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Vinokurtseva A, Quinn MP, Wai M, Leung V, Malvankar-Mehta M, Hutnik CML. Evaluating Measurement Properties of Patient-Reported Outcome Measures in Glaucoma: A Systematic Review. Ophthalmol Glaucoma 2023; 6:541-563. [PMID: 37142217 DOI: 10.1016/j.ogla.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
TOPIC The purpose of the current study was to systematically identify and evaluate existing patient-reported outcome measures (PROMs) for clinical glaucoma practice. CLINICAL RELEVANCE Understanding and incorporating patient preferences into decision-making is now recognized as critical for optimal resource allocation, especially in technologically advancing areas, such as minimally invasive surgeries. Patient-reported outcome measures are instruments designed to evaluate the health outcomes that are most important to patients. Despite their recognized importance, especially in the era of patient-centered care, their routine use in clinical settings remains low. METHODS A systematic literature search was conducted in 6 databases (EMBASE, MEDLINE, PsycINFO, Scopus, BIOSIS, and Web of Science) from the date of inception. Studies were included in the qualitative review if they reported measurement properties of PROMs in adult patients with glaucoma. COnsensus-based Standards for the selection of health Measurement INstruments guidelines were used to assess the included PROMs. The study protocol is registered with PROSPERO (registration number: CRD42020176064). RESULTS The literature search yielded 2661 records. After deduplication, 1259 studies entered level 1 screening, and based on title and abstract review, 164 records proceeded to full-text screening. In 48 included studies, 70 instrument reports discuss 43 distinct instruments in 3 major categories: glaucoma-specific, vision-specific, and general health-related quality of life. Most used measures were glaucoma-specific (Glaucoma Quality of Life [GQL] and Glaucoma Symptom Scale [GSS]) and vision-specific (National Eye Institute Visual Function Questionnaire [NEI VFQ-25]). All 3 have sufficient validity (especially construct), with GQL and GSS having sufficient internal consistency, cross-cultural validity, and reliability, with reports suggesting high methodological quality. CONCLUSION The GQL, GSS, and NEI VFQ-25 are the 3 most used questionnaires in a research setting, having considerable validation in a patient population with glaucoma. Limited reports on interpretability, responsiveness, and feasibility in all 43 identified instruments make identifying a single optimal questionnaire for clinical use challenging and highlight the need for further studies. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anastasiya Vinokurtseva
- Department of Ophthalmology, Schulich School of Medicine, Western University, London, Ontario.
| | - Matthew P Quinn
- Department of Ophthalmology, Queen's University, Kingston, Ontario; Department of Ophthalmology, University of Ottawa, Ottawa, Ontario
| | - Mandy Wai
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario
| | - Victoria Leung
- Department of Physiology and Pharmacology, Western University, London, Ontario
| | - Monali Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine, Western University, London, Ontario; Department of Epidemiology and Biostatistics, Schulich School of Medicine, University of Western Ontario, London, Ontario
| | - Cindy M L Hutnik
- Department of Ophthalmology, Schulich School of Medicine, Western University, London, Ontario; Ivey Eye Institute, St. Joseph's Health Care, London, Ontario
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Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets. Int J Mol Sci 2021; 22:ijms22147650. [PMID: 34299270 PMCID: PMC8304780 DOI: 10.3390/ijms22147650] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome responsible for high mortality and morbidity rates. It has an ever growing social and economic impact and a deeper knowledge of molecular and pathophysiological basis is essential for the ideal management of HFpEF patients. The association between HFpEF and traditional cardiovascular risk factors is known. However, myocardial alterations, as well as pathophysiological mechanisms involved are not completely defined. Under the definition of HFpEF there is a wide spectrum of different myocardial structural alterations. Myocardial hypertrophy and fibrosis, coronary microvascular dysfunction, oxidative stress and inflammation are only some of the main pathological detectable processes. Furthermore, there is a lack of effective pharmacological targets to improve HFpEF patients' outcomes and risk factors control is the primary and unique approach to treat those patients. Myocardial tissue characterization, through invasive and non-invasive techniques, such as endomyocardial biopsy and cardiac magnetic resonance respectively, may represent the starting point to understand the genetic, molecular and pathophysiological mechanisms underlying this complex syndrome. The correlation between histopathological findings and imaging aspects may be the future challenge for the earlier and large-scale HFpEF diagnosis, in order to plan a specific and effective treatment able to modify the disease's natural course.
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Pecchiari M, Pontikis K, Alevrakis E, Vasileiadis I, Kompoti M, Koutsoukou A. Cardiovascular Responses During Sepsis. Compr Physiol 2021; 11:1605-1652. [PMID: 33792902 DOI: 10.1002/cphy.c190044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sepsis is the life-threatening organ dysfunction arising from a dysregulated host response to infection. Although the specific mechanisms leading to organ dysfunction are still debated, impaired tissue oxygenation appears to play a major role, and concomitant hemodynamic alterations are invariably present. The hemodynamic phenotype of affected individuals is highly variable for reasons that have been partially elucidated. Indeed, each patient's circulatory condition is shaped by the complex interplay between the medical history, the volemic status, the interval from disease onset, the pathogen, the site of infection, and the attempted resuscitation. Moreover, the same hemodynamic pattern can be generated by different combinations of various pathophysiological processes, so the presence of a given hemodynamic pattern cannot be directly related to a unique cluster of alterations. Research based on endotoxin administration to healthy volunteers and animal models compensate, to an extent, for the scarcity of clinical studies on the evolution of sepsis hemodynamics. Their results, however, cannot be directly extrapolated to the clinical setting, due to fundamental differences between the septic patient, the healthy volunteer, and the experimental model. Numerous microcirculatory derangements might exist in the septic host, even in the presence of a preserved macrocirculation. This dissociation between the macro- and the microcirculation might account for the limited success of therapeutic interventions targeting typical hemodynamic parameters, such as arterial and cardiac filling pressures, and cardiac output. Finally, physiological studies point to an early contribution of cardiac dysfunction to the septic phenotype, however, our defective diagnostic tools preclude its clinical recognition. © 2021 American Physiological Society. Compr Physiol 11:1605-1652, 2021.
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Affiliation(s)
- Matteo Pecchiari
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Konstantinos Pontikis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Emmanouil Alevrakis
- 4th Department of Pulmonary Medicine, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Maria Kompoti
- Intensive Care Unit, Thriassio General Hospital of Eleusis, Magoula, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
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S SK, Desai N, Gona OJ, K VK, B M. Impact of Updated 2016 ASE/EACVI VIS-À-VIS 2009 ASE Recommendation on the Prevalence of Diastolic Dysfunction and LV Filling Pressures in Patients with Preserved Ejection Fraction. J Cardiovasc Imaging 2021; 29:31-43. [PMID: 33511798 PMCID: PMC7847794 DOI: 10.4250/jcvi.2020.0117] [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] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Assessment of diastolic dysfunction (DD) and left ventricular filling pressures (LVFP) by echocardiography is complex in patients with preserved ejection fraction (EF). The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) jointly published recommendations in 2016 to simplify the diagnosis and classification of DD and the assessment of LVFP. We aimed to study the impact of the updated 2016 ASE/EACVI guidelines vis-à-vis the 2009 ASE recommendations on prevalence of DD and LVFP in patients with preserved EF. METHODS Five hundred patients referred to the echocardiography laboratory from March 2020 to May 2020 were analyzed. Patients with left ventricular ejection fraction (LVEF) < 50% were excluded. All patients underwent comprehensive transthoracic echocardiography. DD and LVFP were assessed by the 2016 ASE/EACVI and 2009 ASE recommendations. The concordance between the guidelines was analyzed by kappa coefficient and overall proportion of agreement. RESULTS Mean age was 53 ± 13 years and 63.4% were men. Prevalence of DD and abnormal LVFP were significantly lower with the 2016 recommendations than with the 2009 recommendations (9.4% vs. 16.8%, p < 0.001 and 8.4% vs. 12.8%, p < 0.05). Patients with Grade 1 DD (100%) and Grade 2 DD (46.4%) were reclassified by the 2016 recommendations. Indeterminate diastolic function (9.8%) was strikingly high according to the 2016 recommendations. The concordance between the two recommendations was moderate (kappa = 0.569). The overall proportion of agreement was 85.4%. CONCLUSIONS Prevalence of DD and abnormal LV filling pressures were lower with application of the 2016 ASE/EACVI recommendations in patients with preserved EF. There was moderate agreement between the 2009 and 2016 recommendations.
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Affiliation(s)
- Sunil Kumar S
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India.
| | - Nagaraj Desai
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Oliver Joel Gona
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | - Vinay Kumar K
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Madhu B
- Department of Community Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
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Ng M, Tong X, He J, Lin Q, Luo L, Chen Y, Shen X, Wan E, Yan A, Yiu K. Feature tracking for assessment of diastolic function by cardiovascular magnetic resonance imaging. Clin Radiol 2020; 75:321.e1-321.e11. [DOI: 10.1016/j.crad.2019.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/22/2019] [Indexed: 01/16/2023]
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Li X, Min X. The role of M-mode echocardiography in patients with heart failure and preserved ejection fraction: A prospective cohort study. Exp Ther Med 2020; 19:1969-1976. [PMID: 32104256 DOI: 10.3892/etm.2020.8428] [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: 10/13/2018] [Accepted: 11/14/2019] [Indexed: 11/05/2022] Open
Abstract
Epicardial movement during diastole is inversely proportional to myocardial stiffness but systolic regional thickening cannot precisely identify ischemic territories. The aim of the present study was to test the hypothesis that a correlation may be present between M-mode echocardiography parameters and poor outcomes in patients with heart failure and preserved ejection fraction. Patients with known cardiovascular disease were included in the test group (n=1,244) and patients without known cardiovascular disease were included in the control group (n=1,952). Patient records of routine measurements, M-mode echocardiography and mortality were collected. The control population and test population had the same left ventricular end-diastolic dimension (P=0.062) and left ventricular end-diastolic volume (P=0.053). A lower mitral flow velocity (P<0.05), higher Tei index (P<0.0001) and reduced distribution of diastolic wall strain (P<0.0001) were reported in the test populations compared with the control population. Patients of the test population with lower diastolic wall strain (<0.28) demonstrated a higher mortality rate than those with higher diastolic wall strain (≥0.28; P<0.0001) at the 3-year follow-up. M-mode echocardiographic parameters may be of use for predicting poor outcomes in patients with heart failure and preserved ejection fraction.
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Affiliation(s)
- Xin Li
- Department of Cardiovascular Medicine, Cardiovascular Research Institute, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, P.R. China
| | - Xinwen Min
- Department of Cardiovascular Medicine, Cardiovascular Research Institute, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, P.R. China
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Nistri S, Mazzone C, Cioffi G, Barbati G, Gentile P, Ballo P, Borca EC, Faganello G, Cherubini A, Bussani R, Sinagra G, Di Lenarda A. Tissue Doppler indices of diastolic function as prognosticator in patients without heart failure in primary care. J Cardiol 2020; 76:18-24. [PMID: 32094011 DOI: 10.1016/j.jjcc.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/28/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) indices of left ventricular (LV) diastolic function provide incremental prognostic information on mortality and morbidity in the general population and in several clinical scenarios. Their independent, additional role in outpatients with normal LV ejection fraction (LVEF) and without heart failure (HF) is undefined. METHODS We reviewed clinical and echocardiographic records of 2628 consecutive outpatients 52.8% male, median age 71 years) with LVEF > 50% without concurrent or prior HF, from the Cardiovascular Center of Trieste. We analyzed septal early mitral annular velocity (e') and its combination with mitral peak early filling velocity (E/e') in relation to the composite end-point of death and cardiovascular hospitalizations. RESULTS During follow-up of 26 months (interquartile range: 12-41), 392 (15%) patients experienced the endpoint (88 deaths). Increasing E/e' showed an overall association with the clinical end-point (log rank p < 0.02), but with no prognostic difference between the middle and upper tertile. Decreasing e' also showed an association with the end-point, with a more balanced stepwise risk increase for increasing tertiles (log rank p < 0.01 for all contrasts). At multivariable analysis, E/e' (either in tertiles or dichotomized according to the threshold of 15) was no longer associated with clinical outcome, whereas e' independently predicted the combined endpoint [hazard ratio 0.73 (0.53-0.94), p = 0.04]. The prognostic value of e' was incremental to that of other clinical and echocardiographic variables (p = 0.04). CONCLUSIONS In outpatients with normal LVEF and without HF, e' and E/e' are both associated with clinical end-points, though only e' is an independent and incremental predictor of outcome. These findings suggest a potential role for e' as a prognosticator, and spread a cautionary word about the utilization of septal E/e' alone as a surrogate for a comprehensive assessment of diastolic function in this context.
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Affiliation(s)
- Stefano Nistri
- CMSR Veneto Medica, Cardiology Service, Altavilla Vicentina, Italy.
| | - Carmine Mazzone
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giovanni Cioffi
- Villa Bianca Hospital, Department of Cardiology, Trento, Italy
| | - Giulia Barbati
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piero Gentile
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piercarlo Ballo
- Santa Maria Annunziata Hospital, Cardiology Unit, Florence, Italy
| | | | - Giorgio Faganello
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | | | | | - Andrea Di Lenarda
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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The diagnostic and prognostic value of serum endocan in patients with cirrhotic cardiomyopathy. ACTA ACUST UNITED AC 2019; 56:182-192. [PMID: 29453929 DOI: 10.2478/rjim-2018-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND We aimed to determine the relationship between endocan and cirrhotic cardiomyopathy. MATERIALS AND METHODS Patients with liver cirrhosis and no heart disease were included in a prospective observational study with liver disease decompensation and death as primary outcomes. RESULTS 83 cirrhotic patients were included and 32 had cirrhotic cardiomyopathy. Endocan levels were significantly lower in patients with cirrhotic cardiomyopathy (5.6 vs. 7 ng/mL, p = 0.034). Endocan correlated with severity of cirrhosis, time to decompensation or death from liver disease (OR 4.5 95% CI 1.06-31.1). CONCLUSION Endocan is a promising biomarker of severity of cirrhosis and may help in the diagnosis of cardiac dysfunction in this population.
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Machine Learning for Electrocardiographic Diagnosis of Left Ventricular Early Diastolic Dysfunction. J Am Coll Cardiol 2019; 71:1661-1662. [PMID: 29650122 DOI: 10.1016/j.jacc.2018.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 11/21/2022]
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Roeh A, Schuster T, Jung P, Schneider J, Halle M, Scherr J. Two dimensional and real-time three dimensional ultrasound measurements of left ventricular diastolic function after marathon running: results from a substudy of the BeMaGIC trial. Int J Cardiovasc Imaging 2019; 35:1861-1869. [PMID: 31154595 DOI: 10.1007/s10554-019-01634-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/24/2019] [Indexed: 01/13/2023]
Abstract
Strenuous exercise results in transient but minor alterations in left ventricular diastolic function (LVDF). The aim of this study is to describe and interpret the kinetics of the well-established 2D parameters of diastolic function and the novel and very sensitive 3D parameters before/after a marathon race. LVDF was evaluated by transthoracic echocardiography (TEE) in 212 healthy male [aged 42 (36-49) years)] marathon runners (all Be-MaGIC-study) in the week prior to (V1), immediately after (V2), 24 h after (V3) and 72 h after (V4) a marathon race. Real time three-dimensional echocardiography (RT3DE) included maximal and minimal left atrium (LA) volume, total LA ejection fraction (Total-EF), total LA stroke volume (Total-SV), true ejection fraction (True-EF) and atrial stroke volume (ASV). After adjustment for possible confounders (heart rate and systolic blood pressure), 2D Parameters of left ventricular inflow (E/A-ratio) decreased from pre- to immediately post-race (- 0.3 ± 0.06, p < 0.001) and returned to baseline within 24 h. [Formula: see text]-ratio remained unchanged directly post-race, but was significantly increased during follow-up of 24 and 72 h. 3D LA Vmin was increased immediately postrace and in the 24 h follow-up, LA Vmax was increased immediately post-race and in the follow-up of 24 and 72 h. During follow-up of 72 h, but not immediately postrace, TrueEF and ASV were significantly increased. Both techniques revealed acute and prolonged alterations of diastolic LV function. Considering all parameters, the recovery of diastolic LV after a marathon seems to take longer than previously assumed.Trial registration ClinicalTrials.gov ID: NCT00933218.
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Affiliation(s)
- Astrid Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany.
| | - Tibor Schuster
- Department for Medical Statistics and Epidemiology, Klinikum Rechts Der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Philip Jung
- Medizinische Klinik und Poliklinik I, Klinikum der Universitaet Muenchen, Munich, Germany
| | - Jens Schneider
- Universitäts Herz-Zentrum Freiburg - Bad Krozingen, Klinik für Kardiologie Und Angiologie II, Bad Krozingen, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, 80802, Munich, Germany
| | - Johannes Scherr
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany
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Validation by Cardiac Catheterization of Noninvasive Estimation of Time Constant of Left Ventricular Pressure Decline as an Index of Relaxation by Speckle Tracking Echocardiography. Am J Cardiol 2018; 121:1645-1651. [PMID: 29653833 DOI: 10.1016/j.amjcard.2018.02.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
Abstract
There has been no established echocardiographic parameter to accurately assess left ventricular (LV) relaxation. Impaired LV relaxation assessed by the time constant of LV pressure decline (Tau) is one of the major components of diastolic dysfunction. We sought to noninvasively estimate Tau (eTau) by speckle tracking echocardiography (STE) and to validate the eTau against Tau by catheterization. Tau was reported to be calculated using the isovolumic relaxation time (IVRT), LV end-systolic pressure, and left atrial (LA) pressure. We reported that pulmonary capillary wedge pressure (ePCWP) can be noninvasively and accurately estimated as 10.8 - 12.4 × Log (LA active emptying function/minimum LA volume index). Therefore, the eTau by STE is noninvasively calculated using the formula: eTau = IVRT / (ln 0.9 × systolic blood pressure-ln ePCWP). Echocardiographic parameters were measured just before catheterization in 110 patients with cardiac disease (age 72 ± 8). There was a good correlation between the eTau and Tau by catheterization (r = 0.69, p <0.001), whereas IVRT and the e' had a poor correlation with Tau (r = 0.33 and -0.33, respectively). The sensitivity and specificity of the eTau to predict prolonged Tau (>48 ms) was 77% and 91%, respectively, with area under curve of 0.87 using an optimal cutoff of 48 ms. Bland-Altman analysis revealed a good agreement between the eTau and Tau. In conclusion, this study demonstrated that the eTau by our noninvasive method has a good correlation with Tau obtained by cardiac catheterization. LV relaxation may be noninvasively and accurately estimated by STE.
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Vaidya GN, Abramov D. Echocardiographic Evaluation of Diastolic Function Is of Limited Value in the Diagnosis and Management of HFpEF. J Card Fail 2018; 24:392-396. [PMID: 29499321 DOI: 10.1016/j.cardfail.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/13/2017] [Accepted: 02/20/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Dmitry Abramov
- Department of Cardiology, Loma Linda University Hospital, Loma Linda, California.
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Magoon R, Malik V, Choudhury A, Chauhan S, Hote MP, Ramakrishnan S, Singh V. A Comparison of the Strain and Tissue Doppler-Based Indices as Echocardiographic Correlates of the Left Ventricular Filling Pressures. J Cardiothorac Vasc Anesth 2017; 32:1297-1304. [PMID: 29290381 DOI: 10.1053/j.jvca.2017.11.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Diastolic strain and strain rate, combined with E (peak transmitral velocity), have been proposed as novel noninvasive predictors of left ventricle (LV) filling pressures, avoiding angulation errors inherent to tissue Doppler indices (TDI). The primary objective was to study the correlation of strain-based indices (SBI) and TDI with pulmonary artery catheter-derived LV end-diastolic pressures (LVEDP). The secondary aim was to determine appropriate cut-off of indices to predict LVEDP ≥15 mmHg. DESIGN A prospective observational clinical study. SETTING Single university hospital. PARTICIPANTS One hundred twenty adults with preserved ejection fraction (EF) undergoing coronary artery bypass grafting. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two-dimensional speckle-tracking echocardiography estimated global longitudinal diastolic strain (Ds) and strain rate (DSr) at peak mitral filling to compute E/Ds and E/10DSr. TDI was measured as the ratio of E and e' (mitral annular diastolic velocity). E/e', E/Ds, and E/10DSr were significantly higher (p < 0.001) in patients with LVEDP ≥15 mm Hg (31/120). Correlation of E/Ds, E/10DSr with LVEDP was R = 0.86 and 0.88 (p < 0.001), respectively, compared with a correlation of R = 0.63 (p < 0.001) for E/e'. SBI correlated well with LVEDP ≥15 mm Hg compared with TDI. E/Ds ≥11 and E/10DSr ≥12 had higher sensitivity and specificity (96.77%, 93.26%; 100%, 96.63%, respectively; area under the curve [AUC] = 0.99) than E/e'≥13 (74%,75%; AUC = 0.84) for prediction of LVEDP ≥15 mmHg. SBI accurately predicted elevated LVEDP in the indeterminate zone of 8<E/e' <13. CONCLUSIONS SBI were better predictors of LVEDP, compared with TDI, in patients with preserved EF and indeterminate E/e' values.
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Affiliation(s)
- Rohan Magoon
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Arindam Choudhury
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Milind P Hote
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sivasubramanian Ramakrishnan
- Department of Cardiology, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Florijn BW, Bijkerk R, van der Veer EP, van Zonneveld AJ. Gender and cardiovascular disease: are sex-biased microRNA networks a driving force behind heart failure with preserved ejection fraction in women? Cardiovasc Res 2017; 114:210-225. [DOI: 10.1093/cvr/cvx223] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/23/2017] [Indexed: 01/08/2023] Open
Abstract
AbstractCardiovascular disease (CVD) is the primary cause of death among men and women worldwide. Nevertheless, our comprehension of how CVD progresses in women and elicits clinical outcomes is lacking, leading CVD to be under-diagnosed and under-treated in women. A clear example of this differential presentation of CVD pathophysiologies in females is the strikingly higher prevalence of heart failure with preserved ejection fraction (HFpEF). Women with a history of pre-eclampsia or those who present with co-morbidities such as obesity, hypertension, and diabetes mellitus are at increased risk of developing HFpEF. Long understood to be a critical CVD risk factor, our understanding of how gender differentially affects the development of CVD has been greatly expanded by extensive genomic and transcriptomic studies. These studies uncovered a pivotal role for differential microRNA (miRNA) expression in response to systemic inflammation, where their co-ordinated expression forms a post-transcriptional regulatory network that instigates microcirculation defects. Importantly, the potential sex-biased expression of the given miRNAs may explain sex-specific cardiovascular pathophysiologies in women, such as HFpEF. Sex-biased miRNAs are regulated by oestrogen (E2) in their transcription and processing or are expressed from loci on the X-chromosome due to incomplete X-chromosome inactivation. Interestingly, while E2-induced miRNAs predominantly appear to serve protective functions, it could be argued that many X-linked miRNAs have been found to challenge microvascular and myocardial integrity. Therefore, menopausal E2 deficiency, resulting in protective miRNA loss, and the augmentation of X-linked miRNA expression, may well contribute to the molecular mechanisms that underlie the female-specific cardiovascular aetiology in HFpEF.
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Affiliation(s)
- Barend W Florijn
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Roel Bijkerk
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Eric P van der Veer
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Anton Jan van Zonneveld
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Yeh HM, Lin TT, Yeh CF, Huang HS, Chang SN, Lin JW, Tsai CT, Lai LP, Huang YY, Chu CL. Biomarkers and echocardiography for evaluating the improvement of the ventricular diastolic function after surgical relief of hydronephrosis. PLoS One 2017; 12:e0188597. [PMID: 29161313 PMCID: PMC5697892 DOI: 10.1371/journal.pone.0188597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/09/2017] [Indexed: 11/24/2022] Open
Abstract
The pathophysiology of cardio-renal syndrome (CRS) is complex. Hydronephrosis caused by urolithiasis may cause cytokine release and lead to cardiac dysfunction. The aim of this study was to evaluate cardiac function changes observed in patients who received double J placement using feasible biomarkers and echocardiography. This was a prospective, single-center study. Eighty-seven patients who presented with acute unilateral hydronephrosis and received ureteroscope stone manipulation were enrolled. Echocardiography and cytokines were measured on the day of the operation and 24 hours after the procedure. Changes before and after surgery were assessed by the paired t-test and Wilcoxon test. Correlation analyses between echocardiographic diastolic indices and cytokine levels were performed using Pearson’s correlation coefficients. Patients with hydronephrosis showed a higher left atrium volume index (LAVI), decreased E', and increased E/ E' ratio, which indicated diastolic dysfunction. Patients with hydronephrosis also exhibited decreased global strain rates during isovolumetric relaxation (SRIVR) and E/ SRIVR, which confirmed the diastolic dysfunction. Significant reductions in LAVI, increases in SRIVR and decreases in E/ SRIVR were observed after the operation. Biomarkers, such as TGF-β and serum NT-proBNP, were significantly decreased after surgery. In addition, a significant correlation was observed between the post-surgical decrease in TGF-β1 and increase in SRIVR. Unilateral hydronephrosis causes cardiac diastolic dysfunction, and relieving hydronephrosis could improve diastolic function. Improvements in cardiac dysfunction can be evaluated by echocardiography and measuring cytokine levels. The results of this study will inform efforts to improve the early diagnosis of CRS and prevent further deterioration of cardiac function when treating patients with hydronephrosis.
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Affiliation(s)
- Huei-Ming Yeh
- Department of Anesthesiology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chih-Fan Yeh
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ho-Shiang Huang
- Department of Urology, National Chengkong University Hospital, Tainan, Taiwan
| | - Sheng-Nan Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Jou-Wei Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ling-Ping Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yi-You Huang
- Insititute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chun-Lin Chu
- Insititute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Anesthesiology, National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
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Dave JK, Kulkarni SV, Pangaonkar PP, Stanczak M, McDonald ME, Cohen IS, Mehrotra P, Savage MP, Walinsky P, Ruggiero NJ, Fischman DL, Ogilby D, VanWhy C, Lombardi M, Forsberg F. Non-Invasive Intra-cardiac Pressure Measurements Using Subharmonic-Aided Pressure Estimation: Proof of Concept in Humans. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2718-2724. [PMID: 28807449 PMCID: PMC5605408 DOI: 10.1016/j.ultrasmedbio.2017.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/05/2017] [Accepted: 07/11/2017] [Indexed: 05/04/2023]
Abstract
This study evaluated the feasibility of employing non-invasive intra-cardiac pressure estimation using subharmonic signals from ultrasound contrast agents in humans. This institutional review board-approved proof-of-concept study included 15 consenting patients scheduled for left and right heart catheterization. During the catheterization procedure, Definity was infused intra-venously at 4-10 mL/min. Ultrasound scanning was performed with a Sonix RP using pulse inversion, three incident acoustic output levels and 2.5-MHz transmit frequency. Radiofrequency data were processed and subharmonic amplitudes were compared with the pressure catheter data. The correlation coefficient between subharmonic signals and pressure catheter data ranged from -0.3 to -0.9. For acquisitions with optimum acoustic output, pressure errors between the subharmonic technique and catheter were as low as 2.6 mmHg. However, automatically determining optimum acoustic output during scanning for each patient remains to be addressed before clinical applicability can be decided.
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Affiliation(s)
- Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Sushmita V Kulkarni
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; College of Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Purva P Pangaonkar
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maureen E McDonald
- Department of Radiologic Sciences, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ira S Cohen
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Praveen Mehrotra
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael P Savage
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul Walinsky
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas J Ruggiero
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David L Fischman
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Ogilby
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carolyn VanWhy
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matthew Lombardi
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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17
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Valor diagnóstico y pronóstico del mapeo de T 1 mediante RMC de los pacientes con insuficiencia cardiaca y fracción de eyección conservada. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Ripoll C, Yotti R, Bañares R, Bermejo J. Pressure volume curves in cirrhosis: More than meets the eye. J Hepatol 2017; 67:656-657. [PMID: 28495426 DOI: 10.1016/j.jhep.2017.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 12/04/2022]
Affiliation(s)
- Cristina Ripoll
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Rafael Bañares
- Department of Digestive Diseases and CIBEREHD, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology and CIBERCV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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19
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von Roeder M, Rommel KP, Kowallick JT, Blazek S, Besler C, Fengler K, Lotz J, Hasenfuß G, Lücke C, Gutberlet M, Schuler G, Schuster A, Lurz P. Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005467. [PMID: 28360259 DOI: 10.1161/circimaging.116.005467] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF), its functional implications beyond the reflection of left ventricular (LV) pathology are not well understood. The aim of this study was to further characterize LA function in HFpEF patients. METHODS AND RESULTS We performed cardiac magnetic resonance myocardial feature tracking in 22 patients with HFpEF and 12 patients without HFpEF. LA reservoir strain, LA conduit strain, and LA booster pump strain were quantified. Peak oxygen uptake (VO2max) was determined. Invasive pressure-volume loops were obtained to evaluate LV diastolic properties. LV early filling was determined from LV volume-time curves as derived from cardiac magnetic resonance. LA reservoir and conduit strain were significantly lower in HFpEF (LA reservoir strain, 22±7% versus 29±6%, P=0.04; LA conduit strain, -9±5% versus -15±4%, P<0.01). Patients with HFpEF showed lower oxygen uptake (17±6 versus 29±8 mL/(kg min); P<0.01). Strain measurement for LA conduit function was strongly associated with VO2max (r=0.80; P<0.01). On multivariable regression analysis, LA conduit strain emerged as strongest predictor for VO2max even after inclusion of LV stiffness and relaxation time (β=0.80; P<0.01). LA conduit strain correlated with the volume of early ventricular filling (r=0.67; P<0.01), but not LV stiffness constant β (-0.34; P=0.051) or relaxation constant τ (r=-0.33; P=0.06). CONCLUSIONS Cardiac magnetic resonance myocardial feature tracking-derived conduit strain is significantly impaired in HFpEF and associated with exercise intolerance. Impaired conduit function is associated with impaired early ventricular filling, as potential mechanism leading to impaired oxygen uptake. Our results propose that impaired LA conduit function represents a distinct feature of HFpEF, independent of LV stiffness and relaxation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02459626.
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Affiliation(s)
- Maximilian von Roeder
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Karl-Philipp Rommel
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Johannes Tammo Kowallick
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Stephan Blazek
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Christian Besler
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Karl Fengler
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Joachim Lotz
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Gerd Hasenfuß
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Christian Lücke
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Matthias Gutberlet
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Gerhard Schuler
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Andreas Schuster
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.)
| | - Philipp Lurz
- From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).
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Lüers C, Edelmann F, Wachter R, Pieske B, Mende M, Angermann C, Ertl G, Düngen HD, Störk S. Prognostic impact of diastolic dysfunction in systolic heart failure-A cross-project analysis from the German Competence Network Heart Failure. Clin Cardiol 2017; 40:667-673. [PMID: 28467622 DOI: 10.1002/clc.22710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the modifying role and prognostic importance of diastolic dysfunction (DD) in patients with heart failure and systolic dysfunction (SD). HYPOTHESIS The echocardiographic evaluation of diastolic function in patients with SD provides further prognostic information. METHODS From the German Competence Network Heart Failure, 1046 heart failure patients with reduced left ventricular ejection fraction (LVEF; <50%) were echocardiographically studied and followed for a median of 5 years. SD was subdivided into nonsevere (LVEF 36%-49%) and severe (LVEF ≤35%); DD was subdivided into nonsevere (E/E' <15) and severe (E/E' ≥15). RESULTS In general, severe SD was associated with higher hazard ratios (HRs; 2-fold to 3.5-fold) for all endpoints (all-cause death, cardiac death, cardiovascular hospitalization, duration of hospitalization). Patients with severe SD had a 2.5-fold risk of death (95% confidence interval [CI]: 1.84-3.47, P < 0.001), and patients with severe DD showed a 1.8-fold risk (95% CI: 1.17-2.61, P = 0.004). Furthermore, we observed a strong interaction of SD and DD: concomitant severe DD in patients with moderate SD increased risk substantially (HR: 1.73, 95% CI: 1.16-2.6, P = 0.007); by contrast, in patients with severe SD, additional presence of severe DD added little or no risk (HR for interaction: 0.5-1.2). CONCLUSIONS In heart failure patients with reduced LVEF, the evaluation of diastolic function provides additional prognostic information. Although severe SD generally increased the risk for all endpoints, the degree of DD and its impact as a prognostic marker for overall and cardiovascular mortality appeared of particular relevance in subjects with nonsevere SD.
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Affiliation(s)
- Claus Lüers
- University of Oldenburg, European Medical School Oldenburg-Groningen, Germany
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Germany.,Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Burkert Pieske
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | | | - Christiane Angermann
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
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Wu CK, Yeh CF, Chiang JY, Lin TT, Wu YF, Chiang CK, Kao TW, Hung KY, Huang JW. Effects of atorvastatin treatment on left ventricular diastolic function in peritoneal dialysis patients—The ALEVENT clinical trial. J Clin Lipidol 2017; 11:657-666. [DOI: 10.1016/j.jacl.2017.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/12/2017] [Accepted: 02/28/2017] [Indexed: 12/31/2022]
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22
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Diagnostic and Prognostic Value of CMR T 1-Mapping in Patients With Heart Failure and Preserved Ejection Fraction. ACTA ACUST UNITED AC 2017; 70:848-855. [PMID: 28314659 DOI: 10.1016/j.rec.2017.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 01/09/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) presents a major challenge in modern cardiology. Although this syndrome is of increasing prevalence and is associated with unfavorable outcomes, treatment trials have failed to establish effective therapies. Currently, solutions to this dilemma are being investigated, including categorizing and characterizing patients more diversely to individualize treatment. In this regard, new imaging techniques might provide important information. Diastolic dysfunction is a diagnostic and pathophysiological cornerstone in HFpEF and is believed to be caused by systemic inflammation with the development of interstitial myocardial fibrosis and myocardial stiffening. Cardiac magnetic resonance (CMR) T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. This review provides an overview of the potential of myocardial tissue characterization with CMR T1 mapping in HFpEF patients, outlining its diagnostic and prognostic implications and discussing future directions. We conclude that CMR T1 mapping is potentially an effective tool for patient characterization in large-scale epidemiological, diagnostic, and therapeutic HFpEF trials beyond traditional imaging parameters.
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Gaasch WH. Deliberations on Diastolic Heart Failure. Am J Cardiol 2017; 119:138-144. [PMID: 28029360 DOI: 10.1016/j.amjcard.2016.08.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 01/09/2023]
Abstract
Studies of left ventricular diastolic dysfunction and diastolic heart failure (DHF), published during the past 4 decades, include a prodigious number and wide variety of research efforts. This review report considers some of the historical literature and incorporates more recent information supporting the idea that patients with DHF constitute a subgroup of the heterogeneous population of patients with heart failure and a preserved ejection fraction. Clinical investigation, particularly therapeutic trials, should be directed at specific targets within the population of interest, not at the broad heart failure with preserved ejection fraction population. To accomplish this, it is important to stipulate criteria for the diagnosis of DHF and to limit our attention to specific subgroups or phenotypes.
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Kumari K, Ganesh V, Jayant A, Dhawan R, Banayan J. Perioperative Hypertension and Diastolic Dysfunction. J Cardiothorac Vasc Anesth 2016; 31:1487-1496. [PMID: 28041811 DOI: 10.1053/j.jvca.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Kamesh Kumari
- Department of Anesthesia and Intensive Care, Nehru Hospital (Level 4), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkata Ganesh
- Department of Anesthesia and Intensive Care, Nehru Hospital (Level 4), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aveek Jayant
- Department of Anesthesia and Intensive Care, Nehru Hospital (Level 4), Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Richa Dhawan
- Department of Anesthesia, Swedish Covenant Hospital, Chicago, IL
| | - Jennifer Banayan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
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25
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de Knegt MC, Biering-Sørensen T, Søgaard P, Sivertsen J, Jensen JS, Møgelvang R. Total average diastolic longitudinal displacement by colour tissue doppler imaging as an assessment of diastolic function. Cardiovasc Ultrasound 2016; 14:41. [PMID: 27639377 PMCID: PMC5027100 DOI: 10.1186/s12947-016-0083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 11/15/2022] Open
Abstract
Background The current method for a non-invasive assessment of diastolic dysfunction is complex with the use of algorithms of many different echocardiographic parameters. Total average diastolic longitudinal displacement (LD), determined by colour tissue Doppler imaging (TDI) via the measurement of LD during early diastole and atrial contraction, can potentially be used as a simple and reliable alternative. Methods In 206 patients, using GE Healthcare Vivid E7 and 9 and Echopac BT11 software, we determined both diastolic LD, measured in the septal and lateral walls in the apical 4-chamber view by TDI, and the degree of diastolic dysfunction, based on current guidelines. Of these 206 patients, 157 had cardiac anomalies that could potentially affect diastolic LD such as severe systolic heart failure (n = 45), LV hypertrophy (n = 49), left ventricular (LV) dilation (n = 30), and mitral regurgitation (n = 33). Intra and interobserver variability of diastolic LD measures was tested in 125 patients. Results A linear relationship between total average diastolic LD and the degree of diastolic dysfunction was found. A total average diastolic LD of 10 mm was found to be a consistent threshold for the general discrimination of patients with or without diastolic dysfunction. Using linear regression, total average diastolic LD was estimated to fall by 2.4 mm for every increase in graded severity of diastolic dysfunction (β = −0.61, p-value <0.001). Patients with LV hypertrophy had preserved total average diastolic LD despite being classified as having diastolic dysfunction. Reproducibility of LD measures was acceptable. Conclusions There is strong evidence suggesting that patients with a total average diastolic LD under 10 mm have diastolic dysfunction. Electronic supplementary material The online version of this article (doi:10.1186/s12947-016-0083-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Chantal de Knegt
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Tor Biering-Sørensen
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Centre for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Sivertsen
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Skov Jensen
- Herlev and Gentofte Hospital, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Rigshospitalet, Department of Cardiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Rommel KP, von Roeder M, Latuscynski K, Oberueck C, Blazek S, Fengler K, Besler C, Sandri M, Lücke C, Gutberlet M, Linke A, Schuler G, Lurz P. Extracellular Volume Fraction for Characterization of Patients With Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol 2016; 67:1815-1825. [PMID: 27081022 DOI: 10.1016/j.jacc.2016.02.018] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/02/2016] [Accepted: 02/09/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Optimal patient characterization in heart failure with preserved ejection fraction (HFpEF) is essential to tailor successful treatment strategies. Cardiac magnetic resonance (CMR)-derived T1 mapping can noninvasively quantify diffuse myocardial fibrosis as extracellular volume fraction (ECV). OBJECTIVES This study aimed to elucidate the diagnostic performance of T1 mapping in HFpEF by examining the relationship between ECV and invasively measured parameters of diastolic function. It also investigated the potential of ECV to differentiate among pathomechanisms in HFpEF. METHODS We performed T1 mapping in 24 patients with HFpEF and 12 patients without heart failure symptoms. Pressure-volume loops were obtained with a conductance catheter during basal conditions and handgrip exercise. Transient pre-load reduction was used to extrapolate the diastolic stiffness constant. RESULTS Patients with HFpEF showed higher ECV (p < 0.01), elevated load-independent passive left ventricular (LV) stiffness constant (beta) (p < 0.001), and a longer time constant of active LV relaxation (p = 0.02). ECV correlated highly with beta (r = 0.75; p < 0.001). Within the HFpEF cohort, patients with ECV greater than the median showed a higher beta (p = 0.05), whereas ECV below the median identified patients with prolonged active LV relaxation (p = 0.01) and a marked hypertensive reaction to exercise due to pathologic arterial elastance (p = 0.04). On multiple linear regression analyses, ECV independently predicted intrinsic LV stiffness (β = 0.75; p < 0.01). CONCLUSIONS Diffuse myocardial fibrosis, assessed by CMR-derived T1 mapping, independently predicts invasively measured LV stiffness in HFpEF. Additionally, ECV helps to noninvasively distinguish the role of passive stiffness and hypertensive exercise response with impaired active relaxation. (Left Ventricular Stiffness vs. Fibrosis Quantification by T1 Mapping in Heart Failure With Preserved Ejection Fraction [STIFFMAP]; NCT02459626).
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Affiliation(s)
- Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Konrad Latuscynski
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Christian Oberueck
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Stephan Blazek
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Karl Fengler
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Marcus Sandri
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Christian Lücke
- Department of Radiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Radiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Axel Linke
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Gerhard Schuler
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Leipzig University, Heart Center, Leipzig, Germany.
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27
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Soyama Y, Mano T, Goda A, Sugahara M, Masai K, Masuyama T. Prognostic value of diastolic wall strain in patients with chronic heart failure with reduced ejection fraction. Heart Vessels 2016; 32:68-75. [PMID: 27115147 DOI: 10.1007/s00380-016-0838-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Abstract
Left ventricular (LV) diastolic dysfunction plays a crucial role in heart failure with reduced ejection fraction (HFrEF). LV stiffness is a main component of diastolic function, but its role and prognostic value in HFrEF patients remains unclear. This study aimed to determine whether diastolic wall strain (DWS) as a noninvasive and simple marker of LV stiffness can predict the prognosis of HFrEF patients who were administrated chronic beta blockade enough. We enrolled 75 HFrEF patients who were administrated chronic beta blockade. We evaluated the echocardiographic parameters and plasma brain natriuretic peptide (BNP) before the induction of beta blockade and also obtained pulmonary artery wedge pressure (PAWP) from the right heart catheterization. DWS was obtained from standard M-mode echocardiography as follows: DWS = [(LV posterior wall thickness (LVPWT) at end-systole - LVPWT at end-diastole)/LVPWT] at end-systole. DWS did not correlate with other echocardiographic parameters and PAWP. We defined primary outcome as HF hospitalization or cardiovascular death and followed for 7 years. The incidence rate was higher in low DWS than high DWS patients (p = 0.04). Other echocardiographic parameters could not be significant predictors of HFrEF outcome under the condition of enough beta blocker therapy. In multivariate analysis, DWS was the independent contributor to the event-free time. Impaired LV stiffness evaluated with DWS was associated with worse outcome and DWS might be an independent prognostic factor in HFrEF patients with chronic beta blockade.
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Affiliation(s)
- Yuko Soyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshiaki Mano
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Akiko Goda
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masataka Sugahara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kumiko Masai
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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28
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von Bibra H, Siegmund T, Kingreen I, Riemer M, Schuster T, Schumm-Draeger PM. Effects of analogue insulin in multiple daily injection therapy of type 2 diabetes on postprandial glucose control and cardiac function compared to human insulin: a randomized controlled long-term study. Cardiovasc Diabetol 2016; 15:7. [PMID: 26772807 PMCID: PMC4715313 DOI: 10.1186/s12933-015-0320-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/23/2015] [Indexed: 01/09/2023] Open
Abstract
Background The prevention of cardiovascular disease, including diastolic cardiac dysfunction with its high prevalence and ominous prognosis, is a therapeutic challenge for patients with type 2 diabetes. Both short and long-acting insulin analogues (AI) have been shown to reduce glucose variability and provide potential benefit for cardiovascular disease although the effects on cardiac function have not yet been evaluated. This long-term, prospective, randomized controlled trial in patients with type 2 diabetes (T2D) tested the hypothesis that a multiple daily injection regimen (MDI) with AI improves postmeal glucose excursions in comparison to human insulin (HI) and that the effects of AI improve diastolic cardiac function. Methods For 36 months, MDI treatment in 109 T2D patients was adapted every 3 months (targets: fasting glucose ≤ 110 mg/dl, postmeal glucose ≤ 150 mg/dl) in both groups: AI (insulin detemir and insulin aspart, n = 61) and HI (NPH-insulin and regular HI, n = 48). Diastolic cardiac function (myocardial velocity E’ using tissue Doppler imaging and the mitral inflow ratio E/A) and vascular function were assessed before and 2 h after a standardized breakfast (48 g carbohydrates). At baseline, both groups were comparable with regards to demographic, cardiac and metabolic data. Analysis of data included traditional statistics as well as the use of a multiple imputation technique shown in brackets [ ]. Results At 36 months, the primary endpoint, postmeal glucose, decreased by 20 ± 62 mg/dl, p = 0.038 [p = 0.021] with AI and increased insignificantly with HI (inter-group p = 0.032 [p = 0.047]) to postmeal glucose levels of 161 ± 39 with AI vs. 195 ± 54 mg/dl with HI (inter-group p = 0.002 [p = 0.010]) whereas the levels of fasting glucose and HbA1c were comparable. With AI, postmeal E’ improved by 0.6 ± 1.4 cm/s, p = 0.009 [p = 0.002] and fasting E’ by 0.4 ± 1.4 cm/s, p = 0.069 [p = 0.013], however, E’ remained unchanged with HI. These changes were consistent with those of the traditional parameter E/A. Conclusions MDI with AI results in better postmeal glucose control compared to HI. The treatment with AI is associated with improved diastolic cardiac function. ClinicalTrials.gov (NTC00747409)
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Affiliation(s)
- Helene von Bibra
- Clinic for Endocrinology, Diabetes and Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
| | - Thorsten Siegmund
- Clinic for Endocrinology, Diabetes and Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
| | - Iris Kingreen
- Clinic for Endocrinology, Diabetes and Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
| | - Markus Riemer
- Clinic for Endocrinology, Diabetes and Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
| | - Tibor Schuster
- Institute for Statistics and Epidemiology in Medicine of the Technische Universität, Munich, Germany.
| | - Petra-Maria Schumm-Draeger
- Clinic for Endocrinology, Diabetes and Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
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29
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Voiosu AM, Daha IC, Voiosu TA, Mateescu BR, Dan GA, Băicuş CR, Voiosu MR, Diculescu MM. Prevalence and impact on survival of hepatopulmonary syndrome and cirrhotic cardiomyopathy in a cohort of cirrhotic patients. Liver Int 2015; 35:2547-55. [PMID: 25974637 DOI: 10.1111/liv.12866] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Extrahepatic complications of cirrhosis increase the risk for decompensation of the liver disease and death. Previous studies show common pathogenetic mechanisms involved in the development of hepatopulmonary syndrome and cirrhotic cardiomyopathy. We aimed to assess the link between these entities and their effect on disease-related patient morbidity and mortality. METHODS Seventy-four consecutive cirrhotic patients without prior history of cardiovascular and pulmonary disease were included in a prospective observational study. Routine blood work, arterial blood gas analysis, pulse oximetry measurements, N-terminal pro-brain natriuretic peptide levels and contrast enhanced echocardiography examination with tissue Doppler imaging were performed in all patients. Patients were followed up for a median of 6 months and disease-related adverse events and death were the main outcomes tested. Statistical analysis was conducted according to the presence of hepatopulmonary syndrome or cirrhotic cardiomyopathy. RESULTS Hepatopulmonary syndrome was diagnosed in 17 patients (23%) and cirrhotic cardiomyopathy in 30 patients (40.5%). There was no association between the presence of cirrhotic cardiomyopathy and the existence of mild or moderate hepatopulmonary syndrome. No echocardiographic parameters were useful in predicting the presence of hepatopulmonary syndrome. N-terminal pro-brain natriuretic peptide levels and length of QT interval did not aid in diagnosis of cirrhotic cardiomyopathy. Neither entity had significant influence on disease-related outcomes in the follow-up period. CONCLUSIONS Hepatopulmonary syndrome and cirrhotic cardiomyopathy are independent complications arising in cirrhosis and have a limited influence on morbidity and mortality on a pre-liver transplantation population.
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Affiliation(s)
- Andrei M Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine, Bucharest, Romania
| | - Ioana C Daha
- "Carol Davila" University of Medicine, Bucharest, Romania.,Department of Cardiology, Colentina Clinical Hospital, Bucharest, Romania
| | - Theodor A Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine, Bucharest, Romania
| | - Bogdan R Mateescu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine, Bucharest, Romania
| | - Gheorghe A Dan
- "Carol Davila" University of Medicine, Bucharest, Romania.,Department of Cardiology, Colentina Clinical Hospital, Bucharest, Romania
| | - Cristian R Băicuş
- "Carol Davila" University of Medicine, Bucharest, Romania.,Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
| | - Mihail R Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine, Bucharest, Romania
| | - Mircea M Diculescu
- "Carol Davila" University of Medicine, Bucharest, Romania.,Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania
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30
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Kim Y, Kim TJ, Park J, Lee S, Kim Y, Lee JS, Lee S. Novel echocardiographic indicator for potential cardioembolic stroke. Eur J Neurol 2015; 23:613-20. [DOI: 10.1111/ene.12909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/01/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Y. Kim
- Department of Neurology Seoul National University Hospital SeoulKorea
- Department of Neurology Catholic University of Korea Bucheon St Mary's Hospital GyeonggidoKorea
| | - T. J. Kim
- Department of Neurology Seoul National University Hospital SeoulKorea
| | - J.‐B. Park
- Department of Cardiology Seoul National University Hospital SeoulKorea
| | - S. Lee
- Department of Cardiology Seoul National University Hospital SeoulKorea
| | - Y.‐J. Kim
- Department of Cardiology Seoul National University Hospital SeoulKorea
| | - J. S. Lee
- Clinical Research Center Asan Medical Center Seoul Korea
| | - S.‐H. Lee
- Department of Neurology Seoul National University Hospital SeoulKorea
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31
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Chang SN, Juang JJM, Tsai CT, Ko JT, Lien WP. A Novel Integrated Score Index of Echocardiographic Indices for the Evaluation of Left Ventricular Diastolic Function. PLoS One 2015; 10:e0142175. [PMID: 26555598 PMCID: PMC4640516 DOI: 10.1371/journal.pone.0142175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022] Open
Abstract
Background We propose a novel integrated score index, which could be used to quantify and grade left ventricular (LV) diastolic function. Methods We enrolled 629 participants [393 healthy subjects, 145 with hypertension (HTN), 24 with hypertrophic cardiomyopathy (HCM), and 67 with coronary artery disease (CAD)]. This score index was with a score of 1 for an E/A ratio < 1, a score of 1 for a septal e’/a’ ratio ≤ 0.8, a score of 2 for a lateral e’/a’ ratio ≤ 1, a score of 2 for a septal E/e’ ratio ≥10–15, a score of 3 for a lateral E/e’ ratio ≥8–15, and a score of 1 for a deceleration time >240 ms. The sum of each score was considered as the final value in this scoring method (either a septal or a lateral E/e’ ratio > 15 was given a total score of 10, regardless of the other measurements). Results After analysis, the AUROC of this integrated score index for predicting any diastolic dysfunction (discriminated by the American Society of Echocardiography guidelines) was 0.962, and the AUROC of the method from the logistic regression was 0.970. The mean values of the score index for the groups were 3.81 ± 0.12 in healthy, 6.48 ± 0.19 in HTN, 7.35 ± 0.46 in HCM, and 6.62 ± 0.29 in CAD. Using the score index, the healthy subjects obtained lower scores compared with those of HTN (p = 0.00), HCM (p = 0.00), and CAD (p = 0.00). Therefore, this score index could discriminate patients with diseases with impaired diastolic function from the healthy subjects when the total sum of the score was equal to or greater than 4. Conclusions If the presently used methods cannot allow the clear diagnosis of LV diastolic dysfunction, this integrated score index might be helpful for discriminating diseases with impaired diastolic function.
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Affiliation(s)
- Sheng-Nan Chang
- National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Dou-Liu City, Taiwan
| | - Jimmy Jyh-Ming Juang
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei, Taiwan
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Wen-Pin Lien
- Cardiovascular Center, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: ;
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32
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Medrano G, Hermosillo-Rodriguez J, Pham T, Granillo A, Hartley CJ, Reddy A, Osuna PM, Entman ML, Taffet GE. Left Atrial Volume and Pulmonary Artery Diameter Are Noninvasive Measures of Age-Related Diastolic Dysfunction in Mice. J Gerontol A Biol Sci Med Sci 2015; 71:1141-50. [PMID: 26511013 DOI: 10.1093/gerona/glv143] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022] Open
Abstract
Impaired cardiac diastolic function occurs with aging in many species and may be difficult to measure noninvasively. In humans, left atrial (LA) volume is a robust measure of chronic diastolic function as the LA is exposed to increased left ventricular filling pressures. We hypothesized that LA volume would be a useful indicator of diastolic function in aging mice. Further, we asked whether pressures were propagated backwards affecting pulmonary arteries (PAs) and right ventricle (RV). We measured LA, PA, and RV infundibulum dimensions with echocardiography and used mouse-specific Doppler systems and pressure catheters for noninvasive and invasive measures. As C57BL/6 mice aged from 3 to 29-31 months, LA volume almost tripled. LA volume increases correlated with traditional diastolic function measures. Within groups of 14- and 31-month-old mice, LA volume correlated with diastolic function measured invasively. In serial studies, mice evaluated at 20 and 24 months showed monotonic increases in LA volume; other parameters changed less predictably. PA diameters, larger in 30-month-old mice than 6-month-old mice, correlated with LA volumes. Noninvasive LA volume and PA diameter assessments are useful and state independent measures of diastolic function in mice, correlating with other measures of diastolic dysfunction in aging. Furthermore, serial measurements over 4 months demonstrated consistent increases in LA volume suitable for longitudinal cardiac aging studies.
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Affiliation(s)
- Guillermo Medrano
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Jesus Hermosillo-Rodriguez
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Thuy Pham
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Alejandro Granillo
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Craig J Hartley
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Anilkumar Reddy
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Patricia Mejia Osuna
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Mark L Entman
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - George E Taffet
- Sections of Cardiovascular Sciences and Geriatrics, Department of Medicine and Huffington Center on Aging, Baylor College of Medicine, and DeBakey Heart Center and Department of Medicine, Houston Methodist Hospital, Houston, Texas.
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Siontis KC, Geske JB, Gersh BJ. Atrial fibrillation pathophysiology and prognosis: insights from cardiovascular imaging. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003020. [PMID: 26022381 DOI: 10.1161/circimaging.115.003020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos C Siontis
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey B Geske
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Bernard J Gersh
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN.
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Schweitzer A, Agmon Y, Aronson D, Abadi S, Mutlak D, Carasso S, Walker JR, Lessick J. Assessment of left sided filling dynamics in diastolic dysfunction using cardiac computed tomography. Eur J Radiol 2015. [PMID: 26205972 DOI: 10.1016/j.ejrad.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction (DD) often accompanies coronary artery disease but is difficult to assess since it involves a complex interaction between LV filling and left atrial (LA) emptying. OBJECTIVE To characterize simultaneous changes in LA and LV volumes using cardiac computed tomography (CT) in a group of patients with various grades of DD based on echocardiography. METHODS We identified 35 patients with DD by echocardiography, who had also undergone cardiac CT, and 35 age-matched normal controls. LV and LA volumes were measured every 10% of the RR interval, using semi-automatic software. From these, - systolic, early-diastolic and late-diastolic volume changes were calculated, and additional parameters of diastolic filling derived. Conduit volume was defined as the difference between the LV and LA early-diastolic volume change. RESULTS Patients with DD had significantly larger LV mass, and LA volumes, reduced early emptying volumes and increased conduit volume as percent of early LV filling (All p<0.001). LA function, manifesting as total emptying fraction (LATEF), decreased proportionately with worsening grades of DD (p<0.001). LA contractile function was maintained until advanced grade-3 DD. By receiver operating characteristic analysis, LATEF had an AUC of 0.88 to separate between normals and DD. At a threshold of <42.5%, LATEF has 97% sensitivity and 69% specificity to detect DD. CONCLUSIONS DD is characterized by reduced LA function and an alteration in the relative contributions of the atrial emptying and conduit volume components of early LV filling. In patients undergoing cardiac CT, it is possible to identify the presence and severity of DD.
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Affiliation(s)
| | - Yoram Agmon
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Doron Aronson
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Sobhi Abadi
- Medical Imaging Department, Rambam Health Care Campus, Haaliya Street, Haifa 31096, Israel.
| | - Diab Mutlak
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Shemy Carasso
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Jonathan R Walker
- Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
| | - Jonathan Lessick
- Cardiology Department, Haaliya Street, Haifa 31096, Israel; Technion-Israel Institute of Technology, Haaliya Street, Haifa 31096, Israel.
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Manolas J. Invasive and noninvasive assessment of exercise-induced ischemic diastolic response using pressure transducers. Curr Cardiol Rev 2015; 11:90-9. [PMID: 25001193 PMCID: PMC4347214 DOI: 10.2174/1573403x10666140704111537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 06/18/2014] [Accepted: 06/30/2014] [Indexed: 01/09/2023] Open
Abstract
Left ventricular (LV) pressure curve shows early high-magnitude changes in the presence of induced ischemia. A dramatic rise in LV and left atrial end-diastolic pressures occurs within seconds to minutes in the presence of ischemia induced by dynamic or handgrip exercise as well as pacing of 38 to 183% and during short coronary balloon occlusion of 32 to 208% of baseline. Changes in relaxation or volumetric filling rate or ejection fraction were significantly less pronounced. Similar end-diastolic abnormalities occurring mainly in patients with coronary artery disease (CAD) have been shown in noninvasive recordings obtained by pressure transducer placed over the point of maximal LV beat (pressocardiograms). Specifically, the amplitude of the A wave to total excursion of pressocardiogram showed a similar high-magnitude increase after dynamic or handgrip exercise in average by 60 to 142% of baseline; however, changes in pressocardiographic relaxation time indexes were only slightly abnormal. A well-defined “ischemic pattern” of pressocardiographic diastolic changes with handgrip, showed a high prevalence in CAD patients. The assessment of diastolic changes in the presence of handgrip-inducible ischemia using noninvasive pressure transducers might provide after further studies a simple complementary diagnostic tool to assist in identification of patients with atypical or asymptomatic CAD.
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Affiliation(s)
- Jan Manolas
- Mobile Unit for Diastolic Stress Test, Department of Check Up, Diagnostic & Therapeutic Center of Athens, Hygeia Hospital, Erythrou Stavrou 4 and Kifissias Ave. Maroussi, Athens 151 23, Greece.
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Leite S, Oliveira-Pinto J, Tavares-Silva M, Abdellatif M, Fontoura D, Falcão-Pires I, Leite-Moreira AF, Lourenço AP. Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study. Am J Physiol Heart Circ Physiol 2015; 308:H1556-63. [PMID: 25862827 DOI: 10.1152/ajpheart.00076.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/10/2015] [Indexed: 11/22/2022]
Abstract
Inclusion of exercise testing in diagnostic guidelines for heart failure with preserved ejection fraction (HFpEF) has been advocated, but the target population, technical challenges, and underlying pathophysiological complexity raise difficulties to implementation. Hemodynamic stress tests may be feasible alternatives. Our aim was to test Trendelenburg positioning, phenylephrine, and dobutamine in the ZSF1 obese rat model to find echocardiographic surrogates for end-diastolic pressure (EDP) elevation and HFpEF. Seventeen-week-old Wistar-Kyoto, ZSF1 lean, and obese rats (n = 7 each) randomly and sequentially underwent (crossover) Trendelenburg (30°), 5 μg·Kg(-1)·min(-1) dobutamine, and 7.5 μg·Kg(-1)·min(-1) phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O2 consumption (V̇o 2 max) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and V̇o 2 max along with higher resting EDP. Both Trendelenburg and phenylephrine increased EDP, whereas dobutamine decreased it. Significant correlations were found between EDP and 1) peak early filling Doppler velocity of transmitral flow (E) to corresponding myocardial tissue Doppler velocity (E') ratio, 2) E to E-wave deceleration time (E/DT) ratio, and 3) left atrial area (LAA). Diagnostic efficiency of E/DT*LAA by receiver-operating characteristic curve analysis for elevation of EDP above a cut-off of 13 mmHg during hemodynamic stress was high (area under curve, AUC = 0.95) but not higher than that of E/E' (AUC = 0.77, P = 0.15). Results in ZSF1 obese rats suggest that noninvasive echocardiography after hemodynamic stress induced by phenylephrine or Trendelenburg can enhance diagnosis of stable HFpEF and constitute an alternative to effort testing.
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Affiliation(s)
- Sara Leite
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Oliveira-Pinto
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Tavares-Silva
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiology, Hospital São João, Porto, Portugal
| | - Mahmoud Abdellatif
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dulce Fontoura
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Adelino F Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiothoracic Surgery, Hospital São João, Porto, Portugal
| | - André P Lourenço
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Anesthesiology, Hospital São João, Porto, Portugal
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The relationship between arterial stiffness and heart failure with preserved ejection fraction: a systemic meta-analysis. Heart Fail Rev 2015; 20:291-303. [DOI: 10.1007/s10741-015-9471-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kawasaki M, Tanaka R, Ono K, Minatoguchi S, Watanabe T, Iwama M, Hirose T, Arai M, Noda T, Watanabe S, Zile MR, Minatoguchi S. A novel ultrasound predictor of pulmonary capillary wedge pressure assessed by the combination of left atrial volume and function: A speckle tracking echocardiography study. J Cardiol 2014; 66:253-62. [PMID: 25547741 DOI: 10.1016/j.jjcc.2014.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/21/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND We hypothesized that a development of a novel index based on the combination of left atrial volume (LAV) and left atrial (LA) function evaluated by the time-LA volume curve using speckle tracking echocardiography (STE) would be accurate and useful to estimate pulmonary capillary wedge pressure (PCWP). Our goal was to develop a novel index of PCWP based on a combination of LAV and LA function using STE. METHODS A cross-validation study was performed with the patients divided into a training study to define the novel index (n=50) and a testing study to validate the index (n=196). PCWP was measured by right heart catheterization, and phasic LAV and emptying function (EF) were measured by STE. RESULTS Simple linear regression analysis in the training study revealed that the novel index that best estimated PCWP was the kinetics-tracking index [KT index=log10 (active LAEF/minimum LAV index)]. Multiple regression analysis revealed that the KT index was the most reliable predictor of PCWP. It had the strongest correlation with PCWP (r=-0.86, p<0.001) among all echocardiographic parameters. In the testing study, PCWP estimated by the KT index was also strongly correlated with measured PCWP (r=0.92, p<0.001). These correlations were also strong in the patients with reduced left ventricular ejection fraction (<50%), chronic heart failure, and chronic atrial fibrillation (r=0.92, r=0.91, r=0.79, p<0.001, respectively). CONCLUSIONS A novel index (KT index) using a combination of LAV and LA function was a powerful and useful predictor of PCWP and may be valuable in routine clinical practice.
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Affiliation(s)
- Masanori Kawasaki
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Ryuhei Tanaka
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Koji Ono
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Shingo Minatoguchi
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takatomo Watanabe
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Takeshi Hirose
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Masazumi Arai
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Sachiro Watanabe
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Michael R Zile
- Medicine-Cardiology, Medical University of South Carolina and Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Shinya Minatoguchi
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
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Arangalage D, Ederhy S, Dufour L, Joffre J, Van der Vynckt C, Lang S, Tzourio C, Cohen A. Relationship between cognitive impairment and echocardiographic parameters: a review. J Am Soc Echocardiogr 2014; 28:264-74. [PMID: 25532969 DOI: 10.1016/j.echo.2014.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Indexed: 01/03/2023]
Abstract
With >24 million people affected worldwide, dementia is one of the main public health challenges modern medicine has to face. The path leading to dementia is often long, with a wide spectrum of clinical presentations, and preceded by a long preclinical phase. Previous studies have demonstrated that clinical strokes and covert vascular lesions of the brain contribute to the risk for developing dementia. Although it is not yet known whether preventing such lesions reduces the risk for dementia, it is likely that starting preventive measures early in the course of the disease may be beneficial. Echocardiography is a widely available, relatively inexpensive, noninvasive imaging modality whereby morphologically or hemodynamically derived parameters may be integrated easily into a risk assessment model for dementia. The aim of this review is to analyze the information that has accumulated over the past two decades on the prognostic value of echocardiographic factors in cognitive impairment. The associations between cognitive impairment and echocardiographic parameters, including left ventricular systolic and diastolic indices, left atrial morphologic parameters, cardiac output, left ventricular mass, and aortic root diameter, have previously been reported. In the light of these studies, it appears that echocardiography may help further improve currently used risk assessment models by allowing detection of subclinical cardiac abnormalities associated with future cognitive impairment. However, many limitations, including methodologic heterogeneity and the observational designs of these studies, restrict the scope of these results. Further prospective studies are required before integrating echocardiography into a preventive strategy.
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Affiliation(s)
- Dimitri Arangalage
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Stéphane Ederhy
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurie Dufour
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Jérémie Joffre
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Clélie Van der Vynckt
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Sylvie Lang
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Tzourio
- INSERM Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, and University of Bordeaux, Bordeaux, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France.
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von Bibra H, Paulus WJ, St John Sutton M, Leclerque C, Schuster T, Schumm-Draeger PM. Quantification of diastolic dysfunction via the age dependence of diastolic function - impact of insulin resistance with and without type 2 diabetes. Int J Cardiol 2014; 182:368-74. [PMID: 25594925 DOI: 10.1016/j.ijcard.2014.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The alarming prevalence of heart failure with preserved ejection fraction requires quantification of diastolic dysfunction (DDF). Myocardial diastolic velocity E' implies that age is the most important determinant. We tested the hypothesis that age allows for quantification of DDF and assessment of the structural and metabolic determinants in patients with and without type 2 diabetes (D). METHODS This prospective, cross-sectional study assessed cardiovascular, metabolic and ultrasound data in 409 consecutive patients (Diabetes Center, Bogenhausen-Munich) between 20 and 90 years without known cardiac disease and either with (n=204) or without D but with common prevalence of cardiovascular risk factors, including a subgroup of healthy individuals (H, n=94). RESULTS In H, E' related to age as: E'norm=-0.163∗years+19.69 (R(2)=0.77, p<0.0001). According to this 1% reduction by annual physiologic aging, DDF was quantitated as E'-E' norm. Compared to nondiabetics, D patients were older, had greater BMI, lower E', more cardiovascular risk and greater DDF. In nondiabetics, grading of DDF by E-E'norm correlated with grading by filling pressure E/E'. Determinants of DDF by multivariate analysis included pulse wave velocity, diastolic blood pressure and the triglyceride/HDL ratio (a marker of insulin resistance) in nondiabetics and in D the same risk factors in reverse sequence and heart rate. Neither left atrial size nor left ventricular mass had significant impact. CONCLUSIONS The physiological impact of age on myocardial function consists of a 1% annual reduction in E' and enables precise quantification of diastolic dysfunction thereby unmasking the importance of metabolic risk for DDF.
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Affiliation(s)
- H von Bibra
- Clinic for Endocrinology, Diabetes & Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
| | - W J Paulus
- Institute for Cardiovascular Research Vrije Universiteit, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - M St John Sutton
- Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA
| | - C Leclerque
- Clinic for Endocrinology, Diabetes & Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany
| | - T Schuster
- Institute for Statistics and Epidemiology in Medicine of the Technische Universität, Munich, Germany
| | - P-M Schumm-Draeger
- Clinic for Endocrinology, Diabetes & Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany
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van Empel VPM, Mariani J, Borlaug BA, Kaye DM. Impaired myocardial oxygen availability contributes to abnormal exercise hemodynamics in heart failure with preserved ejection fraction. J Am Heart Assoc 2014; 3:e001293. [PMID: 25468660 PMCID: PMC4338724 DOI: 10.1161/jaha.114.001293] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hypertension is a frequent risk factor for the development of heart failure with preserved ejection fraction (HFPEF). Progressive extracellular matrix accumulation has been presumed to be the fundamental pathophysiologic mechanism that leads to the transition to impaired diastolic reserve. However, the contribution of other mechanisms affecting active and passive components of diastolic function has not been comprehensively assessed. In this study, we investigated the potential role of impaired myocardial oxygen delivery in the pathophysiology of HFPEF. METHODS AND RESULTS Patients with HFPEF, those with controlled hypertension, and healthy controls underwent simultaneous right-heart catheterization, echocardiography, and paired arterial and coronary sinus blood gas sampling at rest and during supine-cycle ergometry. Despite a lower workload (HFPEF vs control, hypertension: 43±8 versus 114±12, 87±14 W; P<0.001 and P<0.05, respectively), peak exercise pulmonary capillary wedge pressure was markedly higher in HFPEF patients compared with healthy and hypertensive controls (32±2 versus 16±1 and 17±1 mm Hg, both P<0.001). During exercise, the transcardiac oxygen gradient increased significantly in all groups; however, the peak transcardiac oxygen gradient was significantly lower in HFPEF patients (P<0.05). In addition, the left ventricular-work corrected transcardiac oxygen gradient remained significantly lower in HFPEF patients compared with controls (P<0.001). CONCLUSION The current study provides unique data suggesting that the abnormal diastolic reserve observed during exertion in HFPEF patients may, in part, be explained by impaired myocardial oxygen delivery due possibly to microvascular dysfunction. Further studies are required to confirm the structural and functional basis of these findings and to investigate the influence of potential therapies on this abnormality.
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Affiliation(s)
- Vanessa P M van Empel
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (V.M.E., J.M., D.M.K.) Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (V.M.E., J.M., D.M.K.) Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands (V.M.E.)
| | - Justin Mariani
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (V.M.E., J.M., D.M.K.) Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (V.M.E., J.M., D.M.K.)
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic and Foundation, Rochester, MN (B.A.B.)
| | - David M Kaye
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (V.M.E., J.M., D.M.K.) Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (V.M.E., J.M., D.M.K.)
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Schiros CG, Desai RV, Venkatesh BA, Gaddam KK, Agarwal S, Lloyd SG, Calhoun DA, Denney TS, Dell’italia LJ, Gupta H. Left ventricular torsion shear angle volume analysis in patients with hypertension: a global approach for LV diastolic function. J Cardiovasc Magn Reson 2014; 16:70. [PMID: 25316384 PMCID: PMC4177166 DOI: 10.1186/s12968-014-0070-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 08/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Torsion shear angle φ is an important measure of left ventricular (LV) systolic and diastolic functions. Here we provide a novel index utilizing LV normalized torsion shear angle φ ^ volume V ^ loop to assess LV diastolic functional properties. We defined the area within φ ^ V ^ loop as torsion hysteresis area, and hypothesized that it may be an important global parameter of diastolic function. We evaluated the φ ^ changes to increased V ^ during early diastole - d φ ^ / d V ^ as a potential measure of LV suction. METHODS Sixty resistant hypertension patients (HTN), forty control volunteers were studied using cardiovascular magnetic resonance with tissue tagging. Volumetric and torsional parameters were evaluated. RESULTS HTN demonstrated concentric remodeling with preserved ejection fraction. HTN had significantly decreased normalized early filling rate, early diastolic mitral annulus velocity and E/A (1.33 ± 1.13 vs. 2.19 ± 1.07, P < 0.0001) vs. control. Torsion hysteresis area was greater (0.11 ± 0.07 vs. 0.079 ± 0.045, P < 0.001) and peak - d φ ^ / d V ^ at early diastole was higher (10.46 ± 8.51 vs. 6.29 ± 3.85, P = 0.002) than control. Torsion hysteresis area was significantly correlated with E/A (r = -0.23, P = 0.025). Thirteen HTN patients had both E/A ratio < 1.12 (Control mean E/A-1SD) and torsion hysteresis area > 0.12 (Control mean torsion hysteresis area + 1SD). CONCLUSIONS Torsion hysteresis area and peak early diastolic - d φ ^ / d V ^ were significantly increased in hypertensive concentric remodeling. The φ ^ V ^ loop takes into account the active and passive recoil processes of LV diastolic and systolic phases, therefore provides a new global description of LV diastolic function.
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Affiliation(s)
- Chun G Schiros
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Ravi V Desai
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | | | - Krishna K Gaddam
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Shilpi Agarwal
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Steven G Lloyd
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
- />Birmingham Veteran Affairs Medical Center, Birmingham, AL USA
| | - David A Calhoun
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
| | - Thomas S Denney
- />Department of Electrical and Computer Engineering, Auburn University, Auburn, AL USA
| | - Louis J Dell’italia
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
- />Birmingham Veteran Affairs Medical Center, Birmingham, AL USA
| | - Himanshu Gupta
- />Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, BDB 101, CVMRI, 1530 3rd Ave South, Birmingham, AL 35294-0012 USA
- />Birmingham Veteran Affairs Medical Center, Birmingham, AL USA
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43
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Redefining Diastolic Dysfunction Grading. JACC Cardiovasc Imaging 2014; 7:749-58. [DOI: 10.1016/j.jcmg.2014.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/13/2022]
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44
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Influence of age and gender on Doppler index of diastolic function in Chinese hypertensive patients. Ir J Med Sci 2014; 184:791-7. [DOI: 10.1007/s11845-014-1173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
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45
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Shuai XX, Chen YY, Lu YX, Su GH, Wang YH, Zhao HL, Han J. Diagnosis of heart failure with preserved ejection fraction: which parameters and diagnostic strategies are more valuable? Eur J Heart Fail 2014; 13:737-45. [PMID: 21602549 DOI: 10.1093/eurjhf/hfr053] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xin-Xin Shuai
- Department of Cardiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
| | - Yu-Yuan Chen
- Department of Echocardiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
| | - Yong-Xin Lu
- Department of Cardiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
| | - Guan-Hua Su
- Department of Cardiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
| | - Yu-Hui Wang
- Department of Radiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
| | - Hong-Liang Zhao
- Department of Cardiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
| | - Jun Han
- Department of Cardiology, Union Hospital; Tongji Medical College of Huazhong University of Science and Technology; Wuhan 430022 China
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46
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Franssen C, Paulus WJ. The future diagnosis of heart failure with normal ejection fraction: less imaging, more biomarkers? Eur J Heart Fail 2014; 13:1043-5. [DOI: 10.1093/eurjhf/hfr106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Constantijn Franssen
- Institute for Cardiovascular Research; VU University Medical Center Amsterdam; Van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
| | - Walter J. Paulus
- Institute for Cardiovascular Research; VU University Medical Center Amsterdam; Van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
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47
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van den Hurk K, Reijmer YD, van den Berg E, Alssema M, Nijpels G, Kostense PJ, Stehouwer CD, Paulus WJ, Kamp O, Dekker JM, Biessels GJ. Heart failure and cognitive function in the general population: the Hoorn Study. Eur J Heart Fail 2014; 13:1362-9. [DOI: 10.1093/eurjhf/hfr138] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katja van den Hurk
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research; VU University Medical Center; Van der Boechorststraat 7, 1081 BT Amsterdam The Netherlands
| | - Yael D. Reijmer
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
| | - Esther van den Berg
- Experimental Pyschology, Helmholtz Instituut; Utrecht University; Utrecht The Netherlands
| | - Marjan Alssema
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research; VU University Medical Center; Van der Boechorststraat 7, 1081 BT Amsterdam The Netherlands
| | - Giel Nijpels
- Department of General Practice and the EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam The Netherlands
| | - Piet J. Kostense
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research; VU University Medical Center; Van der Boechorststraat 7, 1081 BT Amsterdam The Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM); Maastricht University Medical Centre; Maastricht The Netherlands
| | - Walter J. Paulus
- Department of Physiology; VU University Medical Center; Amsterdam The Netherlands
| | - Otto Kamp
- Department of Cardiology; VU University Medical Center; Amsterdam the Netherlands
| | - Jacqueline M. Dekker
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research; VU University Medical Center; Van der Boechorststraat 7, 1081 BT Amsterdam The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Rudolf Magnus Institute of Neuroscience; University Medical Center Utrecht; Utrecht The Netherlands
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Wu CK, Lee JK, Chiang FT, Lin LY, Lin JW, Hwang JJ, Tseng CD, Tsai CT. Prognostic factors of heart failure with preserved ejection fraction: a 12-year prospective cohort follow-up study. Int J Cardiol 2013; 171:331-7. [PMID: 24439772 DOI: 10.1016/j.ijcard.2013.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 08/09/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although heart failure with preserved ejection fraction (HFpEF) is a clinically important issue, the factors that affect its prognosis are still unclear. The aim of this study was to establish prognostic factors and develop a severity scale for the disease based on a long-term follow-up cohort of HFpEF patients. METHODS The study included 438 HFpEF patients, as confirmed via echocardiography. Baseline characteristics, including echocardiographic findings and genetic polymorphisms, were determined. Patients were followed-up for up to 12 years. Kaplan-Meier curves and Cox regression models were used to determine the risk factors for mortality and major cardiovascular events (MACE). A severity scale was established using the significant risk factors. The receiver operating characteristics (ROC) curves for the scale were plotted. RESULTS The prescription of angiotensin-converting enzyme (ACE) inhibitors [hazard ratio (HR) 0.28; 95% confidence interval (CI): 0.13-0.58 for mortality] and calcium channel blockers (CCB) was associated with a significant decrease in overall mortality and MACE. Echocardiographic E/Em ratio and ACE gene D polymorphisms were powerful factors associated with both mortality and MACE [(E/Em; HR 1.66; 95% CI: 1.32-2.29 for mortality) and (ACE gene D allele, HR 1.99; 95% CI: 1.26-3.16 for mortality)]. The ROC curves indicated a good diagnostic efficiency for severity scores (area under the curve 0.72). CONCLUSIONS In a long-term follow-up cohort of HFpEF patients, simple clinical, echocardiographic, medication, and even genetic variables were associated with MACE or mortality, and the developed composite severity scale identified patients with a higher probability of experiencing the events.
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Affiliation(s)
- Cho-Kai Wu
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Kuang Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Clinical Pathology and Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fu-Tien Chiang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Jou-Wei Lin
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chuen-Den Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chia-Ti Tsai
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan.
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Decreased plasma B-type natriuretic peptide levels in obesity are not explained by altered left ventricular hemodynamics. Obes Res Clin Pract 2013; 5:e267-360. [PMID: 24331139 DOI: 10.1016/j.orcp.2011.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 04/09/2011] [Accepted: 04/12/2011] [Indexed: 12/30/2022]
Abstract
SUMMARY BACKGROUND Although obesity has been reported to be associated with decreased plasma B-type natriuretic peptide (BNP) levels, it is unknown whether the reduced BNP levels in obesity results from decreased left ventricular (LV) hemodynamic load. METHODS We examined the relationships between body mass index (BMI), plasma BNP levels, and LV systolic and diastolic function (ejection fraction [EF] and end-diastolic pressure [EDP]) in 271 consecutive patients undergoing cardiac catheterization for coronary artery disease. When patients were grouped by tertile of BMI, with increasing tertiles of BMI, there was a progressive increase in EDP (lower, middle, and upper tertiles of BMI, 13.5 ± 5.8, 14.9 ± 5.3, and 16.3 ± 5.4 mmHg, respectively; p for trend <0.01) and a progressive decrease in log BNP levels (lower, middle, and upper tertiles of BMI, 3.52 ± 1.29, 2.96 ± 1.08, and 2.87 ± 1.21 ln[pg/ml], respectively, p for trend < 0.001). There was no clear difference in EF across BMI tertiles (p for trend >0.1). Plasma BNP levels correlated positively with EDP (r = 0.38, p < 0.001). In multivariate linear regression including EDP and known correlates of plasma BNP levels, BMI correlated negatively with BNP levels (standardized β = -0.31, p < 0.001). CONCLUSIONS We found that increased BMI was associated with LV diastolic abnormalities without change in systolic function and that patients with increased BMI had reduced plasma BNP levels despite having elevated EDP. These results suggest that the reduced BNP levels in obesity are not explained by altered LV hemodynamics.
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Wu CK, Wang YC, Lee JK, Chang SN, Su MY, Yeh HM, Su MJ, Chen JJ, Chiang FT, Hwang JJ, Lin JL, Tsai CT. Connective tissue growth factor and cardiac diastolic dysfunction: human data from the Taiwan diastolic heart failure registry and molecular basis by cellular and animal models. Eur J Heart Fail 2013; 16:163-72. [PMID: 24464932 DOI: 10.1002/ejhf.33] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/26/2013] [Accepted: 08/02/2013] [Indexed: 01/08/2023] Open
Abstract
AIMS Connective tissue growth factor (CTGF) is an emerging marker for tissue fibrosis. We investigated the association between CTGF and cardiac diastolic function using cellular and animal models and clinical human data. METHODS AND RESULTS A total of 125 patients with a diagnosis of diastolic heart failure (DHF) were recruited from 1283 patients of the Taiwan Diastolic Heart Failure Registry. The severity of DHF was determined by tissue Doppler imaging (E/e'). Cardiac magnetic resonance imaging (CMRI) was used to evaluate myocardial fibrosis in some of the patients (n = 25). Stretch of cardiomyocytes on a flexible membrane base serves as a cellular phenotype of cardiac diastolic dysfunction (DD). A canine model of DD was induced by aortic banding. A significant correlation was found between plasma CTGF and E/e' in DHF patients. The severity of cardiac fibrosis evaluated by CMRI also correlated with CTGF. In the cell model, stretch increased secretion of CTGF from cardiomyocytes. In the canine model, myocardial tissue CTGF expression and fibrosis significantly increased after 2 weeks of aortic banding. Notably, the expression of CTGF paralleled the severity of LV DD (r = 0.40, P < 0.001 for E/e') and haemodynamic changes (r = 0.80, P < 0.001). After adjusting for confounding factors, CTGF levels still correlated with diastolic parameters in both human and canine models (human plasma CTGF, P < 0.001; canine tissue CTGF, P = 0.04). CONCLUSION Plasma CTGF level correlated with the severity of DD and tissue fibrosis in DHF patients. The mechanism may be through myocardial stretch. Our study indicated that CTGF may serve as an early marker for DHF.
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Affiliation(s)
- Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, and Yun-Lin, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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