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Rastogi T, Gargani L, Pellicori P, Lamiral Z, Ambrosio G, Bayés-Genis A, Domingo M, Lupon J, Simonovic D, Pugliese NR, Ruocco G, Duarte K, Coiro S, Palazzuoli A, Girerd N. Prognostic implication of lung ultrasound in heart failure: a pooled analysis of international cohorts. Eur Heart J Cardiovasc Imaging 2024; 25:1216-1225. [PMID: 38606932 DOI: 10.1093/ehjci/jeae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Lung ultrasound (LUS) is often used to assess congestion in heart failure (HF). In this study, we assessed the prognostic role of LUS in patients with HF at admission and hospital discharge, and in an outpatient setting, and explored whether clinical factors [age, sex, left ventricular ejection fraction (LVEF), and atrial fibrillation] impact the prognostic value of LUS findings. Further, we assessed the incremental prognostic value of LUS on top of the following two clinical risk scores: (i) the atrial fibrillation, haemoglobin, elderly, abnormal renal parameters, diabetes mellitus (AHEAD) and (ii) the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) clinical risk scores. METHODS AND RESULTS We pooled data on patients hospitalized for HF or followed up in outpatient clinics from international cohorts. We enrolled 1947 patients at admission (n = 578), discharge (n = 389), and in outpatient clinics (n = 980). The total LUS B-line count was calculated for the eight-zone scanning protocol. The primary outcome was a composite of rehospitalization for HF and all-cause death. Compared with those in the lower tertiles of B lines, patients in the highest tertiles were older, more likely to have signs of HF and had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels. A higher number of B lines was associated with increased risk of primary outcome at discharge [Tertile 3 vs. Tertile 1: adjusted hazard ratio (HR): 5.74 (3.26-10.12), P < 0.0001] and in outpatients [Tertile 3 vs. Tertile 1: adjusted HR: 2.66 (1.08-6.54), P = 0.033]. Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to the MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings. CONCLUSION A higher number of B lines in patients with HF was associated with an increased risk of morbidity and mortality, regardless of the clinical setting.
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Affiliation(s)
- Tripti Rastogi
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Zohra Lamiral
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
| | - Giuseppe Ambrosio
- Department of Cardiology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Antoni Bayés-Genis
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Mar Domingo
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Josep Lupon
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Dejan Simonovic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | | | - Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, ASL CN-1, Mondovì, Cuneo, Italy
| | - Kevin Duarte
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
| | - Stefano Coiro
- Department of Cardiology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Cardio Thoracic and Vascular, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Nicolas Girerd
- Centre d'Investigation Clinique Pierre Drouin-INSERM-Unité mixte de recherche U1116 DCAC-CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, 4, rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France
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Gargani L, Girerd N, Platz E, Pellicori P, Stankovic I, Palazzuoli A, Pivetta E, Miglioranza MH, Soliman-Aboumarie H, Agricola E, Volpicelli G, Price S, Donal E, Cosyns B, Neskovic AN. Lung ultrasound in acute and chronic heart failure: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2023; 24:1569-1582. [PMID: 37450604 PMCID: PMC11032195 DOI: 10.1093/ehjci/jead169] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Paradisa 2 5614, Pisa, Italy
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Nancy, France
| | - Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ivan Stankovic
- Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Serbia
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Italy
| | - Emanuele Pivetta
- Medicina d'Urgenza-MECAU, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, Brazil
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Hatem Soliman-Aboumarie
- Department of Cardiothoracic Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, UK
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Susanna Price
- Departments of Cardiology & Intensive Care, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, Rennes, France
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
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3
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Coiro S, Echivard M, Simonovic D, Duarte K, Santos M, Deljanin-Ilic M, Kobayashi M, Ambrosio G, Girerd N. Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study. Clin Res Cardiol 2023:10.1007/s00392-023-02219-y. [PMID: 37210700 DOI: 10.1007/s00392-023-02219-y] [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: 02/26/2023] [Accepted: 04/27/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis. METHODS We studied two independent case-control studies of HFpEF patients and control subjects undergoing different exercise protocols: (i) submaximal exercise stress echocardiography (ESE) with LUS performed by expert cardiologists (N = 116, HFpEF = 65.5%), and (ii) maximal cycle ergometer test (CET) (N = 54, HFpEF = 50%) with LUS performed by unexperienced physicians shortly trained for the study. B-line kinetics (i.e. peak values and their changes from rest) were assessed. RESULTS In the ESE cohort, the C-index (95% CI) of peak B-lines for HFpEF diagnosis was 0.985 (0.968-1.000), whereas the C-index of rest and exercise HFA-PEFF scores (i.e. including stress echo findings) were < 0.90 (CI 0.823-0.949), and that of H2FPEF score was < 0.70 (CI 0.558-0.764). The C-index increase of peak B-lines on top of the above-mentioned scores was significant (C-index increase > 0.090 and P-value < 0.001 for all). Similar results were observed for change B-lines. Peak B-lines > 5 (sensitivity = 93.4%, specificity = 97.5%) and change B-lines > 3 (sensitivity = 94.7%, specificity = 87.5%) were the best cutoffs for HFpEF diagnosis. Adding peak or change B-lines on top of HFpEF scores and BNP significantly improved diagnostic accuracy. Peak B-lines showed a good diagnostic accuracy in the LUS beginner-led CET cohort (C-index = 0.713, 0.588-0.838). CONCLUSIONS Exercise LUS showed excellent diagnostic value for HFpEF diagnosis regardless of different exercise protocols/level of expertise, with additive diagnostic accuracy on top of available scores and natriuretic peptides.
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Affiliation(s)
- Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Mathieu Echivard
- Département de Cardiologie, CHRU de Nancy, 54500, Vandœuvre-lès-Nancy, France
| | - Dejan Simonovic
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | - Kevin Duarte
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Mario Santos
- Cardiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal
- ICBAS, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Marina Deljanin-Ilic
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | - Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
- CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
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Del Punta L, De Biase N, Armenia S, Di Fiore V, Maremmani D, Gargani L, Mazzola M, De Carlo M, Mengozzi A, Lomonaco T, Galeotti GG, Dini FL, Masi S, Pugliese NR. Combining cardiopulmonary exercise testing with echocardiography: a multiparametric approach to the cardiovascular and cardiopulmonary systems. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad021. [PMID: 39044798 PMCID: PMC11195726 DOI: 10.1093/ehjimp/qyad021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 07/25/2024]
Abstract
Exercise intolerance is a prominent feature of several cardiovascular conditions. However, the physical effort requires the intertwined adaptation of several factors, namely the cardiovascular system, the lungs, and peripheral muscles. Several abnormalities in each domain may be present in a given patient. Cardiopulmonary exercise testing (CPET) has been used to investigate metabolic and ventilatory alterations responsible for exercise intolerance but does not allow for direct evaluation of cardiovascular function. However, this can readily be obtained by concomitant exercise-stress echocardiography (ESE). The combined CPET-ESE approach allows for precise and thorough phenotyping of the pathophysiologic mechanisms underpinning exercise intolerance. Thus, it can be used to refine the diagnostic workup of patients with dyspnoea of unknown origin, as well as improve risk stratification and potentially guide the therapeutic approach in specific conditions, including left and right heart failure or valvular heart disease. However, given its hitherto sporadic use, both the conceptual and technical aspects of CPET-ESE are often poorly known by the clinician. Improving knowledge in this field could significantly aid in anticipating individual disease trajectories and tailoring treatment strategies accordingly. Therefore, we designed this review to revise the pathophysiologic correlates of exercise intolerance, the practical principles of the combined CPET-ESE examination, and its main applications according to current literature.
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Affiliation(s)
- Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Davide Maremmani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco De Carlo
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Tommaso Lomonaco
- Department of Chemistry and Industrial Chemistry, University of Pisa, Pisa, Italy
| | - Gian Giacomo Galeotti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Frank L Dini
- Istituto Auxologico IRCCS, Centro Medico Sant’Agostino, Milan, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
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5
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Coiro S, Huttin O, Kobayashi M, Lamiral Z, Simonovic D, Zannad F, Rossignol P, Girerd N. Validation of the MEDIA echo score for the prognosis of heart failure with preserved ejection fraction. Heart Fail Rev 2023; 28:453-464. [PMID: 36038694 DOI: 10.1007/s10741-022-10266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
There is currently no widely used prognostic score in heart failure (HF) with preserved ejection fraction (HFpEF). The MEDIA echo score, including four variables (pulmonary arterial systolic pressure > 40 mmHg, inferior vena cava collapsibility index < 50%, average E/e' > 9, and lateral mitral annular s' < 7 cm/s), has been proposed as a useful risk stratification tool. This study aimed at further validating the MEDIA echo score in both hospitalised and ambulatory HFpEF patients. The MEDIA echo score ranges from 0 to 4 (each criterion scores 1 point). The associations between MEDIA echo score and cardiovascular outcomes were assessed in two independent HFpEF cohorts, namely patients hospitalised for worsening HFpEF (N = 242, mean age 78 ± 11), and stable ambulatory HFpEF patients (N = 76, mean age 65 ± 8). Using multivariable Cox models, in the worsening HFpEF cohort, patients with a MEDIA echo score of 3-4 displayed a significant increased risk of death (HR 2.10, 95%CI 1.02-4.33, P = 0.043, score 0-1 as reference). In the ambulatory HFpEF cohort, patients with a MEDIA echo score of 2 had a significantly higher risk of death or HF hospitalisation (HR 3.44, 95%CI 1.27-9.30, P = 0.015, score 0 as reference), driven by HF hospitalisation; in that cohort, adding the MEDIA echo score to the clinical model significantly improved reclassification for the combined endpoint (integrated discrimination improvement 6.2%, P = 0.006). The MEDIA echo score significantly predicted the outcome of HFpEF patients in both hospital and ambulatory settings; its use may help refine routine risk stratification on top of well-established prognosticators in stable HFpEF patients.
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Affiliation(s)
- Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy.,Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Olivier Huttin
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Masatake Kobayashi
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Zohra Lamiral
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Dejan Simonovic
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia
| | - Faiez Zannad
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Patrick Rossignol
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France.
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Kagami K, Obokata M, Harada T, Sorimachi H, Yuasa N, Saito Y, Kato T, Wada N, Adachi T, Ishii H. Incremental diagnostic value of post-exercise lung congestion in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:553-561. [PMID: 36691846 DOI: 10.1093/ehjci/jead007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
AIMS Lung ultrasound (LUS) may unmask occult heart failure with preserved ejection fraction (HFpEF) by demonstrating an increase in extravascular lung water (EVLW) during exercise. Here, we sought to examine the dynamic changes in ultrasound B-lines during exercise to identify the optimal timeframe for HFpEF diagnosis. METHODS AND RESULTS Patients with HFpEF (n = 134) and those without HF (controls, n = 121) underwent a combination of exercise stress echocardiography and LUS with simultaneous expired gas analysis to identify exercise EVLW. Exercise EVLW was defined by B-lines that were newly developed or increased during exercise. The E/e' ratio peaked during maximal exercise and immediately decreased during the recovery period in patients with HFpEF. Exercise EVLW was most prominent during the recovery period in patients with HFpEF, while its prevalence did not increase from peak exercise to the recovery period in controls. Exercise EVLW was associated with a higher E/e' ratio and pulmonary artery pressure, lower right ventricular systolic function, and elevated minute ventilation to carbon dioxide production (VE vs. VCO2) slope during peak exercise. Increases in B-lines from rest to the recovery period provided an incremental diagnostic value to identify HFpEF over the H2FPEF score and resting left atrial reservoir strain. CONCLUSION Exercise EVLW was most prominent early during the recovery period; this may be the optimal timeframe for imaging ultrasound B-lines. Exercise stress echocardiography with assessments of recovery EVLW may enhance the diagnosis of HFpEF.
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Affiliation(s)
- Kazuki Kagami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.,Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Naoki Yuasa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshimitsu Kato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Naoki Wada
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takeshi Adachi
- Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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7
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Pálinkás ED, Re F, Peteiro J, Tesic M, Pálinkás A, Torres MAR, Dikic AD, Beleslin B, Van De Heyning CM, D’Alfonso MG, Mori F, Ciampi Q, de Castro Silva Pretto JL, Simova I, Nagy V, Boda K, Sepp R, Olivotto I, Pellikka PA, Picano E. Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy. Int J Cardiovasc Imaging 2022; 38:2593-2604. [DOI: 10.1007/s10554-022-02620-0] [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] [Received: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Background
B-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM).
Aim
To assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM.
Methods
We enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e’; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2.
Results
LUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e’ (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e’ (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion.
Conclusions
Two-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.
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8
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Maestro-Benedicto A, Rivas-Lasarte M, Fernández-Martínez J, López-López L, Solé-González E, Brossa V, Mirabet S, Roig E, Cinca J, Álvarez-García J, Sionis A. Incremental prognostic value of lung ultrasound on contemporary heart failure risk scores. Front Physiol 2022; 13:1006589. [PMID: 36187763 PMCID: PMC9515571 DOI: 10.3389/fphys.2022.1006589] [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: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction: Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up. Methods: We evaluated the discrimination improvement of adding the number of B-lines to 4 contemporary HF risk scores (Get with the Guidelines -GWTG-, MAGGIC, Redin-SCORE, and BCN Bio-HF) by comparing the change in the area under the receiver operating curve (AUC), the net reclassification index (NRI), and the integrated discrimination improvement (IDI). The population of the study was constituted by the 123 patients enrolled in the LUS-HF trial, adjusting the analyses by the intervention. Results: The AUC of the GWTG score increased from 0.682 to 0.789 (p = 0.02), resulting in a NRI of 0.608 and an IDI of 0.136 (p < 0.05). Similar results were observed when adding the number of B-lines to the MAGGIC score, with an AUC that increased from 0.705 to 0.787 (p < 0.05). This increase translated into a NRI of 0.608 and an IDI of 0.038 (p < 0.05). Regarding Redin-SCORE at 1-month and 1-year, the AUC increased from 0.714 to 0.773 and from 0.681 to 0.757, although it did not reach statistical significance (p = 0.08 and p = 0.06 respectively). Both IDI and NRI were significantly improved (0.093 and 0.509 in the 1-month score, p < 0.05; 0.056 and 0.111 in the 1-year score, p < 0.05). Lastly, the AUC for the BCN Bio-HF score increased from 0.733 to 0.772, which was statistically non-significant, with a NRI value of 0.363 (p = 0.06) and an IDI of 0.092 (p < 0.05). Conclusion: Adding the results of LUS evaluated at discharge improved the predictive value of most of the contemporary HF risk scores. As it is a simple, fast, and non-invasive test it may be recommended to assess prognosis at discharge in HF patients.
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Affiliation(s)
- Alba Maestro-Benedicto
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Mercedes Rivas-Lasarte
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
- Cardiology Department, Hospital Universitario Puerta de Hierro CIBERCV, Majadahonda Madrid, Spain
- *Correspondence: Mercedes Rivas-Lasarte,
| | - Juan Fernández-Martínez
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Laura López-López
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Eduard Solé-González
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
- Cardiology Department, Hospital Clinic, Barcelona, Spain
| | - Vicens Brossa
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Sonia Mirabet
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Eulàlia Roig
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
| | - Jesús Álvarez-García
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
- Cardiology Department, Hospital Universitario Ramón y Cajal CIBERCV, Madrid, Spain
| | - Alessandro Sionis
- Cardiology Department, IIB SANT PAU, Hospital de la Santa Creu i Sant Pau CIBERCV, Barcelona, Spain
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9
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Chen C, Zhao J, Xue R, Liu X, Zhu W, Ye M. Prognostic significance of resting cardiac power to left ventricular mass and E/e’ ratio in heart failure with preserved ejection fraction. Front Cardiovasc Med 2022; 9:961837. [PMID: 36061551 PMCID: PMC9433697 DOI: 10.3389/fcvm.2022.961837] [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: 06/05/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCardiac power-to-left ventricular mass (power/mass) is an index reflecting the muscular hydraulic pump capability of the heart, and the E/e’ ratio is a specific indicator for identifying increased left ventricular filling pressure. Limited data exist regarding the prognostic value of incorporating power/mass and E/e’ ratio in heart failure with preserved ejection fraction (HFpEF).Materials and methodsIn total, 475 patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial with complete baseline echocardiography data were included in our analysis. Patients were categorized into four groups according to power/mass and E/e’ ratio. The risk of outcomes was examined using Cox proportional hazards models and competing risk models.ResultsPatients with low power/mass and high E/e’ were more likely to be males (60.5%), with higher waist circumference, and had a higher prevalence of diabetes (52.1%), atrial fibrillation (50.4%), and lower estimated glomerular filtration rate (eGFR). Combined resting power/mass and E/e’ have graded correlations with left ventricular (LV) dysfunction and clinical outcomes in patients with HFpEF. After multivariable adjustments, an integrative approach combining power/mass and E/e’ remained to be a powerful prognostic predictor, with the highest HRs of clinical outcomes observed in patients with low power/mass and high E/e’ (all-cause mortality: HR 3.45; 95% CI: 1.69–7.05; P = 0.001; hospitalization for heart failure: HR 3.27; 95% CI: 1.60–6.67; P = 0.001; and primary endpoint: HR 3.07; 95% CI: 1.73–5.42; P < 0.001).ConclusionIn patients with HFpEF, an echo-derived integrated approach incorporating resting power/mass and E/e’ ratio remained to be a powerful prognosis predictor and may be useful to risk-stratify patients with this heterogeneous syndrome.Clinical Trial Registration[https://clinicaltrials.gov], identifier [NCT00094302].
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Affiliation(s)
- Cong Chen
- Department of Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jie Zhao
- Department of Cardiovascular Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Ruicong Xue
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wengen Zhu,
| | - Min Ye
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Min Ye,
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10
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Chiorescu RM, Lazar RD, Buksa SB, Mocan M, Blendea D. Biomarkers of Volume Overload and Edema in Heart Failure With Reduced Ejection Fraction. Front Cardiovasc Med 2022; 9:910100. [PMID: 35783848 PMCID: PMC9247259 DOI: 10.3389/fcvm.2022.910100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/23/2022] [Indexed: 12/19/2022] Open
Abstract
From a pathogenetic point of view, heart failure (HF) is characterized by the activation of several neurohumoral pathways with a role in maintaining the cardiac output and the adequate perfusion pressure in target organs and tissues. Decreased cardiac output in HF with reduced ejection fraction causes activation of the sympathetic nervous system, the renin angiotensin aldosterone system, arginine-vasopressin system, natriuretic peptides, and endothelin, all of which cause water and salt retention in the body. As a result, patients will present clinically as the main symptoms: dyspnea and peripheral edema caused by fluid redistribution to the lungs and/or by fluid overload. By studying these pathophysiological mechanisms, biomarkers with a prognostic and therapeutic role in the management of edema were identified in patients with HF with low ejection fraction. This review aims to summarize the current data from the specialty literature of such biomarkers with a role in the pathogenesis of edema in HF with low ejection fraction. These biomarkers may be the basis for risk stratification and the development of new therapeutic means in the treatment of edema in these patients.
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Affiliation(s)
- Roxana Mihaela Chiorescu
- Department of Internal Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Roxana-Daiana Lazar
- Nicolae Stancioiu Heart Institute, Cluj-Napoca, Romania
- *Correspondence: Roxana-Daiana Lazar
| | - Sándor-Botond Buksa
- Department of Internal Medicine, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Department of Internal Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Internal Medicine, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Dan Blendea
- Department of Internal Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Nicolae Stancioiu Heart Institute, Cluj-Napoca, Romania
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11
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Delgado V, Gual-Capllonch F. Lung Ultrasound During Exercise Echocardiography: Necessity or Whim? Circ Cardiovasc Imaging 2022; 15:e014153. [PMID: 35580159 DOI: 10.1161/circimaging.122.014153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victoria Delgado
- Heart Institute, Department of Cardiology, Hospital University Germans Trias i Pujol, Badalona, Spain (V.D.)
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12
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Merli E, Ciampi Q, Scali MC, Zagatina A, Merlo PM, Arbucci R, Daros CB, de Castro E Silva Pretto JL, Amor M, Salamè MF, Mosto H, Morrone D, D'Andrea A, Reisenhofer B, Rodriguez-Zanella H, Wierzbowska-Drabik K, Kasprzak JD, Agoston G, Varga A, Lowenstein J, Dodi C, Cortigiani L, Simova I, Samardjieva M, Citro R, Celutkiene J, Re F, Monte I, Gligorova S, Antonini-Canterin F, Pepi M, Carpeggiani C, Pellikka PA, Picano E. Pulmonary Congestion During Exercise Stress Echocardiography in Ischemic and Heart Failure Patients. Circ Cardiovasc Imaging 2022; 15:e013558. [PMID: 35580160 DOI: 10.1161/circimaging.121.013558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lung ultrasound detects pulmonary congestion as B-lines at rest, and more frequently, during exercise stress echocardiography (ESE). METHODS We performed ESE plus lung ultrasound (4-site simplified scan) in 4392 subjects referred for semi-supine bike ESE in 24 certified centers in 9 countries. B-line score ranged from 0 (normal) to 40 (severely abnormal). Five different populations were evaluated: control subjects (n=103); chronic coronary syndromes (n=3701); heart failure with reduced ejection fraction (n=395); heart failure with preserved ejection fraction (n=70); ischemic mitral regurgitation ≥ moderate at rest (n=123). In a subset of 2478 patients, follow-up information was available. RESULTS During ESE, B-lines increased in all study groups except controls. Age, hypertension, abnormal ejection fraction, peak wall motion score index, and abnormal heart rate reserve were associated with B-lines in multivariable regression analysis. Stress B lines (hazard ratio, 2.179 [95% CI, 1.015-4.680]; P=0.046) and ejection fraction <50% (hazard ratio, 2.942 [95% CI, 1.268-6.822]; P=0.012) were independent predictors of all-cause death (n=29 after a median follow-up of 29 months). CONCLUSIONS B-lines identify the pulmonary congestion phenotype at rest, and more frequently, during ESE in ischemic and heart failure patients. Stress B-lines may help to refine risk stratification in these patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03049995.
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Affiliation(s)
- Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Italy (E.M.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy (Q.C.)
| | | | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation (A.Z.)
| | - Pablo Martin Merlo
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina (P.M.M., R.A., J.L.)
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina (P.M.M., R.A., J.L.)
| | | | | | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina (M.A., M.F.S., H.M.)
| | - Michael F Salamè
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina (M.A., M.F.S., H.M.)
| | - Hugo Mosto
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina (M.A., M.F.S., H.M.)
| | - Doralisa Morrone
- Cardiology Department, Cisanello University Hospital, Pisa, Italy (D.M.)
| | - Antonello D'Andrea
- Cardiology, Monaldi Hospital, Second University of Naples, and Nocera Inferiore, Italy (A.D.)
| | | | | | | | - Jaroslaw D Kasprzak
- Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland (K.W.-D., J.D.K.)
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Hungary (G.A., A.V.)
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Hungary (G.A., A.V.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina (P.M.M., R.A., J.L.)
| | - Claudio Dodi
- Cardiology Department, Ospedale di Cremona, Italy (C.D.)
| | | | - Iana Simova
- Cardiology Department, Heart and Brain Center of Excellence, University Hospital, Pleven, Bulgaria (I.S., M.S.).,Medical University, Pleven, Bulgaria (I.S., M.S.)
| | - Martina Samardjieva
- Cardiology Department, Heart and Brain Center of Excellence, University Hospital, Pleven, Bulgaria (I.S., M.S.).,Medical University, Pleven, Bulgaria (I.S., M.S.)
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular-Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy (R.C.)
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (J.C.)
| | - Federica Re
- Ospedale San Camillo, Cardiology Division, Rome, Italy (F.R.)
| | - Ines Monte
- Cardio-Thorax-Vascular Department, Echocardiography Lab, "Policlinico Vittorio Emanuele", Catania University, Italy (I.M.)
| | | | - Francesco Antonini-Canterin
- Highly Specialized Rehabilitation Hospital Motta di Livenza, Cardiac Prevention and Rehabilitation Unit, Treviso, Italy (F.A.-C.)
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (M.P.)
| | | | | | - Eugenio Picano
- Institute of Clinical Physiology, CNR, Pisa Italy (C.C., E.P.)
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13
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Harada T, Kagami K, Kato T, Ishii H, Obokata M. Exercise Stress Echocardiography in the Diagnostic Evaluation of Heart Failure with Preserved Ejection Fraction. J Cardiovasc Dev Dis 2022; 9:jcdd9030087. [PMID: 35323635 PMCID: PMC8950754 DOI: 10.3390/jcdd9030087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
More than half of patients with heart failure have a preserved ejection fraction (HFpEF). The prevalence of HFpEF has been increasing worldwide and is expected to increase further, making it an important health-care problem. The diagnosis of HFpEF is straightforward in the presence of obvious objective signs of congestion; however, it is challenging in patients presenting with a low degree of congestion because abnormal elevation in intracardiac pressures may occur only during physiological stress conditions, such as during exercise. On the basis of this hemodynamic background, current consensus guidelines have emphasized the importance of exercise stress testing to reveal abnormalities during exercise, and exercise stress echocardiography (i.e., diastolic stress echocardiography) may be used as an initial diagnostic approach to HFpEF owing to its noninvasive nature and wide availability. However, evidence supporting the use of this method remains limited and many knowledge gaps exist with respect to diastolic stress echocardiography. This review summarizes the current understanding of the use of diastolic stress echocardiography in the diagnostic evaluation of HFpEF and discusses its strengths and limitations to encourage future studies on this subject.
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Affiliation(s)
- Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan; (T.H.); (K.K.); (T.K.); (H.I.)
| | - Kazuki Kagami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan; (T.H.); (K.K.); (T.K.); (H.I.)
- Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa 359-8513, Saitama, Japan
| | - Toshimitsu Kato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan; (T.H.); (K.K.); (T.K.); (H.I.)
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan; (T.H.); (K.K.); (T.K.); (H.I.)
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan; (T.H.); (K.K.); (T.K.); (H.I.)
- Correspondence: ; Tel.: +81-27-220-8145
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14
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Chen L, Huang Z, Zhao X, Liang J, Lu X, He Y, Kang Y, Xie Y, Liu J, Liu Y, Yang J, Yu W, Deng W, Pan Y, Lu J, Yang Y, Xie X, Qian X, Xu Q, Chen L, Chen K, Chen S. Predictors and Mortality for Worsening Left Ventricular Ejection Fraction in Patients With HFpEF. Front Cardiovasc Med 2022; 9:820178. [PMID: 35282383 PMCID: PMC8907533 DOI: 10.3389/fcvm.2022.820178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Definitions of declined left ventricular ejection fraction (LVEF) vary across studies and research results concerning the association of mortality with declined LVEF are inconsistent. Thus, this study aimed to assess the impact of early worsening LVEF on mortality in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and to establish independent predictors of early worsening LVEF. Methods and Results A total of 1,418 consecutive patients with HFpEF with LVEF remeasurement from the Cardiorenal Improvement registry were included in this study. Worsening LVEF was defined as an absolute decline ≥ 5% from baseline LVEF within 3 to 12 months after discharge. The Cox and logistic regression analyses were performed to assess prognostic effects and predictors for worsening LVEF, respectively. Among 1,418 patients with HFpEF, 457 (32.2%) patients exhibited worsening LVEF. During a median follow-up of 3.2 years (interquartile range: 2.3–4.0 years), 92 (6.5%) patients died. Patients with HFpEF with worsening LVEF had higher mortality relative to those with nonworsening LVEF [9.2 vs. 5.2%; adjusted hazard ratio (aHR): 2.18, 95% CI: 1.35–3.52]. In the multivariate binary logistic regression analysis, baseline left ventricular end-diastolic dimension (LVEDD), LVEF, high-density lipoprotein cholesterol (HDL-C), atrial fibrillation (AF), and diabetes mellitus (DM) emerged as predictive factors of worsening LVEF. Conclusion This study demonstrated that about one out of three patients with HFpEF experiences worsening LVEF during follow-up, which is associated with 2.2-fold increased mortality. Increased LVEDD and LVEF, low HDL-C levels, AF, and DM were predictors of worsening LVEF. Further studies are needed to prospectively assess the efficacy of early active management on prognosis in patients with HF with worsening LVEF. Registration ClinicalTrials.gov, identifier NCT04407936.
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Affiliation(s)
- Liling Chen
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoli Zhao
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingjing Liang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Guangzhou, China
| | - Xiaozhao Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Kang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun Xie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Yang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weixu Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wanling Deng
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
| | - Yuxiong Pan
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
| | - Jin Lu
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
| | - Yanfang Yang
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
| | - Xujing Xie
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
| | - Xiaoxian Qian
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingbo Xu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Guangzhou, China
- Department of Cardiology, Maoming People's Hospital, Maoming, China
- *Correspondence: Qingbo Xu
| | - Longtian Chen
- Department of Hematology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
- Longtian Chen
| | - Kaihong Chen
- Department of Cardiology, Longyan First Hospital Affiliated of Fujian Medical University, Longyan, China
- Kaihong Chen
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shiqun Chen
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15
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Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test. High Blood Press Cardiovasc Prev 2022; 29:145-154. [PMID: 35107808 PMCID: PMC8942964 DOI: 10.1007/s40292-021-00494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
Arterial hypertension (AH) is a global burden and the leading risk factor for mortality worldwide. Haemodynamic abnormalities, longstanding neurohormonal and inflammatory activation, which are commonly observed in patients with AH, promote cardiac structural remodeling ultimately leading to heart failure (HF) if blood pressure values remain uncontrolled. While several epidemiological studies have confirmed the strong link between AH and HF, the pathophysiological processes underlying this transition remain largely unclear. The combined cardiopulmonary-echocardiography stress test (CPET-ESE) represents a precious non-invasive aid to detect alterations in patients at the earliest stages of HF. The opportunity to study the response of the cardiovascular system to exercise, and to differentiate central from peripheral cardiovascular maladaptations, makes the CPET-ESE an ideal technique to gain insights into the mechanisms involved in the transition from AH to HF, by recognizing alterations that might be silent at rest but influence the response to exercise. Identifications of these subclinical alterations might allow for a better risk stratification in hypertensive patients, facilitating the recognition of those at higher risk of evolution towards established HF. This may also lead to the development of novel preventive strategies and help tailor medical treatment. The purpose of this review is to summarise the potential advantages of using CPET-ESE in the characterisation of hypertensive patients in the cardiovascular continuum.
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16
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Morvai-Illés B, Polestyuk-Németh N, Szabó IA, Monoki M, Gargani L, Picano E, Varga A, Ágoston G. The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting. Front Cardiovasc Med 2021; 8:758147. [PMID: 34926610 PMCID: PMC8674474 DOI: 10.3389/fcvm.2021.758147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed. Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting. Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death. Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001). Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.
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Affiliation(s)
- Blanka Morvai-Illés
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Nóra Polestyuk-Németh
- Emergency Patient Care Unit, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Adorján Szabó
- Mures County Clinical Hospital, Cardiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Magdolna Monoki
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Albert Varga
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Gergely Ágoston
- Department of Family Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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17
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Burrage MK, Hundertmark M, Valkovič L, Watson WD, Rayner J, Sabharwal N, Ferreira VM, Neubauer S, Miller JJ, Rider OJ, Lewis AJ. Energetic Basis for Exercise-Induced Pulmonary Congestion in Heart Failure With Preserved Ejection Fraction. Circulation 2021; 144:1664-1678. [PMID: 34743560 PMCID: PMC8601674 DOI: 10.1161/circulationaha.121.054858] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transient pulmonary congestion during exercise is emerging as an important determinant of reduced exercise capacity in heart failure with preserved ejection fraction (HFpEF). We sought to determine whether an abnormal cardiac energetic state underpins this process. METHODS We recruited patients across the spectrum of diastolic dysfunction and HFpEF (controls, n=11; type 2 diabetes, n=9; HFpEF, n=14; and severe diastolic dysfunction attributable to cardiac amyloidosis, n=9). Cardiac energetics were measured using phosphorus spectroscopy to define the myocardial phosphocreatine to ATP ratio. Cardiac function was assessed by cardiovascular magnetic resonance cine imaging and echocardiography and lung water using magnetic resonance proton density mapping. Studies were performed at rest and during submaximal exercise using a magnetic resonance imaging ergometer. RESULTS Paralleling the stepwise decline in diastolic function across the groups (E/e' ratio; P<0.001) was an increase in NT-proBNP (N-terminal pro-brain natriuretic peptide; P<0.001) and a reduction in phosphocreatine/ATP ratio (control, 2.15 [2.09, 2.29]; type 2 diabetes, 1.71 [1.61, 1.91]; HFpEF, 1.66 [1.44, 1.89]; cardiac amyloidosis, 1.30 [1.16, 1.53]; P<0.001). During 20-W exercise, lower left ventricular diastolic filling rates (r=0.58; P<0.001), lower left ventricular diastolic reserve (r=0.55; P<0.001), left atrial dilatation (r=-0.52; P<0.001), lower right ventricular contractile reserve (right ventricular ejection fraction change, r=0.57; P<0.001), and right atrial dilation (r=-0.71; P<0.001) were all linked to lower phosphocreatine/ATP ratio. Along with these changes, pulmonary proton density mapping revealed transient pulmonary congestion in patients with HFpEF (+4.4% [0.5, 6.4]; P=0.002) and cardiac amyloidosis (+6.4% [3.3, 10.0]; P=0.004), which was not seen in healthy controls (-0.1% [-1.9, 2.1]; P=0.89) or type 2 diabetes without HFpEF (+0.8% [-1.7, 1.9]; P=0.82). The development of exercise-induced pulmonary congestion was associated with lower phosphocreatine/ATP ratio (r=-0.43; P=0.004). CONCLUSIONS A gradient of myocardial energetic deficit exists across the spectrum of HFpEF. Even at low workload, this energetic deficit is related to markedly abnormal exercise responses in all 4 cardiac chambers, which is associated with detectable pulmonary congestion. The findings support an energetic basis for transient pulmonary congestion in HFpEF.
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Affiliation(s)
- Matthew K. Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Moritz Hundertmark
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Ladislav Valkovič
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia (L.V.)
| | - William D. Watson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Jennifer Rayner
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Nikant Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Vanessa M. Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Jack J. Miller
- Department of Physics, Clarendon Laboratory (J.J.M.), University of Oxford, UK
- The MR Research Centre and The PET Research Centre, Aarhus University, Denmark (J.J.M.)
| | - Oliver J. Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
| | - Andrew J.M. Lewis
- University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine (M.K.B., M.H., L.V., W.D.W., J.R., V.M.F., S.N., O.J.R., A.J.M.L.), University of Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, UK (J.R., N.S., S.N., O.J.R., A.J.M.L.)
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18
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Sun Y, Si J, Li J, Dai M, King E, Zhang X, Zhang Y, Xia Y, Tse G, Liu Y. Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2021; 8:656536. [PMID: 34778384 PMCID: PMC8585787 DOI: 10.3389/fcvm.2021.656536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/04/2021] [Indexed: 12/17/2022] Open
Abstract
Aims: HFA-PEFF score has been proposed for diagnosing heart failure with preserved ejection fraction (HFpEF). Currently, there are only a limited number of tools for predicting the prognosis. In this study, we evaluated whether the HFA-PEFF score can predict mortality in patients with HFpEF. Methods: This single-center, retrospective observational study enrolled patients diagnosed with HFpEF at the First Affiliated Hospital of Dalian Medical University between January 1, 2015, and April 30, 2018. The subjects were divided according to their HFA-PEFF score into low (0–2 points), intermediate (3–4 points), and high (5–6 points) score groups. The primary outcome was all-cause mortality. Results: A total of 358 patients (mean age: 70.21 ± 8.64 years, 58.1% female) were included. Of these, 63 (17.6%), 156 (43.6%), and 139 (38.8%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 26.9 months, 46 patients (12.8%) died. The percentage of patients who died in the low, intermediate, and high score groups were 1 (1.6%), 18 (11.5%), and 27 (19.4%), respectively. A multivariate Cox regression identified HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR):1.314, 95% CI: 1.013–1.705, P = 0.039]. A Cox analysis demonstrated a significantly higher rate of mortality in the intermediate (HR: 4.912, 95% CI 1.154–20.907, P = 0.031) and high score groups (HR: 5.291, 95% CI: 1.239–22.593, P = 0.024) than the low score group. A receiver operating characteristic (ROC) analysis indicated that the HFA-PEFF score can effectively predict all-cause mortality after adjusting for age and New York Heart Association (NYHA) class [area under the curve (AUC) 0.726, 95% CI 0.651–0.800, P = 0.000]. With an HFA-PEFF score cut-off value of 3.5, the sensitivity and specificity were 78.3 and 54.8%, respectively. The AUC on ROC analysis for the biomarker component of the score was similar to that of the total score. Conclusions: The HFA-PEFF score can be used both to diagnose HFpEF and predict the prognosis. The higher scores are associated with higher all-cause mortality.
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Affiliation(s)
- Yuxi Sun
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinping Si
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiaxin Li
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengyuan Dai
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Emma King
- Cardiovascular Analytics Group, Hong Kong SAR, China
| | - Xinxin Zhang
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanli Zhang
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Cardiovascular Analytics Group, Hong Kong SAR, China.,Kent and Medway Medical School, Canterbury, United Kingdom
| | - Ying Liu
- Heart Failure and Structural Cardiology Ward, First Affiliated Hospital of Dalian Medical University, Dalian, China
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19
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Simonovic D, Coiro S, Deljanin-Ilic M, Kobayashi M, Carluccio E, Girerd N, Ambrosio G. Exercise-induced B-lines in heart failure with preserved ejection fraction occur along with diastolic function worsening. ESC Heart Fail 2021; 8:5068-5080. [PMID: 34655174 PMCID: PMC8712838 DOI: 10.1002/ehf2.13575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 12/27/2022] Open
Abstract
Aims Pulmonary congestion during exercise assessed by lung ultrasound predicts negative outcome in patients with heart failure with preserved ejection fraction (HFpEF). We aimed at assessing predictors of exercise‐induced pulmonary B‐lines in HFpEF patients. Methods and results Eighty‐one I–II NYHA class HFpEF patients (65.0 ± 8.2 y/o, 56.8% females) underwent standard and strain echocardiography, lung ultrasound, and natriuretic peptide assessment during supine exercise echocardiography (baseline and peak exercise). Peak values and their changes were compared in subgroups according to exercise lung congestion grading (peak B‐lines >10 or ≤10). Exercise elicited significant changes for all echocardiographic parameters in both subgroups [39/81 (48.1%) with peak B‐lines >10; 42/81 (51.9%) with B‐lines ≤10]. Peak values and changes of E‐wave (and its derived indices) were significantly higher in patients with >10 peak B‐lines compared with those with ≤10 B‐line (all P‐values <0.03), showing significant correlation with peak B‐lines for all parameters; concomitantly, global longitudinal strain (GLS) and global strain rate (GSR) during systole (GSRs), early (GSRe) and late (GSRa) diastole, and isovolumic relaxation (GSRivr) were reduced in patients with B‐lines >10 (all P‐values <0.05), showing a negative correlation with peak B‐lines. By adjusted linear regression analysis, peak and change diastolic parameters (E‐wave, E/e′, GSRivr, and E/GSRivr) and peak GLS were individually significantly associated with peak B‐lines. By covariate‐adjusted multivariable model, E/e′ and GSRa at peak exercise were retained as independent predictors of peak B‐lines, with substantial goodness of fit of model (adjusted R2 0.776). Conclusions In HFpEF, development of pulmonary congestion upon exercise is mostly concomitant with exercise‐induced worsening of diastolic function.
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Affiliation(s)
- Dejan Simonovic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | - Stefano Coiro
- Cardiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy.,Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France
| | - Marina Deljanin-Ilic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | - Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Erberto Carluccio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.,CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia School of Medicine, Perugia, Italy
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20
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Li N, Zhu Y, Zeng J. Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure. Clin Cardiol 2021; 44:1488-1496. [PMID: 34599512 PMCID: PMC8571545 DOI: 10.1002/clc.23738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic heart failure is one of the common causes of hospitalization and death. Pulmonary congestion is the common disease feature of patients with chronic heart failure, which could be correctly diagnosed by lung ultrasound. Efficacy of lung ultrasound‐guided pulmonary congestion management for patients with acute heart failure is well documented, however, more evidence is needed to establish the clinical value of pulmonary congestion detection by lung ultrasound examination in patients with chronic heart failure. This review summarized current evidence related to the use and clinical value of pulmonary congestion assessment by lung ultrasound in patients with chronic heart failure, aiming to provide new suggestions on promoting the widespread use of lung ultrasound in patients with chronic heart failure to improve the quality of life and outcome of patients with chronic heart failure.
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Affiliation(s)
- Na Li
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China.,Center of Cooperative Postgraduate Cultivation in Xiangtan Central Hospital, University of South China, Xiangtan, China
| | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China.,Center of Cooperative Postgraduate Cultivation in Xiangtan Central Hospital, University of South China, Xiangtan, China
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21
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Picano E, Ciampi Q, Cortigiani L, Arruda-Olson AM, Borguezan-Daros C, de Castro e Silva Pretto JL, Cocchia R, Bossone E, Merli E, Kane GC, Varga A, Agoston G, Scali MC, Morrone D, Simova I, Samardjieva M, Boshchenko A, Ryabova T, Vrublevsky A, Palinkas A, Palinkas ED, Sepp R, Torres MAR, Villarraga HR, Preradović TK, Citro R, Amor M, Mosto H, Salamè M, Leeson P, Mangia C, Gaibazzi N, Tuttolomondo D, Prota C, Peteiro J, Van De Heyning CM, D’Andrea A, Rigo F, Nikolic A, Ostojic M, Lowenstein J, Arbucci R, Haber DML, Merlo PM, Wierzbowska-Drabik K, Kasprzak JD, Haberka M, Camarozano AC, Ratanasit N, Mori F, D’Alfonso MG, Tassetti L, Milazzo A, Olivotto I, Marchi A, Rodriguez-Zanella H, Zagatina A, Padang R, Dekleva M, Djordievic-Dikic A, Boskovic N, Tesic M, Giga V, Beleslin B, Di Salvo G, Lorenzoni V, Cameli M, Mandoli GE, Bombardini T, Caso P, Celutkiene J, Barbieri A, Benfari G, Bartolacelli Y, Malagoli A, Bursi F, Mantovani F, Villari B, Russo A, De Nes M, Carpeggiani C, Monte I, Re F, Cotrim C, Bilardo G, Saad AK, Karuzas A, Matuliauskas D, Colonna P, Antonini-Canterin F, Pepi M, Pellikka PA. Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging. J Clin Med 2021; 10:3641. [PMID: 34441937 PMCID: PMC8397117 DOI: 10.3390/jcm10163641] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021-2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient.
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Affiliation(s)
- Eugenio Picano
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy; (Q.C.); (B.V.)
| | | | - Adelaide M. Arruda-Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | | | | | - Rosangela Cocchia
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, 80100 Naples, Italy; (R.C.); (E.B.)
| | - Eduardo Bossone
- Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, 80100 Naples, Italy; (R.C.); (E.B.)
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, 48100 Ravenna, Italy;
| | - Garvan C. Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Albert Varga
- Institute of Family Medicine, Szeged University Medical School, University of Szeged, 6720 Szeged, Hungary; (A.V.); (G.A.)
| | - Gergely Agoston
- Institute of Family Medicine, Szeged University Medical School, University of Szeged, 6720 Szeged, Hungary; (A.V.); (G.A.)
| | | | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56100 Pisa, Italy;
| | - Iana Simova
- Heart and Brain Center of Excellence, Cardiology Department, University Hospital, Medical University, 5800 Pleven, Bulgaria; (I.S.); (M.S.)
| | - Martina Samardjieva
- Heart and Brain Center of Excellence, Cardiology Department, University Hospital, Medical University, 5800 Pleven, Bulgaria; (I.S.); (M.S.)
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Alexander Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634009 Tomsk, Russia; (A.B.); (T.R.); (A.V.)
| | - Attila Palinkas
- Internal Medicine Department, Elisabeth Hospital, 6800 Hódmezővásárhely, Hungary;
| | - Eszter D. Palinkas
- Albert Szent-Gyorgyi Clinical Center, Department of Internal Medicine, Division of Non-Invasive Cardiology, University Hospital, 6725 Szeged, Hungary; (R.S.); (E.D.P.)
| | - Robert Sepp
- Albert Szent-Gyorgyi Clinical Center, Department of Internal Medicine, Division of Non-Invasive Cardiology, University Hospital, 6725 Szeged, Hungary; (R.S.); (E.D.P.)
| | | | - Hector R. Villarraga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Tamara Kovačević Preradović
- Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, 78 000 Banja Luka, Bosnia and Herzegovina; (T.K.P.); (T.B.)
| | - Rodolfo Citro
- Cardiology Department and Echocardiography Lab, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84100 Salerno, Italy;
| | - Miguel Amor
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Hugo Mosto
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Michael Salamè
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires C1221, Argentina; (M.A.); (H.M.); (M.S.)
| | - Paul Leeson
- RDM Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford OX3 9DU, UK;
| | - Cristina Mangia
- CNR, ISAC-Institute of Sciences of Atmosphere and Climate, 73100 Lecce, Italy;
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy; (N.G.); (D.T.)
| | - Domenico Tuttolomondo
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy; (N.G.); (D.T.)
| | - Costantina Prota
- Cardiology Department, Vallo della Lucania Hospital, 84100 Salerno, Italy;
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain;
| | | | - Antonello D’Andrea
- UOC Cardiologia/UTIC/Emodinamica, PO Umberto I, Nocera Inferiore (ASL Salerno)—Università Luigi Vanvitelli della Campania, 84014 Salerno, Italy; (A.D.); (P.C.)
| | - Fausto Rigo
- Department of Cardiology, Dolo Hospital, 30031 Venice, Italy;
| | - Aleksandra Nikolic
- Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade 11000, Serbia; (A.N.); (M.O.)
| | - Miodrag Ostojic
- Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade 11000, Serbia; (A.N.); (M.O.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Diego M. Lowenstein Haber
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Pablo M. Merlo
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (J.L.); (R.A.); (D.M.L.H.); (P.M.M.)
| | - Karina Wierzbowska-Drabik
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Jaroslaw D. Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University, 91-347 Lodz, Poland; (K.W.-D.); (J.D.K.)
| | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Ana Cristina Camarozano
- Medicine Department, Hospital de Clinicas UFPR, Federal University of Paranà, Curitiba 80000-000, Brazil;
| | - Nithima Ratanasit
- Department of Medicine, Division of Cardiology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Maria Grazia D’Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Luigi Tassetti
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Alessandra Milazzo
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Iacopo Olivotto
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | - Alberto Marchi
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.); (L.T.); (A.M.); (I.O.); (A.M.)
| | | | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Hospital, 199034 Saint Petersburg, Russia;
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
| | - Milica Dekleva
- Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade 11000, Serbia;
| | - Ana Djordievic-Dikic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Nikola Boskovic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Milorad Tesic
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Vojislav Giga
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Branko Beleslin
- University Clinical Centre of Serbia, Medical School, Cardiology Clinic, University of Belgrade, 11000 Belgrade, Serbia; (A.D.-D.); (N.B.); (M.T.); (V.G.); (B.B.)
| | - Giovanni Di Salvo
- Division of Pediatric Cardiology, University Hospital, 35100 Padua, Italy;
| | | | - Matteo Cameli
- Division of Cardiology, University Hospital, 53100 Siena, Italy; (M.C.); (G.E.M.)
| | - Giulia Elena Mandoli
- Division of Cardiology, University Hospital, 53100 Siena, Italy; (M.C.); (G.E.M.)
| | - Tonino Bombardini
- Clinic of Cardiovascular Diseases, University Clinical Centre of the Republic of Srpska, 78 000 Banja Luka, Bosnia and Herzegovina; (T.K.P.); (T.B.)
| | - Pio Caso
- UOC Cardiologia/UTIC/Emodinamica, PO Umberto I, Nocera Inferiore (ASL Salerno)—Università Luigi Vanvitelli della Campania, 84014 Salerno, Italy; (A.D.); (P.C.)
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Andrea Barbieri
- Noninvasive Cardiology, University Hospital, 43100 Parma, Italy;
| | - Giovanni Benfari
- Cardiology Department, University of Verona, 37121 Verona, Italy;
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, S. Orsola-Malpighi Hospital, 40100 Bologna, Italy;
| | - Alessandro Malagoli
- Nephro-Cardiovascular Department, Division of Cardiology, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Francesca Bursi
- ASST Santi Paolo e Carlo, Presidio Ospedale San Paolo, 20100 Milano, Italy;
| | - Francesca Mantovani
- Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Cardiology, 42100 Reggio Emilia, Italy;
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy; (Q.C.); (B.V.)
| | - Antonello Russo
- Association for Public Health “Salute Pubblica”, 72100 Brindisi, Italy;
| | - Michele De Nes
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Clara Carpeggiani
- CNR, Biomedicine Department, Institute of Clinical Physiology, 56100 Pisa, Italy; (M.D.N.); (C.C.)
| | - Ines Monte
- Echocardiography Laboratory, Cardio-Thorax-Vascular Department, “ Policlinico Vittorio Emanuele”, Catania University, 95100 Catania, Italy;
| | - Federica Re
- Ospedale San Camillo, Cardiology Division, 00100 Rome, Italy;
| | - Carlos Cotrim
- Heart Center, Hospital da Cruz Vermelha, Lisbon, and Medical School of University of Algarve, 1549-008 Lisbon, Portugal;
| | - Giuseppe Bilardo
- UOC di Cardiologia, ULSS1 DOLOMITI, Presidio Ospedaliero di Feltre, 32032 Belluno, Italy;
| | - Ariel K. Saad
- División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires C1120, Argentina;
| | - Arnas Karuzas
- Ligence Medical Solutions, 49206 Vilnius, Lithuania; (A.K.); (D.M.)
| | | | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, 70100 Bari, Italy;
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
| | - Francesco Antonini-Canterin
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
- Cardiac Prevention and Rehabilitation Unit, Highly Specialized Rehabilitation Hospital Motta di Livenza, Motta di Livenza, 31045 Treviso, Italy
| | - Mauro Pepi
- Italian Society of Echocardiography and Cardiovascular Imaging, 20138 Milan, Italy; (F.A.-C.); (M.P.)
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Patricia A. Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.M.A.-O.); (G.C.K.); (H.R.V.); (R.P.); (P.A.P.)
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22
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Stojanovic D, Mitic V, Stojanovic M, Petrovic D, Ignjatovic A, Milojkovic M, Dunjic O, Milenkovic J, Bojanic V, Deljanin Ilic M. The Discriminatory Ability of Renalase and Biomarkers of Cardiac Remodeling for the Prediction of Ischemia in Chronic Heart Failure Patients With the Regard to the Ejection Fraction. Front Cardiovasc Med 2021; 8:691513. [PMID: 34395559 PMCID: PMC8358392 DOI: 10.3389/fcvm.2021.691513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Renalase has been implicated in chronic heart failure (CHF); however, nothing is known about renalase discriminatory ability and prognostic evaluation. The aims of the study were to assess whether plasma renalase may be validated as a predictor of ischemia in CHF patients stratified to the left ventricular ejection fraction (LVEF) and to determine its discriminatory ability coupled with biomarkers representing a range of heart failure (HF) pathophysiology: brain natriuretic peptide (BNP), soluble suppressor of tumorigenicity (sST2), galectin-3, growth differentiation factor 15 (GDF-15), syndecan-1, and cystatin C. Methods: A total of 77 CHF patients were stratified according to the LVEF and were subjected to exercise stress testing. Receiver operating characteristic curves were constructed, and the areas under curves (AUC) were determined, whereas the calibration was evaluated using the Hosmer-Lemeshow statistic. A DeLong test was performed to compare the AUCs of biomarkers. Results: Independent predictors for ischemia in the total HF cohort were increased plasma concentrations: BNP (p = 0.008), renalase (p = 0.012), sST2 (p = 0.020), galectin-3 (p = 0.018), GDF-15 (p = 0.034), and syndecan-1 (p = 0.024), whereas after adjustments, only BNP (p = 0.010) demonstrated predictive power. In patients with LVEF <45% (HFrEF), independent predictors of ischemia were BNP (p = 0.001), renalase (p < 0.001), sST2 (p = 0.004), galectin-3 (p = 0.003), GDF-15 (p = 0.001), and syndecan-1 (p < 0.001). The AUC of BNP (0.837) was statistically higher compared to those of sST2 (DeLong test: p = 0.042), syndecan-1 (DeLong: p = 0.022), and cystatin C (DeLong: p = 0.022). The AUCs of renalase (0.753), galectin-3 (0.726), and GDF-15 (0.735) were similar and were non-inferior compared to BNP, regarding ischemia prediction. In HFrEF patients, the AUC of BNP (0.980) was statistically higher compared to those of renalase (DeLong: p < 0.001), sST2 (DeLong: p < 0.004), galectin-3 (DeLong: p < 0.001), GDF-15 (DeLong: p = 0.001), syndecan-1 (DeLong: p = 0.009), and cystatin C (DeLong: p = 0.001). The AUC of renalase (0.814) was statistically higher compared to those of galectin-3 (DeLong: p = 0.014) and GDF-15 (DeLong: p = 0.046) and similar to that of sST2. No significant results were obtained in the patients with LVEF >45%. Conclusion: Plasma renalase concentration provided significant discrimination for the prediction of ischemia in patients with CHF and appeared to have similar discriminatory potential to that of BNP. Although further confirmatory studies are warranted, renalase seems to be a relevant biomarker for ischemia prediction, implying its potential contribution to ischemia-risk stratification.
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Affiliation(s)
- Dijana Stojanovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Valentina Mitic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Dejan Petrovic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Maja Milojkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Olivera Dunjic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Jelena Milenkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Vladmila Bojanic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marina Deljanin Ilic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
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23
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Wang C, Han S, Tong F, Li Y, Li Z, Sun Z. Predictive Value of the Serum Cystatin C/Prealbumin Ratio in Combination With NT-proBNP Levels for Long-Term Prognosis in Chronic Heart Failure Patients: A Retrospective Cohort Study. Front Cardiovasc Med 2021; 8:684919. [PMID: 34336949 PMCID: PMC8316687 DOI: 10.3389/fcvm.2021.684919] [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: 03/24/2021] [Accepted: 06/24/2021] [Indexed: 12/28/2022] Open
Abstract
Aim: The present study was established to investigate the use of the serum cystatin C/prealbumin (Cys-C/PAB) ratio as a predictive factor for long-term prognosis in patients with chronic heart failure. Methods: We divided our retrospective cohort of 6,311 patients admitted to hospital due to an episode of heart failure (HF) into three groups according to the Cys-C/PAB ratio. The endpoints were cardiovascular and all-cause mortality. Median follow-up time were 3.3 years (2–8 years), during which 2,945 (46.7%) patients died. Results: The Cys-C/PAB ratio was revealed to be an independent predictor of cardiovascular mortality (HR: 1.12, 95% CI: 1.15–1.23, P < 0.01) and all-cause mortality (HR: 1.19, 95% CI: 1.13–1.24, P < 0.01) by multivariable Cox analysis. Integrated discrimination improvement (IDI) showed that the Cys-C/PAB ratio in conjunction with the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) conferred a significant improvement in predicting individual risks of cardiovascular (P = 0.023) and all-cause (P = 0.028) mortality. For those with a high Cys-C/PAB ratio in combination with a high NT-proBNP level, the long-term cardiovascular mortality risk ratio was 8.6-times higher than for those with low values, and 7.51-times for all-cause mortality. Our study also showed that Cys-C/PAB and NT-proBNP in combination displayed higher value for the prediction of cardiovascular and all-cause in-hospital mortality in patients with HF. Conclusions: The Cys-C/PAB ratio is valuable for predicting cardiovascular and all-cause mortality in patients with HF and offers additional information to that provided by NT-proBNP.
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Affiliation(s)
- Chuanhe Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Su Han
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhichao Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
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24
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Pugliese NR, DE Biase N, Balletti A, Filidei F, Pieroni A, D'Angelo G, Armenia S, Mazzola M, Gargani L, Del Punta L, Asomov M, Cerri E, Franzoni F, Nesti L, Mengozzi A, Paneni F, Masi S. Characterisation of haemodynamic and metabolic abnormalities in the heart failure spectrum: the role of combined cardiopulmonary and exercise echocardiography stress test. Minerva Cardiol Angiol 2021; 70:370-384. [PMID: 34137244 DOI: 10.23736/s2724-5683.21.05743-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heart failure (HF) is a complex clinical syndrome characterised by different etiologies and a broad spectrum of cardiac structural and functional abnormalities. Current guidelines suggest a classification based on left ventricular ejection fraction (LVEF), distinguishing HF with reduced (HFrEF) from preserved (HFpEF) LVEF. HF should also be thought of as a continuous range of conditions, from asymptomatic stages to clinically manifest syndrome. The transition from one stage to the next is associated with a worse prognosis. While the rate of HF-related hospitalisation is similar in HFrEF and HFpEF once clinical manifestations occur, accurate knowledge of the steps and risk factors leading to HF progression is still lacking, especially in HFpEF. Precise hemodynamic and metabolic characterisation of patients with or at risk of HF may help identify different disease trajectories and risk factors, with the potential to identify specific treatment targets that might offset the slippery slope towards overt clinical manifestations. Exercise can unravel early metabolic and haemodynamic alterations that might be silent at rest, potentially leading to improved risk stratification and more effective treatment strategies. Cardiopulmonary exercise testing (CPET) offers valuable aid to investigate functional alterations in subjects with or at risk of HF, while echocardiography can assess cardiac structure and function objectively, both at rest and during exercise (exercise stress echocardiography, ESE). The purpose of this narrative review is to summarise the potential advantages of using an integrated CPET-ESE evaluation in the characterisation of both subjects at risk of developing HF and patients with stable HF.
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Affiliation(s)
- Nicola R Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy -
| | - Nicolò DE Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Pieroni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Institute of Clinical Physiology, C.N.R., Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, C.N.R., Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Muzaffar Asomov
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eugenio Cerri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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25
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Huttin O, Fraser AG, Lund LH, Donal E, Linde C, Kobayashi M, Erdei T, Machu J, Duarte K, Rossignol P, Paulus W, Zannad F, Girerd N. Risk stratification with echocardiographic biomarkers in heart failure with preserved ejection fraction: the media echo score. ESC Heart Fail 2021; 8:1827-1839. [PMID: 33656803 PMCID: PMC8120404 DOI: 10.1002/ehf2.13251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Echocardiographic predictors of outcomes in heart failure with preserved ejection fraction (HFpEF) have not been systematically or independently validated. We aimed at identifying echocardiographic predictors of cardiovascular events in a large cohort of patients with HFpEF and to validate these in an independent large cohort. METHODS AND RESULTS We assessed the association between echocardiographic parameters and cardiovascular outcomes in 515 patients with heart failure with preserved left ventricular (LV) ejection fraction (>50%) in the MEtabolic Road to DIAstolic Heart Failure (MEDIA) multicentre study. We validated out findings in 286 patients from the Karolinska-Rennes Prospective Study of HFpEF (KaRen). After multiple adjustments including N-terminal pro-brain natriuretic peptide (NT-proBNP), the significant predictors of death or cardiovascular hospitalization were pulmonary arterial systolic pressure > 40 mmHg, respiratory variation in inferior vena cava diameter > 0.5, E/e' > 9, and lateral mitral annular s' < 7 cm/s. The combination of these four variables differentiated patients with <10% vs. >35% 1 year risk. Adding these four echocardiographic variables on top of clinical variables and NT-proBNP yielded significant net reclassification improvement (33.8%, P < 0.0001) and increase in C-index (5.3%, a change from 72.2% to 77.5%, P = 0.015) of similar magnitude as the addition of NT-proBNP on top of clinical variables alone. In the KaRen cohort, these four variables yielded a similar improvement in net reclassification improvement (22.3%, P = 0.014) and C-index (4.0%, P = 0.029). CONCLUSIONS Use of four simple echocardiographic parameters (within the MEDIA echo score), indicative of pulmonary hypertension, elevated central venous pressure, LV diastolic dysfunction, and LV long-axis systolic dysfunction, independently predicted prognosis and improved risk stratification additionally to clinical variables and NT-proBNP in HFpEF. This finding was validated in an independent cohort.
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Affiliation(s)
- Olivier Huttin
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux Louis MathieuCentre Hospitalier Universitaire de Nancy4 Rue du MorvanNancy54500France
| | | | - Lars H. Lund
- Department of MedicineKarolinska InstitutetSolnaSweden
- Department of CardiologyKarolinska University HospitalSolnaSweden
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI‐UMR 1099University of RennesRennesFrance
| | - Cecilia Linde
- Department of MedicineKarolinska InstitutetSolnaSweden
- Department of CardiologyKarolinska University HospitalSolnaSweden
| | - Masatake Kobayashi
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Tamas Erdei
- School of MedicineCardiff UniversityCardiffUK
| | - Jean‐Loup Machu
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Kevin Duarte
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Patrick Rossignol
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Walter Paulus
- Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Faiez Zannad
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Nicolas Girerd
- Inserm, Centre d'Investigations Cliniques‐Plurithématique 1433Inserm U1116, CHRU Nancy, Université de Lorraine, and F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux Louis MathieuCentre Hospitalier Universitaire de Nancy4 Rue du MorvanNancy54500France
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26
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Siriopol D, Popa R, Mihaila M, Rusu F, Sascau R, Statescu C, Cătălina Z, Vasiliu V, Bucur A, Neamtu A, Siriopol I, Cianga P, Kanbay M, Covic A. Application of survival classification and regression tree analysis for identification of subgroups of risk in patients with heart failure and reduced left ventricular ejection fraction. Int J Cardiovasc Imaging 2021; 37:1853-1861. [DOI: 10.1007/s10554-021-02159-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
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27
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Picano E, Zagatina A, Wierzbowska-Drabik K, Borguezan Daros C, D’Andrea A, Ciampi Q. Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography. J Clin Med 2020; 9:E3184. [PMID: 33008112 PMCID: PMC7601661 DOI: 10.3390/jcm9103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease (CAD). In the last five years much has changed and RWMA is not enough on its own to stratify patient risk and dictate therapy. Patients arriving at SE labs often have comorbidities and are undergoing full anti-ischemic therapy. The SE positivity rate based on RWMA fell from 70% in the eighties to 10% in the last decade. The understanding of CAD pathophysiology has shifted from a regional hydraulic disease to a systemic biologic disease. The conventional view of CAD encouraged the use of coronary anatomic imaging for diagnosis and the oculo-stenotic reflex for the deployment of therapy. This has led to a clinical oversimplification that ignores the lessons of pathophysiology and epidemiology, and in fact, CAD is not synonymous with ischemic heart disease. Patients with CAD may also have other vulnerabilities such as coronary plaque (step A of ABCDE-SE), alveolar-capillary membrane and pulmonary congestion (step B), preload and contractile reserve (step C), coronary microcirculation (step D) and cardiac autonomic balance (step E). The SE methodology based on two-dimensional echocardiography is now integrated with lung ultrasound (step B for B-lines), volumetric echocardiography (step C), color- and pulsed-wave Doppler (step D) and non-imaging electrocardiogram-based heart rate assessment (step E). In addition, qualitative assessment based on the naked eye has now become more quantitative, has been improved by contrast and based on cardiac strain and artificial intelligence. ABCDE-SE is now ready for large scale multicenter testing in the SE2030 study.
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Affiliation(s)
- Eugenio Picano
- Biomedicine Department, CNR Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Angela Zagatina
- Cardiology Department, Saint Petersburg State University Clinic, Saint Petersburg State University, 199034 Saint Petersburg, Russia;
| | - Karina Wierzbowska-Drabik
- First Department and Chair of Cardiology, Bieganski Hospital, Medical University, 90926 Lodz, Poland;
| | | | | | - Quirino Ciampi
- Cardiolody Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
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