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Higuchi K, Manne M, Tchou P, Baranowski B, Bhargava M, Callahan T, Chung M, Dresing T, Hussein A, Kanj M, Mayuga K, Nakhla S, Saliba W, Rickard J, Wazni O, Santangeli P, Sroubek J, Varma N. Left Ventricular Mass as a Modulator of Ventricular Arrhythmia Risk and Sex Differences Following CRT for Non-Ischemic Cardiomyopathy and LBBB. Heart Rhythm 2024:S1547-5271(24)03084-4. [PMID: 39084586 DOI: 10.1016/j.hrthm.2024.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Risk for ventricular arrhythmias (VA) following cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM). OBJECTIVE To evaluate sex differences and baseline/post-implant change [Δ] of LVM on VA risk after CRT implant among patients with non-ischemic cardiomyopathy (NICM) and left bundle branch block. METHODS Among patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by ROC (Youden-index cut-point) for baseline LVM and ΔLVM, and baseline patient characteristics using a multivariable Cox regression model. RESULTS 118 patients (71[60.2%] female, age 60.5 ±11.3 years, LVEF 19.2 ±7.0%, QRS 165.6 ±20 ms, LVM 313.9 ±108.8 g) were enrolled and followed for median 90 (IQR 44-158) months. Thirty-five (29.6%) patients received appropriate shocks or anti-tachycardia pacing at a median of 73.5 (IQR 25-130) months post-implant. Males had a higher VA incidence (male 18/47 [38.3%] vs. female 17/71 [23.9%], P=0.02). Baseline LVM >308.9g separated patients with higher VA risk (P=0.001). Less than a 20% decrease in LVM increased VA risk (P<0.001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (Hazard ratio 1.01 [95%CI, 1.001-1.009], Log-rank P=0.003). Sex differences in VA risk were eliminated by the baseline LVM parameters. CONCLUSION VA risk after CRT in NICM was associated with baseline LV >308.9g and a decrease in LVM ≤ 20%, without sex differences.
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Affiliation(s)
- Koji Higuchi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Mahesh Manne
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Tchou
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mandeep Bhargava
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mina Chung
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Hussein
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth Mayuga
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Walid Saliba
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - John Rickard
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Pasquale Santangeli
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jakub Sroubek
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Niraj Varma
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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2
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do Nascimento EA, Fernandes FDA, Mira PAC, He Z, Zhou W, Mesquita CT. Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling. Arq Bras Cardiol 2023; 120:e20220077. [PMID: 37018787 PMCID: PMC10392842 DOI: 10.36660/abc.20220077] [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: 01/31/2022] [Revised: 09/25/2022] [Accepted: 11/23/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV). OBJECTIVE The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling. METHODS Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance. RESULTS At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT. CONCLUSIONS LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.
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Affiliation(s)
- Erivelton Alessandro do Nascimento
- Universidade Federal FluminenseHospital Universitário Antônio PedroPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Serviço de Cardiologia, Hospital Universitário Antônio Pedro e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
- Instituto Estadual de Cardiologia Aloysio de CastroDepartamento de Arritmias CardíacasRio de JaneiroRJBrasilInstituto Estadual de Cardiologia Aloysio de Castro – Departamento de Arritmias Cardíacas, Rio de Janeiro, RJ – Brasil
| | - Fernando de Amorim Fernandes
- Universidade Federal FluminenseDepartamento de RadiologiaPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
| | - Pedro Augusto Carvalho Mira
- Universidade Federal FluminenseLaboratório de Ciências do ExercícioNiteróiRJBrasilUniversidade Federal Fluminense – Laboratório de Ciências do Exercício, Niterói, RJ – Brasil
| | - Zhuo He
- Department of Applied ComputingMichigan Technological UniversityHoughtonMIEUADepartment of Applied Computing, Michigan Technological University, Houghton – MI – EUA
| | - Weihua Zhou
- Department of Applied ComputingMichigan Technological UniversityHoughtonMIEUADepartment of Applied Computing, Michigan Technological University, Houghton – MI – EUA
| | - Claudio Tinoco Mesquita
- Universidade Federal FluminenseDepartamento de RadiologiaPós-Graduação em Ciências CardiovascularesNiteróiRJBrasilUniversidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil
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3
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Guaricci AI, Masci PG, Muscogiuri G, Guglielmo M, Baggiano A, Fusini L, Lorenzoni V, Martini C, Andreini D, Pavon AG, Aquaro GD, Barison A, Todiere G, Rabbat MG, Tat E, Raineri C, Valentini A, Varga-Szemes A, Schoepf UJ, De Cecco CN, Bogaert J, Dobrovie M, Symons R, Focardi M, Gismondi A, Lozano-Torres J, Rodriguez-Palomares JF, Lanzillo C, Di Roma M, Moro C, Di Giovine G, Margonato D, De Lazzari M, Perazzolo Marra M, Nese A, Casavecchia G, Gravina M, Marzo F, Carigi S, Pica S, Lombardi M, Censi S, Squeri A, Palumbo A, Gaibazzi N, Camastra G, Sbarbati S, Pedrotti P, Masi A, Carrabba N, Pradella S, Timpani M, Cicala G, Presicci C, Puglisi S, Sverzellati N, Santobuono VE, Pepi M, Schwitter J, Pontone G. CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry. Europace 2021; 23:1072-1083. [PMID: 33792661 DOI: 10.1093/europace/euaa401] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients. METHODS AND RESULTS In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction <50% were included. All-cause mortality and major adverse arrhythmic cardiac events (MAACE) were the primary and secondary endpoints, respectively. During a median follow-up of 959 days, all-cause mortality and MAACE occurred in 72 (7%) and 93 (9%) patients, respectively. Age and >3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117-1.056, P < 0.001 and HR: 2.077, 95% CI: 1.211-3.562, P = 0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and >3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231-3.690, P = 0.007; HR: 3.161, 95% CI: 1.750-5.709, P < 0.001; and HR: 1.693, 95% CI: 1.084-2.644, P = 0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P < 0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort. CONCLUSION In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation.
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Affiliation(s)
| | | | - Giuseppe Muscogiuri
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marco Guglielmo
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Andrea Baggiano
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | | | - Chiara Martini
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Daniele Andreini
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Anna Giulia Pavon
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Switzerland
| | - Giovanni D Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Andrea Barison
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | | | - Emily Tat
- Loyola University of Chicago, Chicago, IL, USA
| | - Claudia Raineri
- Department of Cardiology, Città della salute e della Scienza - Ospedale Molinette -Turin, Pavia, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Monica Dobrovie
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Rolf Symons
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Annalaura Gismondi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Jordi Lozano-Torres
- Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josè F Rodriguez-Palomares
- Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigaciín Biomédica en Red-CV, CIBER CV. Spain
| | | | - Mauro Di Roma
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Claudio Moro
- Department of Cardiology, ASST Monza, P.O. Desio, Italy
| | | | | | | | | | - Alberto Nese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | - Grazia Casavecchia
- Cardiology Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Matteo Gravina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Samuela Carigi
- Department of Cardiology, Infermi Hospital, Rimini, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Stefano Censi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Alessandro Palumbo
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | | | - Patrizia Pedrotti
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ambra Masi
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department of Careggi Hospital, Florence, Italy
| | | | - Mauro Timpani
- Department of Neuroscience, Imaging and Clinical Sciences, SS Annunziata Hospital, Chieti, Italy
| | - Gloria Cicala
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Cristina Presicci
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Puglisi
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Mauro Pepi
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Juerg Schwitter
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Switzerland.,Lausanne University, Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Gianluca Pontone
- Department of Cardiovascular, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy
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4
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Wang Q, Fu C, Xia H, Gao Y. Elevated Plasma Homocysteine Level Associated with Further Left Ventricular Structure and Function Damages in Type 2 Diabetic Patients: A Three-Dimensional Speckle Tracking Echocardiography Study. Metab Syndr Relat Disord 2021; 19:443-451. [PMID: 34227868 DOI: 10.1089/met.2020.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims: The aims of this study were to explore the left ventricular (LV) structural remodeling and its risk factors in type 2 diabetes mellitus (T2DM) patients with or without hyperhomocysteinemia (hHcy) and to detect the accompanied LV dysfunction using three-dimensional speckle tracking echocardiography (3DSTE). Methods: There were totally 80 T2DM patients with undamaged LV ejection fraction (≥55%) in this study, 40 of whom were also diagnosed with hHcy as co-morbidity. Forty age- and gender-matched controls were also recruited. The risk factors and corresponding diagnostic values for LV remodeling (LVR) were, respectively, determined using logistic regression and area under the receiver operating characteristic curves (AUC). The 3DSTE was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS). Results: The constituent ratio of LV geometry showed significant differences among the study populations (P = 0.01). Compared with the controls, three types of LVR accounted for larger proportion in the two T2DM groups, whereas LV hypertrophy was most prevalent in those with T2DM and hHcy. Glycosylated hemoglobin (HbA1c), total plasma homocysteine (tHcy), and HbA1c plus tHcy were all significant risk factors associated with LVR in T2DM patients (AUC values: 0.741, 0.746 and 0.851, respectively). The patients with T2DM alone had significantly lower GLS and GAS than the controls (both P < 0.05). The patients with T2DM and hHcy had significantly lower GLS, GCS, GAS, and GRS than the controls (all P < 0.001), and also had significantly lower GLS, GCS, and GRS than the patients with T2DM alone (all P < 0.05). Conclusions: The 3DSTE plus conventional echocardiography could be used as an effective supplement for detecting early and occult cardiac damages in T2DM patients with plasma homocysteine at normal or elevated levels.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chixue Fu
- Department of Ultrasound, the Armed Police Corps Hospital of Chongqing, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yunhua Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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5
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Giamouzis G, Dimos A, Xanthopoulos A, Skoularigis J, Triposkiadis F. Left ventricular hypertrophy and sudden cardiac death. Heart Fail Rev 2021; 27:711-724. [PMID: 34184173 DOI: 10.1007/s10741-021-10134-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) is among the leading causes of death worldwide, and it remains a public health problem, as it involves young subjects. Current guideline-directed risk stratification for primary prevention is largely based on left ventricular (LV) ejection fraction (LVEF), and preventive strategies such as implantation of a cardiac defibrillator (ICD) are justified only for documented low LVEF (i.e., ≤ 35%). Unfortunately, only a small percentage of primary prevention ICDs, implanted on the basis of a low LVEF, will deliver life-saving therapies on an annual basis. On the other hand, the vast majority of patients that experience SCD have LVEF > 35%, which is clamoring for better understanding of the underlying mechanisms. It is mandatory that additional variables be considered, both independently and in combination with the EF, to improve SCD risk prediction. LV hypertrophy (LVH) is a strong independent risk factor for SCD regardless of the etiology and the severity of symptoms. Concentric and eccentric LV hypertrophy, and even earlier concentric remodeling without hypertrophy, are all associated with increased risk of SCD. In this paper, we summarize the physiology and physiopathology of LVH, review the epidemiological evidence supporting the association between LVH and SCD, briefly discuss the mechanisms linking LVH with SCD, and emphasize the need to evaluate LV geometry as a potential risk stratification tool regardless of the LVEF.
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Affiliation(s)
- Grigorios Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. .,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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6
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Urzua Fresno CM, Folador L, Shalmon T, Hamad FMD, Singh SM, Karur GR, Tan NS, Mangat I, Kirpalani A, Chacko BR, Jimenez-Juan L, Yan AT, Deva DP. Prognostic value of cardiovascular magnetic resonance left ventricular volumetry and geometry in patients receiving an implantable cardioverter defibrillator. J Cardiovasc Magn Reson 2021; 23:72. [PMID: 34108003 PMCID: PMC8191093 DOI: 10.1186/s12968-021-00768-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/28/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Current indications for implantable cardioverter defibrillator (ICD) implantation for sudden cardiac death prevention rely primarily on left ventricular (LV) ejection fraction (LVEF). Currently, two different contouring methods by cardiovascular magnetic resonance (CMR) are used for LVEF calculation. We evaluated the comparative prognostic value of these two methods in the ICD population, and if measures of LV geometry added predictive value. METHODS In this retrospective, 2-center observational cohort study, patients underwent CMR prior to ICD implantation for primary or secondary prevention from January 2005 to December 2018. Two readers, blinded to all clinical and outcome data assessed CMR studies by: (a) including the LV trabeculae and papillary muscles (TPM) (trabeculated endocardial contours), and (b) excluding LV TPM (rounded endocardial contours) from the total LV mass for calculation of LVEF, LV volumes and mass. LV sphericity and sphere-volume indices were also calculated. The primary outcome was a composite of appropriate ICD shocks or death. RESULTS Of the 372 consecutive eligible patients, 129 patients (34.7%) had appropriate ICD shock, and 65 (17.5%) died over a median duration follow-up of 61 months (IQR 38-103). LVEF was higher when including TPM versus excluding TPM (36% vs. 31%, p < 0.001). The rate of appropriate ICD shock or all-cause death was higher among patients with lower LVEF both including and excluding TPM (p for trend = 0.019 and 0.004, respectively). In multivariable models adjusting for age, primary prevention, ischemic heart disease and late gadolinium enhancement, both LVEF (HR per 10% including TPM 0.814 [95%CI 0.688-0.962] p = 0.016, vs. HR per 10% excluding TPM 0.780 [95%CI 0.639-0.951] p = 0.014) and LV mass index (HR per 10 g/m2 including TPM 1.099 [95%CI 1.027-1.175] p = 0.006; HR per 10 g/m2 excluding TPM 1.126 [95%CI 1.032-1.228] p = 0.008) had independent prognostic value. Higher LV end-systolic volumes and LV sphericity were significantly associated with increased mortality but showed no added prognostic value. CONCLUSION Both CMR post-processing methods showed similar prognostic value and can be used for LVEF assessment. LVEF and indexed LV mass are independent predictors for appropriate ICD shocks and all-cause mortality in the ICD population.
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Affiliation(s)
- Camila M. Urzua Fresno
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Luciano Folador
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Radiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS Brazil
| | - Tamar Shalmon
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Faisal Mhd. Dib Hamad
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Sheldon M. Singh
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gauri R. Karur
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Nigel S. Tan
- Division of Cardiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Iqwal Mangat
- Division of Cardiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Binita Riya Chacko
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Andrew T. Yan
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Division of Cardiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Djeven P. Deva
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
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7
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Structural and Physiological Imaging to Predict the Risk of Lethal Ventricular Arrhythmias and Sudden Death. JACC Cardiovasc Imaging 2020; 12:2049-2064. [PMID: 31601379 DOI: 10.1016/j.jcmg.2019.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022]
Abstract
Identifying patients at risk of sudden cardiac death remains a major challenge in cardiovascular medicine. Advances in cardiovascular imaging have identified several anatomic and functional variables that can be quantified as continuous variables to predict the risk of developing lethal ventricular tachyarrhythmias in patients with depressed left ventricular (LV) systolic function. Some, such as LV mass, volume, and the dyssynchrony of contraction, can be derived from currently available echocardiographic and nuclear imaging modalities. Others require advanced cardiac imaging modalities with quantification of myocardial scar with gadolinium-enhanced cardiac magnetic resonance and myocardial sympathetic denervation using norepinephrine analogs and positron emission tomography or single-photon emission computed tomography offering the most promise. There is an immediate need to develop a sequential cost-effective approach that capitalizes on readily available clinical information complemented with advanced imaging modalities in selected patients to improve risk stratification for arrhythmic death beyond LV ejection fraction.
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8
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Ricciardi C, Cantoni V, Improta G, Iuppariello L, Latessa I, Cesarelli M, Triassi M, Cuocolo A. Application of data mining in a cohort of Italian subjects undergoing myocardial perfusion imaging at an academic medical center. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105343. [PMID: 31981760 DOI: 10.1016/j.cmpb.2020.105343] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Coronary artery disease (CAD) is still one of the primary causes of death in the developed countries. Stress single-photon emission computed tomography is used to evaluate myocardial perfusion and ventricular function in patients with suspected or known CAD. This study sought to test data mining and machine learning tools and to compare some supervised learning algorithms in a large cohort of Italian subjects with suspected or known CAD who underwent stress myocardial perfusion imaging. METHODS The dataset consisted of 10,265 patients with suspected or known CAD. The analysis was conducted using Knime analytics platform in order to implement Random Forests, C4.5, Gradient boosted tree, Naïve Bayes, and K nearest neighbor (KNN) after a procedure of features filtering. K-fold cross-validation was employed. RESULTS Accuracy, error, precision, recall, and specificity were computed through the above-mentioned algorithms. Random Forests and gradients boosted trees obtained the highest accuracy (>95%), while it was comprised between 83% and 88%. The highest value for sensitivity and specificity was obtained by C4.5 (99.3%) and by Gradient boosted tree (96.9%). Naïve Bayes had the lowest precision (70.9%) and specificity (72.0%), KNN the lowest recall and sensitivity (79.2%). CONCLUSIONS The high scores obtained by the implementation of the algorithms suggests health facilities consider the idea of including services of advanced data analysis to help clinicians in decision-making. Similar applications of this kind of study in other contexts could support this idea.
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Affiliation(s)
- Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University Hospital of Naples 'Federico II', Naples, Italy
| | - Luigi Iuppariello
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Imma Latessa
- Department of Public Health, University Hospital of Naples 'Federico II', Naples, Italy
| | - Mario Cesarelli
- DIETI, University of Naples 'Federico II', Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS; Telese Terme (BN), Italy.
| | - Maria Triassi
- Department of Public Health, University Hospital of Naples 'Federico II', Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy
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9
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Gimelli A, Liga R, Clemente A, Marras G, Kusch A, Marzullo P. Left ventricular eccentricity index measured with SPECT myocardial perfusion imaging: An additional parameter of adverse cardiac remodeling. J Nucl Cardiol 2020; 27:71-79. [PMID: 28083831 DOI: 10.1007/s12350-017-0777-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/27/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Single-photon emission computed-tomography (SPECT) allows the quantification of LV eccentricity index (EI), a measure of cardiac remodeling. We sought to evaluate the feasibility of EI measurement with SPECT myocardial perfusion imaging and its interactions with relevant LV functional and structural parameters. METHODS AND RESULTS Four-hundred and fifty-six patients underwent myocardial perfusion imaging on a Cadmium-Zinc-Telluride (CZT) camera. The summed rest, stress, and difference scores were calculated. From rest images, the LV end-diastolic (EDV) and end-systolic volumes, ejection fraction (EF), and peak filling rate (PFR) were calculated. In every patient, the EI, ranging from 0 (sphere) to 1 (line), was computed using a dedicated software (QGS/QPS; Cedars-Sinai Medical Center). Three-hundred and thirty-eight/456 (74%) patients showed a normal EF (>50%), while 26% had LV systolic dysfunction. The EI was computed from CZT images with excellent reproducibility (interclass correlation coefficient: 0.99, 95% CI 0.98-0.99). More impaired EI values correlated with the presence of a more abnormal LV perfusion (P < .001), function (EF and PFR, P < .001), and structure (EDV, P < .001). On multivariate analysis, higher EDV (P < .001) and depressed EF (P = .014) values were independent predictors of abnormal EI. CONCLUSIONS The evaluation of LV eccentricity is feasible on gated CZT images. Abnormal EI associates with significant cardiac structural and functional abnormalities.
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Affiliation(s)
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
| | | | | | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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10
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Silverman MG, Yeri A, Moorthy MV, Camacho Garcia F, Chatterjee NA, Glinge CSA, Tfelt-Hansen J, Salvador AM, Pico AR, Shah R, Albert CM, Das S. Circulating miRNAs and Risk of Sudden Death in Patients With Coronary Heart Disease. JACC Clin Electrophysiol 2019; 6:70-79. [PMID: 31971908 DOI: 10.1016/j.jacep.2019.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study evaluated whether plasma miRNAs were specifically associated with sudden cardiac and/or arrhythmic death (SCD) in a cohort of patients with coronary heart disease (CHD), most of whom were without primary prevention implantable cardioverter-defibrillators. BACKGROUND Novel biomarkers for sudden death risk stratification are needed in patients with CHD to more precisely target preventive therapies, such as implantable cardioverter-defibrillators. miRNAs have been implicated in regulating inflammation and cardiac fibrosis in cells, and plasma miRNAs have been shown to predict cardiovascular death in patients with CHD. METHODS We performed a nested case control study within a multicenter cohort of 5,956 patients with CHD followed prospectively for SCD. Plasma levels of 18 candidate miRNAs previously associated with cardiac remodeling were measured in 129 SCD cases and 258 control subjects matched on age, sex, race, and left ventricular ejection fraction. RESULTS miR-150-5p, miR-29a-3p, and miR-30a-5p were associated with increased SCD risk (odds ratios and 95% confidence intervals: 2.03 [1.12 to 3.67]; p = 0.02; 1.93 [1.07 to 3.50]; p = 0.02; 0.55 [0.31 to 0.97]; p = 0.04, respectively, for third vs. first tertile miRNA level). Unfavorable levels of all 3 miRNAs was associated with a 4.8-fold increased SCD risk (1.59 to 14.51; p = 0.006). A bioinformatics-based approach predicted miR-150-5p, miR-29a-3p, and miR-30a-5p to be involved in apoptosis, fibrosis, and inflammation. CONCLUSIONS These findings suggest that plasma miRNAs may regulate pathways important for remodeling and may be useful in identifying patients with CHD at increased risk of SCD.
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Affiliation(s)
- Michael G Silverman
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashish Yeri
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Vinayaga Moorthy
- Center for Arrhythmia Prevention, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fernando Camacho Garcia
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neal A Chatterjee
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, University of Washington Medical Center, Seattle, Washington, USA
| | - Charlotte S A Glinge
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ane M Salvador
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander R Pico
- Institute of Data Science and Biotechnology, Gladstone Institutes, San Francisco, California, USA
| | - Ravi Shah
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine M Albert
- Center for Arrhythmia Prevention, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Saumya Das
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Gaudieri V, Nappi C, Acampa W, Zampella E, Assante R, Mannarino T, Genova A, De Simini G, Klain M, Germano G, Petretta M, Cuocolo A. Added prognostic value of left ventricular shape by gated SPECT imaging in patients with suspected coronary artery disease and normal myocardial perfusion. J Nucl Cardiol 2019; 26:1148-1156. [PMID: 29071670 DOI: 10.1007/s12350-017-1090-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/29/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Left ventricular (LV) remodeling is associated with adverse cardiovascular events. We evaluated the added prognostic value of LV shape index (SI) assessed by gated single-photon emission tomography (SPECT) in patients without known coronary artery disease (CAD). METHODS AND RESULTS We studied 674 patients with normal myocardial perfusion and normal LV ejection fraction (EF) on stress gated SPECT imaging. An automated software program was used to calculate end-diastolic and end-systolic LVSI. An LVSI ≤ 0.54 at end-systole was considered normal. Follow-up was 96% complete with a median follow-up of 37 months. During follow-up, 25 events occurred (3.8% cumulative event rate). Event-free survival was lower in patients with abnormal end-systolic LVSI (P < .001). Age (P = .021), diabetes (P = .048), and end-systolic LVSI (P < .001) were independent predictors of events. LVSI added prognostic information increasing the global chi-square of the model including age and diabetes from 15.15 to 25.97 (P < .001). The effect of diabetes on hazard ratio increased with increasing values of end-systolic LVSI. The probability of events at 48 months predicted by Weibull analysis progressively increased with increasing values of end-systolic LVSI and was higher in patients with diabetes as compared to those without. Decision curve analyses indicate that the model including end-systolic LVSI resulted in an increased net benefit between 5% and 30% threshold probability, indicating superior estimation of outcomes at low threshold probability levels. CONCLUSIONS The evaluation of LVSI may identify patients with early-stage LV remodeling and at higher risk of adverse cardiac events, even in the presence of normal myocardial perfusion.
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Affiliation(s)
- Valeria Gaudieri
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Andrea Genova
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giovanni De Simini
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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Silva AP, Mendes F, Carias E, Gonçalves RB, Fragoso A, Dias C, Tavares N, Café HM, Santos N, Rato F, Leão Neves P, Almeida E. Plasmatic Klotho and FGF23 Levels as Biomarkers of CKD-Associated Cardiac Disease in Type 2 Diabetic Patients. Int J Mol Sci 2019; 20:E1536. [PMID: 30934737 PMCID: PMC6480092 DOI: 10.3390/ijms20071536] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Research over the past decade has focused on the role of Klotho as a cardio protective agent that prevents the effects of aging on the heart and reduces the burden of cardiovascular disease CVD. The role of the interaction between fibroblast growth factor 23-(FGF-23)/Klotho in Klotho-mediated actions is still under debate. The main objective was to ascertain the potential use of plasmatic Klotho and FGF23 as markers for CKD-associated cardiac disease and mortality. METHODS This was a prospective analysis conducted in an outpatient diabetic nephropathy clinic, enrolling 107 diabetic patients with stage 2⁻3 CKD. Patients were divided into three groups according to their left ventricular mass index and relative wall thickness. RESULTS Multinomial regression analysis demonstrated that low Klotho and higher FGF-23 levels were linked to a greater risk of concentric hypertrophy. In the generalized linear model (GLM), Klotho, FGF-23 and cardiac geometry groups were statistically significant as independent variables of cardiovascular hospitalization (p = 0.007). According to the Cox regression model, fatal cardiovascular events were associated with the following cardiac geometric classifications; eccentric hypertrophy (p = 0.050); concentric hypertrophy (p = 0.041), and serum phosphate ≥ 3.6 mg/dL (p = 0.025), FGF-23 ≥ 168 (p = 0.0149), α-klotho < 313 (p = 0.044). CONCLUSIONS In our population, Klotho and FGF23 are associated with cardiovascular risk in the early stages of CKD.
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Affiliation(s)
- Ana Paula Silva
- Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal.
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal.
| | - Filipa Mendes
- Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal.
| | - Eduarda Carias
- Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal.
| | - Rui Baptista Gonçalves
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal.
| | - André Fragoso
- Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal.
| | - Carolina Dias
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal.
| | - Nelson Tavares
- Cardiology Department, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal.
| | - Hugo Mendonça Café
- Cardiology Department, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal.
| | - Nélio Santos
- Clinic Pathology Department, Centro Hospitalar Universitário do Algarve, 8000-836, Faro, Portugal.
| | - Fátima Rato
- Clinic Pathology Department, Centro Hospitalar Universitário do Algarve, 8000-836, Faro, Portugal.
| | - Pedro Leão Neves
- Nephrology Department, Centro Hospitalar Universitário do Algarve, 800-836 Faro, Portugal.
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal.
| | - Edgar Almeida
- Faculdadade de Medicina da Universidade de Lisboa, 1600-190 Lisboa, Portugal.
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13
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Gimelli A, Liga R, Giorgetti A, Casagranda M, Marzullo P. Stress-induced alteration of left ventricular eccentricity: An additional marker of multivessel CAD. J Nucl Cardiol 2019; 26:227-232. [PMID: 28353212 DOI: 10.1007/s12350-017-0862-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Abnormal left ventricular (LV) eccentricity index (EI) is a marker of adverse cardiac remodeling. However, the interaction between stress-induced alterations of EI and major cardiac parameters has not been explored. We sought to evaluate the relationship between LV EI and coronary artery disease (CAD) burden in patients submitted to myocardial perfusion imaging (MPI). METHODS AND RESULTS Three-hundred and forty-three patients underwent MPI and coronary angiography. LV ejection fraction (EF) and EI were computed from gated stress images as measures of stress-induced functional impairment. One-hundred and thirty-six (40%), 122 (35%), and 85 (25%) patients had normal coronary arteries, single-vessel CAD, and multivessel CAD, respectively. Post-stress EI was lower in patients with multivessel CAD than in those with normal coronary arteries and single-vessel CAD (P = 0.001). This relationship was confirmed only in patients undergoing exercise stress test, where a lower post-stress EI predicted the presence of multivessel CAD (P = 0.039). CONCLUSIONS Post-stress alterations of LV EI on MPI may unmask the presence of multivessel CAD.
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Affiliation(s)
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
| | | | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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