart failure with reduced ejection fraction (HFrEF) patients, and 29 with asymptomatic left ventricular diastolic dysfunction (LVDD) were recruited. Forty-five normal subjects acted as controls. Systolic LV longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te-SD and Ts-SD) were calculated. Results: Te-SD and Ts-SD were prolonged in HFpEF and HFrEF patients than in the control group (p<0.05). However, Ts-SD was shorter in HFpEF patients compared to HFrEF patients despite a narrow QRS complex (p<0.05). LV global LS, LSrS, and LSrE were decreased in patients with HFpEF and HFrEF compared to other groups, with HFrEF being even more reduced than HFpEF (p<0.05). Reduced LS, LSrS, and LSrE could effectively differentiate HF from asymptomatic LVDD patients (p<0.05). Conclusion: HFrEF exhibited increased systolic dyssynchrony compared to HFpEF despite a narrow QRS complex in addition to the more reduced diastolic and systolic function. Therefore, targeting to improve diastolic and systolic function instead of managing systolic dyssynchrony might be of great importance in the treatment of HFpEF.
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Affiliation(s)
- Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Xuanyi Jin
- Department of Cardiology, Mayo Clinic (Arizona), Scottsdale, Arizona, United States, 85259
| | - Pingping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Xianfeng Zheng
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Dalin Jia
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China, 110001
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Hammami R, Boudabbous M, Jdidi J, Trabelsi F, Mroua F, Kallel R, Amouri A, Abid D, Tahri N, Abid L, Kammoun S. Cirrhotic cardiomyopathy: is there any correlation between the stage of cardiac impairment and the severity of liver disease? Libyan J Med 2017; 12:1283162. [PMID: 28245727 PMCID: PMC5345598 DOI: 10.1080/19932820.2017.1283162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/12/2017] [Indexed: 02/08/2023] Open
Abstract
Cirrhotic cardiomyopathy is associated with poor prognosis and risk of acute heart failure after liver transplantation or interventional procedures. We aimed to assess the relationship between the severity of cardiac impairment and hepatic disease. Eighty patients and eighty controls underwent echocardiography, tissue Doppler imaging and speckle tracking measures. We assess the correlation between echocardiographic parameters and Child and MELD scores. Systolic parameters function (s wave, p < 0.001) and global longitudinal strain (p < 0.001) as well as diastolic parameters were significantly more impaired in cirrhotic patients compared to controls. There were no differences among the different groups in 'Child score' regarding systolic function as well as diastolic function. Paradoxically, the left atrium size correlated positively to both Child (p = 0.01, r = 0.26) and MELD scores (p = 0.02, r = 0.24). Left ventricular ejection fraction was significantly lower in decompensated patients as compared to compensated patients(p = 0.02).. We did not identify any association between severity of liver disease and cardiac dysfunction. Therefore, a transthoracic echocardiography should be performed in all cirrhotic patients before interventional and surgical procedures regardless of the severity of liver disease.
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Affiliation(s)
- Rania Hammami
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | | | - Jihen Jdidi
- Epidemiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Fatma Trabelsi
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Fakher Mroua
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Rahma Kallel
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Ali Amouri
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Dorra Abid
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Nabil Tahri
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Leila Abid
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Samir Kammoun
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
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Armstrong AC, Muller M, Ambale-Ventakesh B, Halstead M, Kishi S, Bryan N, Sidney S, Correia LCL, Gidding SS, Launer LJ, Lima JA. Association of early left ventricular dysfunction with advanced magnetic resonance white matter and gray matter brain measures: The CARDIA study. Echocardiography 2017; 34:1617-1622. [PMID: 29114921 PMCID: PMC5718174 DOI: 10.1111/echo.13695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Relations between heart failure and clinically manifested stroke are well known, but the associations between heart and brain early abnormalities are not totally clear. AIMS We explore relations of subclinical brain abnormalities with early cardiac dysfunction in a large healthy middle-aged biracial cohort. METHODS The CARDIA study enrolled 5115 young adults aged 18-30 years at baseline (1985-1986). We assessed 719 Caucasian and African American participants of the CARDIA study, with echocardiograms and brain MRI at follow-up year 25 (2010-2011). Echocardiography assessed aortic root diameter; LVEF; circumferential, longitudinal, and radial deformation. Cerebral MRI DTI, and, on a subset, ASL perfusion sequences were used to assess white matter fractional anisotropy and gray matter cerebral blood flow (CBF). Linear regression explored relations between cardiac parameters and cerebral measures, adjusting for anthropometrics, risk factors, and brain constitutional variation. RESULTS Mean age 50 ± 4 years, SBP 118 ± 15 mm Hg; 60% white, and 48% men. Mean CBF was 46 ± 9 mL/100 g/min, and white matter fractional anisotropy was 0.31 ± 0.02. Worse circumferential deformation and larger aortic root were related to worse white matter fractional anisotropy. Worse radial systolic deformation was related to worse CBF in multivariable models. LVEF did not relate to early brain abnormalities. CONCLUSIONS In spite of no apparent effect of LV ejection fraction, early subclinical cardiac dysfunction and brain abnormalities are present and associated in middle-aged generally healthy individuals.
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Affiliation(s)
- Anderson C. Armstrong
- Johns Hopkins University, Baltimore, MD
- Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil
| | | | | | | | | | - Nick Bryan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Stephen Sidney
- Health System Kaiser Permanente Northern California Division of Research, Oakland, CA
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Kruzliak P, Berezin A, Kremzer A, Samura T, Benacka R, Mozos I, Egom E, Rodrigo L. Global Longitudinal Strain and Strain Rate in Type Two Diabetes Patients with Chronic Heart Failure: Relevance to Osteoprotegerin. Folia Med (Plovdiv) 2017; 58:164-173. [PMID: 27760011 DOI: 10.1515/folmed-2016-0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Biomechanical stress and inflammatory biomarkers relate to global contractility dysfunction; however, adding these biomarkers into a risk model constructed on clinical data does not improve its prediction value in chronic heart failure (CHF). AIM The aim of this study was to evaluate whether biomarkers predict declining of left ventricular global contractility function in diabetic patients with ischemia-induced CHF. PATIENTS AND METHODS The study retrospectively evolved 54 diabetic patients who had systolic or diastolic ischemia-induced CHF that was defined as left-ventricular ejection fraction (LVEF) ≤45% or 46-55% respectively assessed by quantitative echocardiography and other conventional criteria according to current clinical guidelines. Two-dimensional transthoracic echocardiography and tissue Doppler imaging were performed according to a conventional method. Radial, longitudinal, and circumferential strain and strain rate values were obtained by speckle-tracking Imaging analysis of both LV short axis and long axis views. Serum adiponectin, NT-pro brain natriuretic peptide (BNP), osteoprotegerin, and hs- C-reactive protein (CRP) were determined at baseline by ELISA. RESULTS We found lower global longitudinal strain and strain rate in diabetic patients with LVEF <45% than these in diabetic patients that did not have LVEF (Р=0.001 for all cases). Multivariate logistic regression analysis showed that NT-proBNP (r=0.432; P=0.001 and r=0.402; P=0.001, respectively), osteoprotegerin (r=0.422; P=0.001 and r=0.401; P=0.001, respectively), hs-CRP (r=0.408; P=0.001 and r=0.404; P=0.001, respectively) were independently inversely associated with global longitudinal strain and strain rate in CHF patients. CONCLUSION We suggest that osteoprotegerin may be useful in improving the NT-proBNP based model as predictor of decreased global contractility function in diabetic patients with CHF.
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Affiliation(s)
- Peter Kruzliak
- Laboratory of Structural Biology and Proteomics, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Alexander Berezin
- Department of Internal Medicine, State Medical University, Zaporozhye, Ukraine
| | - Alexander Kremzer
- Department of Clinical Pharmacology, State Medical University, Zaporozhye, Ukraine
| | - Tatyana Samura
- Department of Clinical Pharmacology, State Medical University, Zaporozhye, Ukraine
| | | | - Ioana Mozos
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timișoara, Romania
| | - Emmanuel Egom
- Department of Clinical Medicine, Education Division, Trinity College, University of Dublin, Dublin, Ireland
| | - Luis Rodrigo
- Central University Hospital of Asturia, University of Oviedo, Oviedo, Spain
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Wisotzkey BL, Jorgensen NW, Albers EL, Kemna MS, Boucek RJ, Kronmal RA, Law YM, Bhat AH. Feasibility and interpretation of global longitudinal strain imaging in pediatric heart transplant recipients. Pediatr Transplant 2017; 21. [PMID: 28295946 DOI: 10.1111/petr.12909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/07/2023]
Abstract
Evaluation of myocardial mechanics after heart transplant is important in monitoring allograft function and identifying rejection. Speckle tracking global longitudinal strain (GLS) may be more sensitive to early regional changes from rejection. This study aimed to determine feasibility of GLS in pediatric hearts during surveillance echocardiograms, compare their GLS to published norms (-18% to -22%), and assess association of GLS with other indices of graft function. Retrospective review of transplant echocardiograms from 2013 to 2014. Philips QLAB was used for post-acquisition GLS analysis. Multiple linear regression was used to assess the association of GLS with echocardiographic/catheterization indices, and B-type natriuretic peptide (BNP). Forty-seven patients (84 studies) were included. Calculation of GLS was feasible in 82 studies (97%) with inter- and intra-observer variability of 0.71 and 0.69. Patients (n=9) with rejection had GLS of -16.4% (SD=3.5%) compared to those without [-16.8% (SD=3.7%)]. GLS worsened linearly with increasing Ln(BNP) (P=<.001), left ventricular volume in diastole (P=<.001), septal a' wave (P=<.001), and pulmonary capillary wedge pressure (P=<.001). Speckle tracking-based GLS is feasible and reproducible in pediatric heart recipients and is reduced at baseline. The role of GLS and BNP in detecting early systolic dysfunction warrants further investigation.
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Affiliation(s)
- Bethany L Wisotzkey
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Neal W Jorgensen
- Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Erin L Albers
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Mariska S Kemna
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Robert J Boucek
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Richard A Kronmal
- Division of Biostatistics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Yuk M Law
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Aarti H Bhat
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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Parwani AS, Morris DA, Blaschke F, Huemer M, Pieske B, Haverkamp W, Boldt LH. Left atrial strain predicts recurrence of atrial arrhythmias after catheter ablation of persistent atrial fibrillation. Open Heart 2017; 4:e000572. [PMID: 28674624 PMCID: PMC5471873 DOI: 10.1136/openhrt-2016-000572] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/09/2017] [Accepted: 03/07/2017] [Indexed: 12/24/2022] Open
Abstract
Introduction Success rates of catheter ablation (CA) of persistent atrial fibrillation (AF) are very variable. Identifying patients in whom sinus rhythm maintenance cannot be achieved after CA is a critical issue. Methods 2D speckle-tracking echocardiography was performed before the first CA procedure in consecutive patients with persistent AF. Left atrial (LA) strain was correlated with recurrence of atrial arrhythmias during the follow-up period of 15 months after one CA procedure with or without antiarrhythmic drugs (primary endpoint). In a secondary analysis, recurrences after two CA procedures were analysed. Results 102 patients were included. Patients with recurrence of atrial arrhythmias after one CA procedure (n=55) had significantly lower LA strain than those without recurrence (LA strain 9.7±2.4% vs 16.2±3.0%; p<0.001). Recurrence rate was significantly higher in patients with LA strain <10% than in those with LA strain between 10% and 14.5% and >14.5% (97.7%, 42.1% and 10.3%, respectively; p<0.001). In Cox regression analysis including age, comorbidities, left ventricular dysfunction and LA enlargement, low LA strain (<10%) was the strongest factor associated with recurrence of AF (HR 6.4 (2.4–16.9), p<0.001). Even after inclusion of a second CA procedure, LA strain <10% maintained a high predictive value for recurrence of atrial arrhythmias (86.4% (95% CI 73.3% to 93.6%)). Conclusion In patients with persistent AF, LA strain imaging could be very useful to select those patients who have a high risk of not benefiting from CA.
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Affiliation(s)
| | | | - Florian Blaschke
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Assessing hemodynamics noninvasively in patients with heart failure. Curr Opin Cardiol 2016; 31:493-500. [PMID: 27258534 DOI: 10.1097/hco.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Describe the contemporary assessment of cardiac hemodynamics using a comprehensive echo-Doppler examination in the heart failure (HF) patient. RECENT FINDINGS Cardiac flow and filling pressures, on both the left and right sides of the heart, are fundamental to the accurate assessment of the HF patient. Accurate assessment of left ventricular (LV) and right ventricular (RV) systolic and diastolic function is necessary to establish, or exclude, HF as a cause or component of dyspnea in a given patient and to help determine causes of hemodynamic instability in HF patients. Variables such as spectral Doppler (mitral and tricuspid inflow, pulmonary and hepatic venous flow, and pulmonary valve regurgitation signal), tissue Doppler imaging, and speckle tracking, applied to the left and right heart, can help to accurately estimate cardiac hemodynamics. SUMMARY A comprehensive echocardiogram with Doppler can provide an accurate assessment of left and right heart hemodynamics that is fundamental to the assessment and management of the HF patient.
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Hiemstra JA, Lee DI, Chakir K, Gutiérrez-Aguilar M, Marshall KD, Zgoda PJ, Cruz Rivera N, Dozier DG, Ferguson BS, Heublein DM, Burnett JC, Scherf C, Ivey JR, Minervini G, McDonald KS, Baines CP, Krenz M, Domeier TL, Emter CA. Saxagliptin and Tadalafil Differentially Alter Cyclic Guanosine Monophosphate (cGMP) Signaling and Left Ventricular Function in Aortic-Banded Mini-Swine. J Am Heart Assoc 2016; 5:e003277. [PMID: 27098966 PMCID: PMC4843537 DOI: 10.1161/jaha.116.003277] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cyclic guanosine monophosphate-protein kinase G-phosphodiesterase 5 signaling may be disturbed in heart failure (HF) with preserved ejection fraction, contributing to cardiac remodeling and dysfunction. The purpose of this study was to manipulate cyclic guanosine monophosphate signaling using the dipeptidyl-peptidase 4 inhibitor saxagliptin and phosphodiesterase 5 inhibitor tadalafil. We hypothesized that preservation of cyclic guanosine monophosphate cGMP signaling would attenuate pathological cardiac remodeling and improve left ventricular (LV) function. METHODS AND RESULTS We assessed LV hypertrophy and function at the organ and cellular level in aortic-banded pigs. Concentric hypertrophy was equal in all groups, but LV collagen deposition was increased in only HF animals. Prevention of fibrotic remodeling by saxagliptin and tadalafil was correlated with neuropeptide Y plasma levels. Saxagliptin better preserved integrated LV systolic and diastolic function by maintaining normal LV chamber volumes and contractility (end-systolic pressure-volume relationship, preload recruitable SW) while preventing changes to early/late diastolic longitudinal strain rate. Function was similar to the HF group in tadalafil-treated animals including increased LV contractility, reduced chamber volume, and decreased longitudinal, circumferential, and radial mechanics. Saxagliptin and tadalafil prevented a negative cardiomyocyte shortening-frequency relationship observed in HF animals. Saxagliptin increased phosphodiesterase 5 activity while tadalafil increased cyclic guanosine monophosphate levels; however, neither drug increased downstream PKG activity. Early mitochondrial dysfunction, evident as decreased calcium-retention capacity and Complex II-dependent respiratory control, was present in both HF and tadalafil-treated animals. CONCLUSIONS Both saxagliptin and tadalafil prevented increased LV collagen deposition in a manner related to the attenuation of increased plasma neuropeptide Y levels. Saxagliptin appears superior for treating heart failure with preserved ejection fraction, considering its comprehensive effects on integrated LV systolic and diastolic function.
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Affiliation(s)
- Jessica A Hiemstra
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Dong I Lee
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Khalid Chakir
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Manuel Gutiérrez-Aguilar
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Kurt D Marshall
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Pamela J Zgoda
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Noelany Cruz Rivera
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Daniel G Dozier
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Brian S Ferguson
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | | | | | - Carolin Scherf
- Department of Veterinary Pathobiology, University of Missouri-Columbia, Columbia, MO
| | - Jan R Ivey
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | | | - Kerry S McDonald
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO
| | - Christopher P Baines
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Maike Krenz
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Timothy L Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO
| | - Craig A Emter
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
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Meng S, Guo L, Li G. Early changes in right ventricular longitudinal function in chronic asymptomatic alcoholics revealed by two-dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2016; 14:16. [PMID: 27094037 PMCID: PMC4837624 DOI: 10.1186/s12947-016-0058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart ventricular dysfunction has been characterized as reduced longitudinal function of the right ventricle (RV), and is associated with chronic alcohol abuse. This study investigated the use of two-dimensional speckle tracking echocardiography (2DSTE) to assess the longitudinal systolic and diastolic RV function of patients with alcoholic myocardial damage. METHODS We stratified 92 asymptomatic alcoholic men into three groups of increasing alcohol intake, Groups A-C. Thirty age-matched normal adult men served as the control group. Conventional echocardiography and tricuspid annulus peak systolic excursion (TAPSE) parameters were obtained. 2DSTE parameters were recorded from an apical 4-chamber view of the RV free wall. LV peak global longitudinal systolic strain was calculated from segmental averaging of the three apical long-axis views. RESULTS In Group C, the RV end diastolic diameter (RVEDD) was dramatically higher than that of Groups A, B and the control, while TAPSE was significantly lower in Group C compared with the other experimental groups. In Group B, the longitudinal early diastolic strain rate (SRe) and late diastolic strain rate (SRa) of the RV free wall, and LV longitudinal strain were significantly lower than that of Group A or the control. In Group C, all the 2DSTE parameters were significantly lower than that of the other groups. A significant negative linear correlation was noted between global RV systolic parameters systolic strain peak (S), peak systolic strain rate (SRs) and TAPSE (r1=-0.84, r2=-0.72, respectively, P <0.05). CONCLUSIONS Two-dimensional STE provided an effective and non-invasive method to assess the RV longitudinal function of patients with alcoholic myocardial damage. This methodology may be useful for diagnosing, directing treatment, and judging prognosis of alcoholic cardiac damage.
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Affiliation(s)
- Sisi Meng
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Lijuan Guo
- Department of Echocardiography, Liaoning Provincial People's Hospital, Shenyang, 110000, China
| | - Guangsen Li
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China.
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Todaro MC, Khandheria BK, Longobardo L, Zito C, Cusmà-Piccione M, Di Bella G, Oreto L, Mohammed M, Oreto G, Carerj S. New diagnostic perspectives on heart failure with preserved ejection fraction: systolic function beyond ejection fraction. J Cardiovasc Med (Hagerstown) 2016; 16:527-37. [PMID: 25469729 DOI: 10.2459/jcm.0000000000000199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although preserved ejection fraction is found in more than 50% of patients with heart failure, its acceptance as a specific clinical entity is limited. More understanding of the physiopathology, early diagnosis and medical management is needed. With no existing systematic information in the literature, the aim of this review is to provide a comprehensive overview of the new imaging techniques for diagnosing heart failure with preserved ejection fraction, particularly in the early stages of the disease, underlying the pivotal role of new technologies such as two-dimensional speckle tracking echocardiography and vascular stiffness.
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Affiliation(s)
- Maria Chiara Todaro
- aClinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
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Smith SP, Secomb TW, Hong BD, Moulton MJ. Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8957307. [PMID: 27042673 PMCID: PMC4794589 DOI: 10.1155/2016/8957307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/11/2016] [Accepted: 01/24/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects. METHODS Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded. RESULTS Peak longitudinal and circumferential strain was globally reduced in patients (p < 0.001), when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p < 0.001). LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p < 0.001). CONCLUSIONS This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains.
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Affiliation(s)
- Shane P. Smith
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Timothy W. Secomb
- Department of Physiology, University of Arizona, Tucson, AZ 85724, USA
- Program in Applied Mathematics, University of Arizona, Tucson, AZ 85721, USA
| | - Brian D. Hong
- Program in Applied Mathematics, University of Arizona, Tucson, AZ 85721, USA
| | - Michael J. Moulton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Chan YH, Lee HF, Wu LS, Wang CL, Wu CT, Yeh YH, Ho YWJ, Hsu LA, Chu PH, Kuo CT. Ratio of transmitral early filling velocity to early diastolic strain rate predicts outcomes in patients with systolic heart failure. Eur Heart J Cardiovasc Imaging 2016; 18:79-85. [DOI: 10.1093/ehjci/jew015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/15/2016] [Indexed: 11/12/2022] Open
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Wu WC, Ma H, Xie RA, Gao LJ, Tang Y, Wang H. Evaluation of Left Ventricular Diastolic Dysfunction with Early Systolic Dysfunction Using Two-Dimensional Speckle Tracking Echocardiography in Canine Heart Failure Model. Echocardiography 2015; 33:618-27. [PMID: 26661342 DOI: 10.1111/echo.13133] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This study evaluated the role of two-dimensional speckle tracking echocardiography (2DSTE) for predicting left ventricular (LV) diastolic dysfunction in pacing-induced canine heart failure. METHODS Pacing systems were implanted in 8 adult mongrel dogs, and continuous rapid right ventricular pacing (RVP, 240 beats/min) was maintained for 2 weeks. The obtained measurements from 2DSTE included global strain rate during early diastole (SRe) and during late diastole (SRa) in the longitudinal (L-SRe, L-SRa), circumferential (C-SRe, C-SRa), and radial directions (R-SRe, R-SRa). Changes in heart morphology were observed by light microscopy and transmission electron microscopy at 2 weeks. RESULTS The onset of LV diastolic dysfunction with early systolic dysfunction occurred 3 days after RVP initiation. Most of the strain rate imaging indices were altered at 1 or 3 days after RVP onset and continued to worsen until heart failure developed. Light and transmission electron microscopy showed myocardial vacuolar degeneration and mitochondrial swelling in the left ventricular at 2 weeks after RVP onset. Pearson's correlation analysis revealed that parameters of conventional echocardiography and 2DSTE showed moderate correlation with LV pressure parameters, including E/Esep' (r = 0.58, P < 0.01), L-SRe (r = -0.58, P < 0.01), E/L-SRe (r = 0.65, P < 0.01), and R-SRe (r = 0.53, P < 0.01). ROC curves analysis showed that these indices of conventional echocardiography and strain rate imaging could effectively predict LV diastolic dysfunction (area under the curve: E/Esep' 0.78; L-SRe 0.84; E/L-SRe 0.80; R-SRe 0.80). CONCLUSION 2DSTE was a sensitive and accurate technique that could be used for predicting LV diastolic dysfunction in canine heart failure model.
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Affiliation(s)
- Wei-Chun Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Ma
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Echocardiography, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rong-Ai Xie
- Department of Cardiology, Peking University Shougang Hospital, Beijing, China
| | - Li-Jian Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Tang
- The Animal Experimental Center of Fuwai Hospital, Beijing, China
| | - Hao Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chivite D, Franco J, Formiga F. [Chronic heart failure in the elderly patient]. Rev Esp Geriatr Gerontol 2015; 50:237-246. [PMID: 25962334 DOI: 10.1016/j.regg.2015.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
The prevalence and incidence of heart failure (HF) is increasing, especially in the elderly population, and is becoming a major geriatric problem. Elderly patients with HF usually show etiopathogenic, epidemiological, and even clinical characteristics significantly different from those present in younger patients. Their treatment, however, derives from clinical trials performed with only a few elderly subjects. Moreover, beyond the cardiovascular disease itself, it is essential to evaluate the patient as a whole, given the interrelationship between HF and the characteristic geriatric syndromes of the elderly patient. This review examines the peculiarities in the most prevalent "real world" HF patient.
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Affiliation(s)
- David Chivite
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Jhonatan Franco
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, Liu L, Pitt B, Pfeffer MA, Solomon SD. Prognostic Importance of Impaired Systolic Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circulation 2015; 132:402-14. [PMID: 26130119 PMCID: PMC4526442 DOI: 10.1161/circulationaha.115.015884] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Impairment in left ventricular systolic function has been described in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic relevance is not known. We determined whether left ventricular longitudinal strain (LS) is predictive of cardiovascular outcomes in HFpEF beyond clinical and conventional echocardiographic measures. METHODS AND RESULTS LS was assessed by 2-dimensional speckle-tracking echocardiography at baseline in 447 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. At a median follow-up of 2.6 years (interquartile range, 1.5-3.9 years), 115 patients experienced the primary composite outcome of cardiovascular death, HF hospitalization, or aborted cardiac arrest. Impaired LS, defined as an absolute LS <15.8%, was present in 52% of patients and was predictive of the composite outcome (adjusted hazard ratio, 2.14; 95% confidence interval, 1.26-3.66; P=0.005), cardiovascular death alone (adjusted hazard ratio, 3.20; 95% confidence interval, 1.44-7.12; P=0.004), and HF hospitalization alone (adjusted hazard ratio, 2.23; 95% confidence interval, 1.16-4.28; P=0.016) after adjustment for clinical and conventional echocardiographic variables. LS was the strongest echocardiographic predictor of the composite outcome. Exploratory analysis in a subset of 131 patients with follow-up LS assessed after 12 to 18 months demonstrated a trend toward improvement in LS associated with spironolactone in patients enrolled in the Americas but not in Russia or Georgia. CONCLUSIONS Impaired left ventricular systolic function is a powerful predictor of HF hospitalization, cardiovascular death, or aborted cardiac arrest in HFpEF independent of clinical predictors. Impaired LS represents a novel imaging biomarker to identify patients with HFpEF at particularly high risk for cardiovascular morbidity and mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
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Affiliation(s)
- Amil M Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
| | - Brian Claggett
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Nancy K Sweitzer
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Sanjiv J Shah
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Inder S Anand
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Li Liu
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Bertram Pitt
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Marc A Pfeffer
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | - Scott D Solomon
- From Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., L.L., M.A.P., S.D.S.); Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.)
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Structural and functional cardiac analyses using modern and sensitive myocardial techniques in adult Pompe disease. Int J Cardiovasc Imaging 2015; 31:947-56. [PMID: 25744427 DOI: 10.1007/s10554-015-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/17/2015] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to analyze comprehensively the heart using modern and sensitive myocardial techniques in order to determine if structural or functional cardiac alterations are present in adult Pompe disease. Twelve patients with adult Pompe disease and a control group of 187 healthy subjects of similar age and gender were included. Structural and functional cardiac characteristics were analyzed by conventional and 2D speckle-tracking echocardiography. In addition, in a subgroup of adult Pompe patients, we analyzed the myocardial and musculoskeletal features by means of cardiac and whole-body muscle magnetic resonance imaging. Patients with Pompe disease had significant structural and functional musculoskeletal alterations such as atrophy with fatty replacement and weakness in trunk and extremities. In contrast, Pompe patients had similar structural and functional myocardial features to healthy subjects (LV strain -20.7 ± 1.9 vs. -21.3 ± 2.1%; RV strain -24.2 ± 5.3 vs. -24.8 ± 3.8%; LA strain 41.5 ± 10.3 vs. 44.8 ± 11.0%; P > 0.05; and no evidence of LV and RV hypertrophy or LA enlargement). In addition, there was no evidence of valvular cardiac alterations, electrocardiographic abnormalities, or myocardial fibrosis in Pompe patients. In the current study analyzing the heart with modern and sensitive myocardial techniques, we evidenced that functional and structural cardiac alterations are not present when Pompe disease begins in adulthood. Therefore, these findings suggest that adult Pompe disease should not be taken into consideration in the differential diagnostic of structural or functional cardiac disorders.
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