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Sooriyakanthan M, Graham FJ, Ho N, Leong-Poi H, Tsang W. Alterations in Left Atrial and Ventricular Coupling in Mixed Aortic Valve Disease. Eur Heart J Cardiovasc Imaging 2024:jeae199. [PMID: 39119781 DOI: 10.1093/ehjci/jeae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/05/2024] [Accepted: 08/07/2024] [Indexed: 08/10/2024] Open
Abstract
AIMS To characterize left atrial (LA) and left ventricular (LV) function and atrioventricular (AV) coupling in patients with moderate mixed aortic valve disease (MMAVD) against those with isolated moderate or severe aortic valve disease and controls. METHODS & RESULTS Retrospective LA and LV peak longitudinal strain (LS) analysis were performed on 260 patients (46 MMAVD, 81 moderate aortic stenosis (AS), 50 severe AS, 48 moderate aortic regurgitation (AR), and 35 severe AR) and 66 controls. Peak LV and LA LS and AV coupling, assessed by combined peak LA and LV strain, was compared between the groups. ANOVA and 2-sided t-tests were used and a p-value of <0.01 was considered significant.LV strain was significantly lower in those with MMAVD compared to controls and those with moderate or severe isolated AR but comparable to those with moderate or severe AS (-17.1±1.1% MMAVD vs. -17.7±1.5% moderate AS p=0.02; vs. -17.0%±1.5% severe AS, p=0.74). AV coupling was significantly lower in those with MMAVD compared to controls and those with moderate AS or AR but comparable to those with severe AS or AR (47.1±6.8% MMAVD vs. 45.1±5.6% severe AS, p=0.13; vs. 50.4±9% severe AR, p=0.07). CONCLUSIONS Impairments in AV coupling are comparable for patients with MMAVD and those with severe isolated AS or AR. Impairments in LV GLS in MMAVD mirror those found in severe AS. These findings suggest that haemodynamic consequences and adverse remodelling are similar for patients with MMAVD and isolated severe disease.
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Affiliation(s)
- Maala Sooriyakanthan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Fraser J Graham
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Natalie Ho
- The Scarborough Health Network, Toronto, Canada
| | | | - Wendy Tsang
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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Verwerft J, Stassen J, Falter M, Bekhuis Y, Hoedemakers S, Gojevic T, Ferreira SM, Vanhentenrijk S, Stroobants S, Jogani S, Hansen D, Jasaityte R, Cosyns B, Van De Bruaene A, Bertrand PB, de Boer RA, Gevaert AB, Verbrugge FH, Herbots L, Claessen G. Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2024; 13:e032228. [PMID: 39028104 DOI: 10.1161/jaha.123.032228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/19/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Half of patients with heart failure with preserved ejection fraction (HFpEF) remain undiagnosed by resting evaluation alone. Therefore, exercise testing is proposed. The diastolic stress test (DST), however, has limited sensitivity. We aimed to determine the clinical significance of adding the mean pulmonary artery pressure over cardiac output (mPAP/CO) slope to the DST in suspected HFpEF. METHODS AND RESULTS In this prospective cohort study, consecutive patients (n=1936) with suspected HFpEF underwent exercise echocardiography with simultaneous respiratory gas analysis. These patients were stratified by exercise E over e' (exE/e') and mPAP/CO slope, and peak oxygen uptake, natriuretic peptides (NT-proBNP [N-terminal pro-B-type natriuretic peptide]), and score-based HFpEF likelihood were compared. Twenty-two percent of patients (n=428) had exE/e'<15 despite a mPAP/CO slope>3 mm Hg/L per min, 24% (n=464) had a positive DST (exE/e'≥15), and 54% (n=1044) had a normal DST and slope. Percentage of predicted oxygen uptake was similar in the group with exE/e'<15 but high mPAP/CO slope and the positive DST group (-2% [-5% to +1%]), yet worse than in those with normal DST and slope (-12% [-14% to -9%]). Patients with exE/e'<15 but a high slope had NT-proBNP levels and H2FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder; filling pressure) scores intermediate to the positive DST group and the group with both a normal DST and slope. CONCLUSIONS Twenty-two percent of patients with suspected HFpEF presented with a mPAP/CO slope>3 mm Hg/L per min despite a negative DST. These patients had HFpEF characteristics and a peak oxygen uptake as low as patients with a positive DST. Therefore, an elevated mPAP/CO slope might indicate HFpEF irrespective of the DST result.
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Affiliation(s)
- Jan Verwerft
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Jan Stassen
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Maarten Falter
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Youri Bekhuis
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
- Centre for Cardiovascular Diseases University Hospital Brussels Jette Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
- Department of Cardiology Ziekenhuis-Oost Limburg Genk Belgium
- Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Sarah Hoedemakers
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
- Centre for Cardiovascular Diseases University Hospital Brussels Jette Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
| | - Tin Gojevic
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
| | - Sara Moura Ferreira
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Simon Vanhentenrijk
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Centre for Cardiovascular Diseases University Hospital Brussels Jette Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
| | - Sarah Stroobants
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Siddharth Jogani
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences REVAL/BIOMED, Hasselt University Hasselt Belgium
| | - Ruta Jasaityte
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Bernard Cosyns
- Centre for Cardiovascular Diseases University Hospital Brussels Jette Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
| | - Alexander Van De Bruaene
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Philippe B Bertrand
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
- Department of Cardiology Ziekenhuis-Oost Limburg Genk Belgium
| | | | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department University of Antwerp Belgium
- Department of Cardiology Antwerp University Hospital (UZA) Edegem Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases University Hospital Brussels Jette Belgium
- Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium
| | - Lieven Herbots
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
| | - Guido Claessen
- Department of Cardiology Jessa Hospital Hasselt Belgium
- Faculty of Medicine and Life Sciences Biomedical Research Institute, Hasselt University Hasselt Belgium
- Department of Cardiovascular Sciences KU Leuven Leuven Belgium
- Faculty of Rehabilitation Sciences REVAL/BIOMED, Hasselt University Hasselt Belgium
- Baker Heart and Diabetes Institute Melbourne Australia
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3
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Mangia M, D'Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J Cardiovasc Dev Dis 2024; 11:241. [PMID: 39195149 DOI: 10.3390/jcdd11080241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
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Affiliation(s)
- Mario Mangia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Emilio D'Andrea
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Stefano Nistri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
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Avcı Demir F, Bingöl G, Uçar M, Özden Ö, Özmen E, Tüner H, Nasifov M, Ünlü S. Left Atrial Coupling Index Predicts Heart Failure in Patients with End Stage Renal Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1195. [PMID: 39202477 PMCID: PMC11356076 DOI: 10.3390/medicina60081195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a' wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments.
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Affiliation(s)
- Fulya Avcı Demir
- Department of Cardiology, Medical Park Hospital, 07160 Antalya, Turkey
- Department of Cardiology, Istinye University, 34010 Istanbul, Turkey
| | - Gülsüm Bingöl
- Department of Cardiology, Istanbul Arel University, 34537 Istanbul, Turkey;
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Mustafa Uçar
- Department of Cardiology, Celal Bayar University, 45140 Manisa, Turkey;
| | - Özge Özden
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Emre Özmen
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Haşim Tüner
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Muharrem Nasifov
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Serkan Ünlü
- Department of Cardiology, Gazi University, 06570 Ankara, Turkey;
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Ji L, Gao X, Xiao W, Yu S. Assessment of left atrial function provides incremental value: the left atrial volumetric/mechanical coupling index in patients with chronic kidney disease. Front Cardiovasc Med 2024; 11:1407531. [PMID: 39045007 PMCID: PMC11265283 DOI: 10.3389/fcvm.2024.1407531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
Background Heart failure is a common cause of adverse cardiovascular outcomes in patients with chronic kidney disease (CKD). Left atrial (LA) characteristics are thought to be involved in the development of heart failure. However, LA assessment is complex. Though a variety of parameters have been defined, there is no single parameter that best defines LA function. Pilot data indicate that left atrial volumetric/mechanical coupling index (LACI) may be useful, but data with CKD are lacking. Aim The objective of this study was to define LACI in a cohort of patients with CKD and to assess its value in evaluating LA function and predicting heart failure. Methods A cohort of patients with CKD was enrolled at our hospital between 2021 and 2023. Follow-up was performed for heart failure. LACI is a volumetric to mechanical coupling index, calculated as the ratio of the LA volume index to the tissue-Doppler myocardial velocity at atrial contraction. Spearman's rank correlation or Pearson's correlation was used to calculate the correlation between LACI and echocardiographic/hemodynamic variables. Receiver operating characteristic curve (ROC) analysis was utilised to derive the area under the curve (AUC) for LACI, LVGLS, LASr, LASct and LASI for the detection of heart failure. Kaplan-Meier survival curves were employed to compare clinical outcomes based on LACI thresholds. A multivariable logistic regression analysis was employed to assess the relationship between risk factors and elevated LACI. Cox proportional hazards regression was used to identify risk factors for heart failure. Results LACI showed a positive correlation with NT-proBNP, CK-MB, LAVI, E/e' and LASI (r = 0.504, 0.536, 0.856, 0.541 and 0.509, p < 0.001); and a negative correlation with LASr (r = -0.509, p < 0.001). On the ROC analysis for the determination of heart failure, the AUC of LACI was comparable to those of LVGLS (0.588 vs. 509, p = 0.464), LASr (0.588 vs. 0.448, p = 0.132), LASct (0.588 vs. 0.566, p = 0.971) and LASI (0.588 vs. 0.570, p = 0.874). The cardiovascular risk factors increased by LACI were age, BMI, diabetes, triglycerides, LA size, LASr, LASI, E/A, E/e' and EF (p < 0.05). During a median follow-up of 16 months (range, 6-28 months), the event-free survival curves demonstrated a higher risk of heart failure in the group with LACI > 5.0 (log-rank test: P < 0.001). LACI > 5.0 was an independent predictor of heart failure [OR: 0.121, 95% CI (0.020-0.740), p = 0.022]. Conclusion LACI may prove to be a valuable tool for assessing LA function in patients with CKD, and could be integrated into the routine assessment of LA for the purpose of prognostic assessment and clinical decision-making in patients with CKD.
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Affiliation(s)
- Liqin Ji
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Xue Gao
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Weiwei Xiao
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Shaomei Yu
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Fortuni F, Biagioli P, Myagmardorj R, Mengoni A, Chua AP, Zuchi C, Sforna S, Bax J, Ajmone Marsan N, Ambrosio G, Carluccio E. Left Atrioventricular Coupling Index: A Novel Diastolic Parameter to Refine Prognosis in Heart Failure. J Am Soc Echocardiogr 2024:S0894-7317(24)00341-9. [PMID: 38950757 DOI: 10.1016/j.echo.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Left atrioventricular coupling index (LACI), an index coupling left atrial to left ventricular (LV) volume at end-diastole, has been shown to be associated with prognosis in different clinical settings. However, the relation between LACI and LV diastolic dysfunction (DD) remains to be established. The aims of the present study were to investigate the association between LACI and LV DD and to assess its prognostic value in patients with heart failure (HF). METHODS A total of 1,158 patients with HF in stable condition, on optimal medical therapy, were retrospectively analyzed (derivation cohort). Clinical and echocardiographic features were characterized across LACI tertiles. The independent prognostic value of LACI (end point: all-cause death or HF hospitalization) was assessed using Cox regression. Results were validated in an external cohort of 242 patients with HF. RESULTS In the derivation cohort, the median LACI value was 0.29 (interquartile range, 0.19-0.42). Patients in the third tertile (LACI > 0.36) were older and presented with more advanced HF symptoms. Although the prevalence of grade 1 DD (American Society of Echocardiography/European Association of Cardiovascular Imaging classification) progressively decreased across LACI tertiles, the prevalence of grade 3 DD significantly increased (8%, 23%, and 46%, respectively; P < .0001). A cutoff value of ≥0.26 identified moderate to severe DD with an area under the curve of 0.75. During follow-up (median, 28 months; interquartile range, 11-53 months), 407 patients (35%) reached the end point. On multivariable analysis, LACI was independently associated with outcomes (hazard ratio for a 1-SD increase, 1.16; 95% CI, 1.06-1.28; P = .002), showing incremental predictive value over the DD grading system (net reclassification improvement = 0.150, P < .0001). The prognostic value of LACI was consistent in the external validation cohort. CONCLUSIONS LACI is associated with DD severity and is an independent predictor of outcomes in patients with HF.
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Affiliation(s)
- Federico Fortuni
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Paolo Biagioli
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Aileen Paula Chua
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cinzia Zuchi
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Stefano Sforna
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy; Center for Clinical and Translational Research, University of Perugia, Perugia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
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Pai RG, Varadarajan P. Diastolic Heart Failure Mechanisms and Assessment Revisited. J Clin Med 2024; 13:3043. [PMID: 38892754 PMCID: PMC11172756 DOI: 10.3390/jcm13113043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/22/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
The syndrome of heart failure (HF) with preserved ejection fraction (HFpEF) makes up about half of the HF population. The HF mechanisms in these patients are varied and not fully understood. In addition, the term "diastolic HF" was switched to HFpEF because of difficulties in measuring the left ventricular (LV) diastolic performance. In the late stages, HFpEF carries a prognosis that is as bad as or worse than that of HFrEF. Hence, it is important to recognize LV diastolic impairment at an earlier stage so that the causal mechanisms, if any, can be treated to retard its progression. Despite the availability of numerous disease-modifying agents for HFrEF, there are hardly any available treatments for HFpEF. With our aging population, there will be an epidemic of HFpEF and hence this entity needs attention and respect. In this paper, we review the fundamental mechanisms of HFpEF, the physiology of LV filling and how LV diastolic function can be comprehensively measured. We also speculate how this may help with the early recognition of diastolic HF and its treatment.
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Affiliation(s)
- Ramdas G. Pai
- Department of Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA;
- Department of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
| | - Padmini Varadarajan
- Department of Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA;
- Department of Medicine, California University of Science and Medicine, Colton, CA 92324, USA
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8
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Bursi F, Enriquez-Sarano M. The Left Atrium: Passive Receptacle or Active Contributor to Mitral Regurgitation Severity and Outcome. JACC Case Rep 2024; 29:102195. [PMID: 38361572 PMCID: PMC10865207 DOI: 10.1016/j.jaccas.2023.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Francesca Bursi
- University of Milan, Department of Health Sciences, Division of Cardiology, San Paolo Hospital, Milan, Italy
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9
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Teis A, Delgado V. Artificial Intelligence, Left Atrial Ventricular Coupling Index, and Stress Cardiac Magnetic Resonance: An Interesting Combination. JACC Cardiovasc Imaging 2023; 16:1303-1305. [PMID: 37204385 DOI: 10.1016/j.jcmg.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Albert Teis
- Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Victoria Delgado
- Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.
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10
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Costanzo MR, Marwick TH. Right Atrium as Barometer of Right Ventricular Stiffness and Treatment Responsiveness in Precapillary Pulmonary Hypertension. J Am Coll Cardiol 2023; 82:718-720. [PMID: 37587583 DOI: 10.1016/j.jacc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/18/2023]
Affiliation(s)
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. https://twitter.com/Tom_marwick
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Benfari G, Skaarup KG, Johansen ND, Jensen G, Schnohr P, Møgelvang R, Nistri S, Biering-Sørensen T. Left Atrial Volumetric/Mechanical Coupling Index in the General Population: Distribution and Prediction of Incident Atrial Fibrillation: From the Copenhagen City Heart Study. J Am Soc Echocardiogr 2023; 36:339-341. [PMID: 36460212 DOI: 10.1016/j.echo.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
| | | | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Jensen
- Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter Schnohr
- Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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12
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Wang Y, Yang M, Zhang J, Ren J, Liu N, Liu B, Lu L, Yang B. S-Doped carbonized polymer dots inhibit early myocardial fibrosis by regulating mitochondrial function. Biomater Sci 2023; 11:894-907. [PMID: 36524407 DOI: 10.1039/d2bm00578f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Myocardial fibrosis (MF) is a critical pathological lesion in the progression of various acute and chronic cardiovascular diseases. However, there is still a lack of clinically effective drugs and treatments for MF therapies. Herein, for the first time, we developed fluorescent sulfur-doped carbonized polymer dots (S-CPDs) as new nano-antioxidants to reduce the cardiomyocyte damage caused by reactive oxygen species (ROS) in the early stage of fibrotic lesions. In vitro results suggested that the pre-protection of S-CPDs significantly increased the survival rate of H9c2 cells under severe oxidative stress, inhibited the isoproterenol (ISO)-induced hypertrophy of myocardial cells through improving the content of mitochondria related proteins and adenosine triphosphate (ATP) in cells. Moreover, S-CPD administration could effectively decrease cardiac hypertrophy and promote heart function in MF rat models. The rapid internalization, high biocompatibility and fluorescence imaging potential of S-CPDs revealed their promising application prospects in the diagnoses and treatments of cardiovascular diseases.
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Affiliation(s)
- Yiran Wang
- Department of Cardiology, The Second Hospital of Jilin University, Changchun 130021, P.R. China.
| | - Mingxi Yang
- Department of Hand Surgery, The First Hospital of Jilin University, Changchun 130021, P.R. China. .,State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China.
| | - Jiayi Zhang
- Department of Hand Surgery, The First Hospital of Jilin University, Changchun 130021, P.R. China.
| | - Jingyan Ren
- Department of Hand Surgery, The First Hospital of Jilin University, Changchun 130021, P.R. China.
| | - Ning Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun 130021, P.R. China.
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun 130021, P.R. China.
| | - Laijin Lu
- Department of Hand Surgery, The First Hospital of Jilin University, Changchun 130021, P.R. China.
| | - Bai Yang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, P.R. China.
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13
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Left atrial strain determinants and clinical features according to the heart failure stages. New insight from EACVI MASCOT registry. Int J Cardiovasc Imaging 2022; 38:2635-2644. [DOI: 10.1007/s10554-022-02669-x] [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: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
AbstractFew studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. This is a multicenter prospective observational study enrolling 745 patients with HF stages. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window. Median global PALS was 17% [24–32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R2 = 0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta: −3.60 ± 0.20, p < 0.0001). Among HF stages, LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R = − 0.26 p < 0.0001, R = − 0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0/A (R = − 0.11; P = 0.1) to C (R = − 0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting the HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e′ ratio, and mitral regurgitation grade (p < 0.0001). Although influenced by LV-GLS and LA size across HF stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction.
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14
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Meucci MC, Fortuni F, Galloo X, Bootsma M, Crea F, Bax JJ, Marsan NA, Delgado V. Left atrioventricular coupling index in hypertrophic cardiomyopathy and risk of new-onset atrial fibrillation. Int J Cardiol 2022; 363:87-93. [PMID: 35716931 DOI: 10.1016/j.ijcard.2022.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUNDS This study aimed to investigate the association between left atrioventricular coupling index (LACI) and the occurrence of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). METHODS A total of 373 patients with HCM and no history of AF were evaluated by transthoracic echocardiography. LACI was defined by the ratio of left atrial (LA) end-diastolic volume divided by left ventricular (LV) end-diastolic volume. The cut-off value for LACI (≥40%) to identify LA-LV uncoupling was chosen based on the risk excess of new-onset AF described with a spline curve analysis. RESULTS The median LACI was 37.5% (IQR: 24.4-56.7) and LA-LV uncoupling (LACI ≥40%) was observed in 171 (45.8%) patients. During a median follow-up of 11 (IQR 7-15) years, 118 (31.6%) subjects developed new-onset AF. The cumulative event-free survival at 10 years was 53% for patients with LA-LV uncoupling versus 94% for patients without LA-LV uncoupling (p < 0.001). Multivariable Cox regression analyses performed separately for each LA parameter showed an independent association between new-onset AF and LACI (hazard ratio [HR], 1.021; 95% CI, 1.017-1.026), LA maximum volume indexed (HR, 1.028; 95% CI, 1.017-1.039), LA minimum volume indexed (HR, 1.047; 95% CI, 1.037-1.060) and LA emptying fraction (HR, 0.967; 95% CI, 0.959-0.977, all p < 0.001). The inclusion of LACI in the multivariate model provided a larger improvement in the risk stratification for new-onset AF, as compared to conventional LA parameters. CONCLUSION In patients with HCM, LACI was more predictive of the occurrence of new-onset AF than conventional LA parameters.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Cardiology, Brussels, Belgium
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Hospital University Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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15
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Iliadis C, Kalbacher D, Lurz P, Petrescu AM, Orban M, Puscas T, Lupi L, Stazzoni L, Pires-Morais G, Koell B, Besler C, Ruf TF, Stolz L, Tence N, Adamo M, Giannini C, Guerreiro C, Hellmich M, Baldus S, Schofer N, Thiele H, von Bardeleben RS, Hausleiter J, Karam N, Metra M, Petronio AS, Melica B, Pfister R. Left Atrial Volume Index and Outcome after Transcatheter Edge-to-edge Valve Repair for Secondary Mitral Regurgitation. Eur J Heart Fail 2022; 24:1282-1292. [PMID: 35642951 DOI: 10.1002/ejhf.2565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To investigate the role of left atrial (LA) volume index in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (TEER). METHODS Outcomes were evaluated in SMR patients of a European multicenter registry according to baseline left atrial volume index (LAVi). Main analysis was performed for all-cause mortality; residual MR and NYHA class improvement were analyzed for patients available. RESULTS 1,074 patients were included with a median LAVi (interquartile range) of 58 ml/m2 (46-73). Postprocedural reduction of MR grade to ≤2+ was similar across LAVi quintiles, ranging 91%-96% (p=0.26). Symptomatic benefit (≥1 NYHA class improvement) also did not differ by LAVi quintiles (61%-68% of patients) (p=0.66). The risk of mortality increased by 23% to 42% in the four upper quintiles compared to the bottom quintile (LAVi <42ml/m2 ). The hazard ratio of mortality was 1.35 (95%-CI 1.02-1.78, p=0.035) associated with a LAVi >42ml/m2 , which was attenuated after multivariable adjustment (1.18, 95%-CI 0.83-1.67, p=0.36). A significant interaction was found for MR severity and pulmonary hypertension, with an increased risk of death associated with enlarged LAVi in patients with inframedian effective regurgitation orifice area (EROA, HR 1.99, 95%-CI 1.06-3.74, p=0.032) and in patients with systolic pulmonary pressure ≤50 mmHg (HR 1.67, 95%-CI 1.02-2.75, p=0.042) in multivariable analysis. CONCLUSION Procedural success and symptomatic benefit were high throughout the whole range of LAVi. The prognostic impact of LA enlargement was relevant in patients with less severe SMR and without pulmonary hypertension, reinforcing the need to identify patients in the early course of backward congestion to achieve good long-term outcome after TEER.
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Affiliation(s)
- Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Aniela Monica Petrescu
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tania Puscas
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Laura Lupi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Laura Stazzoni
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tobias Friedrich Ruf
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Noemie Tence
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ralph Stephan von Bardeleben
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Nicole Karam
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
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16
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Essayagh B, Benfari G, Antoine C, Maalouf J, Pislaru S, Thapa P, Michelena HI, Enriquez‐Sarano M. Incremental Prognosis by Left Atrial Functional Assessment: The Left Atrial Coupling Index in Patients With Floppy Mitral Valves. J Am Heart Assoc 2022; 11:e024814. [PMID: 35470696 PMCID: PMC9238580 DOI: 10.1161/jaha.121.024814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
Background Emerging data suggest important prognostic value to left atrial (LA) characteristics, but the independent impact of LA function on outcome remains unsubstantiated. Thus, we aimed to define the incremental prognostic value of LA coupling index (LACI), coupling volumetric and mechanical LA characteristics and calculated as the ratio of left atrial volume index to tissue Doppler imaging a', in a large cohort of patients with isolated floppy mitral valve. Methods and Results All consecutive 4792 patients (61±16 years, 48% women) with isolated floppy mitral valve in sinus rhythm diagnosed at Mayo Clinic from 2003 to 2011, comprehensively characterized and with prospectively measured left atrial volume index and tissue Doppler imaging a' in routine practice, were enrolled, and their long-term survival analyzed. Overall, LACI was 5.8±3.7 and was <5 in 2422 versus ≥5 in 2370 patients. LACI was independently higher with older age, more mitral regurgitation (no 3.8±2.3, mild 5.1±3.0, moderate 6.5±3.8, and severe 7.8±4.3), and with diastolic (higher E/e') and systolic (higher end-systolic dimension) left ventricular dysfunction (all P≤0.0001). At diagnosis, higher LACI was associated with more severe presentation (more dyspnea, more severe functional tricuspid regurgitation, and elevated pulmonary artery pressure, all P≤0.0001) independently of age, sex, comorbidity index, ventricular function, and mitral regurgitation severity. During 7.0±3.0 years follow-up, 1146 patients underwent mitral valve surgery (94% repair, 6% replacement), and 880 died, 780 under medical management. In spline curve analysis, LACI ≥5 was identified as the threshold for excess mortality, with much reduced 10-year survival under medical management (60±2% versus 85±1% for LACI <5, P<0.0001), even after comprehensive adjustment (adjusted hazard ratio, 1.30 [95% CI, 1.10-1.53] for LACI ≥5; P=0.002). Association of LACI ≥5 with higher mortality persisted, stratifying by mitral regurgitation severity of LA enlargement grade (all P<0.001) and after propensity-score matching (P=0.02). Multiple statistical methods confirmed the significant incremental predictive power of LACI over left atrial volume index (all P<0.0001). Conclusions LA functional assessment by LACI in routine practice is achievable in a large number of patients with floppy mitral valve using conventional Doppler echocardiographic measurements. Higher LACI is associated with worse clinical presentation, but irrespective of baseline characteristics, LACI is strongly, independently, and incrementally determinant of outcome, demonstrating the crucial importance of LA functional response to mitral valve disease.
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Affiliation(s)
- Benjamin Essayagh
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Cardiovascular MedicineSimone Veil HospitalCannesFrance
| | - Giovanni Benfari
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Department of Cardiovascular MedicineUniversity of VeronaVeronaItaly
| | | | - Joseph Maalouf
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Sorin Pislaru
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Prabin Thapa
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | | | - Maurice Enriquez‐Sarano
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Minneapolis Heart InstituteMinneapolisMN
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17
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Malagoli A, Rossi L, Zanni A, Sticozzi C, Piepoli MF, Benfari G. Quantified mitral regurgitation and left atrial function in heart failure with reduced ejection fraction: interplay and outcome implications. Eur J Heart Fail 2022; 24:694-702. [PMID: 35014120 DOI: 10.1002/ejhf.2429] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS The clinical and prognostic importance of functional mitral regurgitation (FMR) in heart failure patients with reduced ejection fraction (HFrEF) has been highly debated. This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with left atrial (LA) function in a prospective cohort of consecutive HFrEF outpatients. METHODS AND RESULTS Overall, 286 consecutive outpatients with chronic HFrEF were prospectively enrolled. FMR was quantified by effective regurgitant orifice area (EROA). Global peak atrial longitudinal strain (PALS) was measured by speckle tracking echocardiography. The primary endpoint was a composite of congestive heart failure hospitalization or CV death. During a mean follow-up of 4.1 ± 1.5 years, the primary endpoint occurred in 99 patients (35%). The spline modelling of the risk by FMR severity showed an excess event risk starting at about the EROA value of 0.1 cm2 . There was a remarkable graded association between the EROA strata, even if tested per 0.1 cm2 increase, and the risk of CV events (hazard ratio [HR] EROA per 0.10 cm2 increase: 1.42, 95% confidence interval [CI] 1.19-1.68; p < 0.0001). EROA ≥0.30 cm2 was associated with CV events regardless of LA function (HR 2.34, 95% CI 1.29-4.19; p = 0.005). Less severe FMR (EROA ≥0.10 cm2 ) was associated with a dismal outcome only in patients with reduced LA function (PALS <14%) (5-year CV event rate 51 ± 4%); conversely, the risk of events was relative reduced when preserved global PALS and FMR coexisted (5-year CV event rate 38 ± 6%). CONCLUSIONS Our results refine the independent association between FMR and CV outcome among HFrEF outpatients. Within a moderate EROA range, LA function mitigates the clinical consequences of mitral regurgitation, providing measurable proof of the interplay between regurgitation and LA compliance.
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Affiliation(s)
- Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Rossi
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Alessia Zanni
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Massimo F Piepoli
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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18
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Pezel T, Ambale-Venkatesh B, Quinaglia T, Heckbert SR, Kato Y, de Vasconcellos HD, Wu CO, Post WS, Henry P, Bluemke DA, Lima JAC. Change in Left Atrioventricular Coupling Index to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA). Radiology 2022; 303:317-326. [PMID: 35191736 PMCID: PMC9081516 DOI: 10.1148/radiol.210315] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results Among the 1911 participants (mean age, 59 years ± 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years ± 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P < .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P < .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P < .001). Conclusion Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leiner in this issue.
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Affiliation(s)
- Théo Pezel
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Bharath Ambale-Venkatesh
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Thiago Quinaglia
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Susan R Heckbert
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Yoko Kato
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Henrique Doria de Vasconcellos
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Colin O Wu
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Wendy S Post
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - Patrick Henry
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - David A Bluemke
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
| | - João A C Lima
- From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.)
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Pezel T, Ambale Venkatesh B, Kato Y, De Vasconcellos HD, Heckbert SR, Wu CO, Post WS, Bluemke DA, Cohen-Solal A, Henry P, Lima JAC. Left Atrioventricular Coupling Index to Predict Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2021; 8:704611. [PMID: 34540915 PMCID: PMC8442844 DOI: 10.3389/fcvm.2021.704611] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Although left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic value as predictors of heart failure (HF), the close physiological relationship between the LA and LV suggest that the assessment of LA/LV coupling could better reflect left atrioventricular dysfunction and be a better predictor of HF. Aim: We investigated the prognostic value of a left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), as well as change in LACI to predict incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods: In the MESA, 2,250 study participants, free of clinically recognized HF and cardiovascular disease (CVD) at baseline, had LACI assessed by CMR imaging at baseline (Exam 1, 2000-2002), and 10 years later (Exam 5, 2010-2012). Left atrioventricular coupling index was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident HF after adjustment for traditional MESA-HF risk factors. The incremental risk prediction was calculated using C-statistic, categorical net reclassification index (NRI) and integrative discrimination index (IDI). Results: Among the 2,250 participants (mean age 59.3 ± 9.3 years and 47.6% male participants), 50 incident HF events occurred over 6.8 ± 1.3 years after the second CMR exam. After adjustment, greater LACI and ΔLACI were independently associated with HF (adjusted HR 1.44, 95% CI [1.25-1.66] and adjusted HR 1.55, 95% CI [1.30-1.85], respectively; both p < 0.0001). Adjusted models for LACI showed significant improvement in model discrimination and reclassification compared to currently used HF risk score model for predicting HF incidence (C-statistic: 0.81 vs. 0.77; NRI = 0.411; IDI = 0.043). After adjustment, ΔLACI showed also significant improvement in model discrimination compared to the multivariable model with traditional MESA-HF risk factors for predicting incident HF (C-statistic: 0.82 vs. 0.77; NRI = 0.491; IDI = 0.058). Conclusions: In a multi-ethnic population, atrioventricular coupling (LACI), and coupling change (ΔLACI) are independently associated with incident HF. Both have incremental prognostic value for predicting HF events over traditional HF risk factors.
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Affiliation(s)
- Theo Pezel
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, Baltimore, MD, United States.,Department of Cardiology, Lariboisiere Hospital - Assistance Publique des Hôpitaux de Paris (APHP), Inserm UMRS 942, University of Paris, Paris, France
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Yoko Kato
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Henrique Doria De Vasconcellos
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Colin O Wu
- Division of Intramural Research, National Heart Lung and Blood Institute, Bethesda, MD, United States
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisiere Hospital - Assistance Publique des Hôpitaux de Paris (APHP), Inserm UMRS 942, University of Paris, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisiere Hospital - Assistance Publique des Hôpitaux de Paris (APHP), Inserm UMRS 942, University of Paris, Paris, France
| | - João A C Lima
- Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
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20
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Carpenito M, Fanti D, Mega S, Benfari G, Bono MC, Rossi A, Ribichini FL, Grigioni F. The Central Role of Left Atrium in Heart Failure. Front Cardiovasc Med 2021; 8:704762. [PMID: 34485406 PMCID: PMC8414134 DOI: 10.3389/fcvm.2021.704762] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
In past cardiovascular medicine, the attention to the left ventricle-identified as the only indicator and determinant of healthy or unhealthy cardiac conditions- has systematically hidden the role of the left atrium (LA). The recent advances in cardiovascular imaging have provided a better understanding of LA anatomy, physiology, and pathology, making us realize that this functional structure is far from being an innocent spectator. We now know that the LA's mechanical and neuro-hormonal properties play a relevant part in several cardiovascular diseases, including atrial fibrillation, ischemic heart disease, valvular heart disease, and heart failure. The present review aims to describe the role of LA in the specific setting of heart failure. We provide currently available information on LA structure and function and summarize its role as a determinant of symptoms, prognosis, and potential therapeutic target in heart failure patients.
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Affiliation(s)
- Myriam Carpenito
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Diego Fanti
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Simona Mega
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Maria Caterina Bono
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Francesco Grigioni
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
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21
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Enriquez-Sarano M, Benfari G, Messika-Zeitoun D, Grigioni F, Michelena HI. Functional mitral regurgitation: a proportionate or disproportionate focus of attention? Eur J Heart Fail 2021; 23:1759-1762. [PMID: 34383994 DOI: 10.1002/ejhf.2330] [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: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 01/04/2023] Open
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22
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Vidula MK, Chirinos JA. Left Atrial Coupling Index and Its Prognostic Value in Heart Failure With Reduced Ejection Fraction. Circ Cardiovasc Imaging 2021; 14:e012221. [PMID: 33463365 PMCID: PMC7987881 DOI: 10.1161/circimaging.120.012221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mahesh K. Vidula
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julio A. Chirinos
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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