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Chawla S, Sato R, Duggal A, Alwakeel M, Hasegawa D, Alayan D, Collier P, Sanfilippo F, Lanspa M, Dugar S. Correlation between tissue Doppler-derived left ventricular systolic velocity (S') and left ventricle ejection fraction in sepsis and septic shock: a retrospective cohort study. J Intensive Care 2023; 11:28. [PMID: 37400918 DOI: 10.1186/s40560-023-00678-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Tissue Doppler-derived left ventricular systolic velocity (mitral S') has shown excellent correlation to left ventricular ejection fraction (LVEF) in non-critically patients. However, their correlation in septic patients remains poorly understood and its impact on mortality is undetermined. We investigated the relationship between mitral S' and LVEF in a large cohort of critically-ill septic patients. METHODS We conducted a retrospective cohort study between 01/2011 and 12/2020. All adult patients (≥ 18 years) who were admitted to the medical intensive care unit (MICU) with sepsis and septic shock that underwent a transthoracic echocardiogram (TTE) within 72 h were included. Pearson correlation test was used to assess correlation between average mitral S' and LVEF. Pearson correlation was used to assess correlation between average mitral S' and LVEF. We also assessed the association between mitral S', LVEF and 28-day mortality. RESULTS 2519 patients met the inclusion criteria. The study population included 1216 (48.3%) males with a median age of 64 (IQR: 53-73), and a median APACHE III score of 85 (IQR: 67, 108). The median septal, lateral, and average mitral S' were 8 cm/s (IQR): 6.0, 10.0], 9 cm/s (IQR: 6.0, 10.0), and 8.5 cm/s (IQR: 6.5, 10.5), respectively. Mitral S' was noted to have moderate correlation with LVEF (r = 0.46). In multivariable logistic regression analysis, average mitral S' was associated with an increase in both 28-day ICU and in-hospital mortality with odds ratio (OR) 1.04 (95% CI 1.01-1.08, p = 0.02) and OR 1.04 (95% CI 1.01-1.07, p = 0.02), respectively. CONCLUSIONS Even though mitral S' and LVEF may be related, they are not exchangeable and were only found to have moderate correlation in this study. LVEF is U-shaped, while mitral S' has a linear relation with 28-day ICU mortality. An increase in average mitral S' was associated with higher 28-day mortality.
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Affiliation(s)
- Sanchit Chawla
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ryota Sato
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA
| | - Mahmoud Alwakeel
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daisuke Hasegawa
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Dina Alayan
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Filippo Sanfilippo
- Anaesthesiology and Intensive Care, University of Catania, Catania, Italy
- Policlinico-San Marco University Hospital, Catania, Italy
| | - Michael Lanspa
- Critical Care Echocardiography Service, Intermountain Medical Center, Murray, UT, USA
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.
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2
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Oliveira BC, Santos PP, Figueiredo AM, Rafacho BPM, Ishikawa L, Zanati SG, Fernandes AAH, Azevedo PS, Polegato BF, Zornoff LAM, Minicucci MF, Paiva SAR. Influence of Consumption of Orange Juice (Citrus Sinensis) on Cardiac Remodeling of Rats Submitted to Myocardial Infarction. Arq Bras Cardiol 2021; 116:1127-1136. [PMID: 34133599 PMCID: PMC8288524 DOI: 10.36660/abc.20190397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 06/10/2020] [Indexed: 12/22/2022] Open
Abstract
Fundamento O suco de laranja (SL) é rico em polifenóis com propriedades anti-inflamatórias e antioxidantes. Após o infarto do miocárdio (IM), mudanças complexas ocorrem na estrutura e na função cardíacas, processo conhecido como remodelação cardíaca (RC). O estresse oxidativo e a inflamação podem modular esse processo. Nossa hipótese foi a de que o consumo de SL atenua a RC após o IM. Objetivos Avaliar a influência do SL sobre a RC após IM pela análise de variáveis funcionais, morfológicas, de estresse oxidativo, de inflação, e de metabolismo energético. Métodos Um total de 242 ratos machos pesando entre 200 e 250g foram submetidos a um procedimento cirúrgico (ligação da artéria coronária ou cirurgia simulada). Sete dia após a cirurgia, os animais sobreviventes foram divididos para um dos quatro grupos: 1) SM, animais sham que receberam água e maltodextrina (n= 20); 2) SSL, animais sham que receberam SL (n= 20); 3) IM, animais infartados que receberam água e maltodextrina (n= 40); e 4) ISL, animais infartados que receberam SL (n = 40). A análise estatística foi realizada pelo teste de ANOVA com dois fatores com o teste de Holm-Sidak. Os resultados foram apresentados em média ± desvio padrão, e o nível de significância adotado foi de 5%. Resultados Três meses depois, o IM levou à hipertrofia do ventrículo esquerdo (VE), com disfunção sistólica e diastólica, e aumento nos mediadores inflamatórios e de estresse oxidativo. Os animais que consumiram SL apresentaram menor atividade da glutationa peroxidase e maior expressão da heme-oxigenase-1 (HO-1). Conclusão O SL atenuou a RC, e a HO-1 pode exercer um importante papel nesse processo.
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Affiliation(s)
- Bruna C Oliveira
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Priscila P Santos
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Amanda M Figueiredo
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Bruna P M Rafacho
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Larissa Ishikawa
- Instituto de Biociências Campus de Botucatu (UNESP), Botucatu , SP - Brasil
| | - Silméia G Zanati
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Ana A H Fernandes
- Instituto de Biociências Campus de Botucatu (UNESP), Botucatu , SP - Brasil
| | - Paula S Azevedo
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Bertha F Polegato
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Leonardo A M Zornoff
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Marcos F Minicucci
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil
| | - Sergio A R Paiva
- Universidade Estadual Paulista Júlio de Mesquita Filho Campus de Botucatu - Faculdade de Medicina de Botucatu , Botucatu , SP - Brasil.,Food Research Center FoRC , São Paulo , SP - Brasil
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Jensen TH, Juhl-Olsen P, Nielsen BRR, Heiberg J, Duez CHV, Jeppesen AN, Frederiksen CA, Kirkegaard H, Grejs AM. Echocardiographic parameters during prolonged targeted temperature Management in out-of-hospital Cardiac Arrest Survivors to predict neurological outcome - a post-hoc analysis of the TTH48 trial. Scand J Trauma Resusc Emerg Med 2021; 29:37. [PMID: 33608045 PMCID: PMC7893899 DOI: 10.1186/s13049-021-00849-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Transthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We hypothesized that changes in average peak systolic mitral annular velocity (s') from 24 h (h) to 72 h following start of targeted temperature management (TTM) predict six-month neurological outcome in comatose OHCA survivors. METHODS We investigated the association between peak systolic velocity of the mitral plane (s') and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33 ± 1 °C for 24 h (h) (n = 47) vs. 48 h (n = 52) following OHCA (TTH48-trial). TTE was conducted at 24 h, 48 h, and 72 h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s'. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e', E/e' and tricuspid annular plane systolic excursion (TAPSE). RESULTS Across all three scan time points s' was not associated with neurological outcome (ORs: 24 h: 1.0 (95%CI: 0.7-1.4, p = 0.98), 48 h: 1.13 (95%CI: 0.9-1.4, p = 0.34), 72 h: 1.04 (95%CI: 0.8-1.4, p = 0.76)). LVEF, GLS, E/e', and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e' at 48 h following TTM was 5.74 cm/s (95%CI: 5.27-6.22) in patients with good outcome (CPC180 1-2) vs. 4.95 cm/s (95%CI: 4.37-5.54) in patients with poor outcome (CPC180 3-5) (p = 0.04). CONCLUSIONS s' assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA. TRIAL REGISTRATION NCT02066753 . Registered 14 February 2014 - Retrospectively registered.
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Affiliation(s)
- Thomas Hvid Jensen
- Department of Cardiology, Viborg Regional Hospital, Heibergs Alle 2K, 8800, Viborg, Denmark.
| | - Peter Juhl-Olsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Johan Heiberg
- Centre of Head and Orthopaedics Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Morten Grejs
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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Røe ÅT, Ruud M, Espe EK, Manfra O, Longobardi S, Aronsen JM, Nordén ES, Husebye T, Kolstad TRS, Cataliotti A, Christensen G, Sejersted OM, Niederer SA, Andersen GØ, Sjaastad I, Louch WE. Regional diastolic dysfunction in post-infarction heart failure: role of local mechanical load and SERCA expression. Cardiovasc Res 2020; 115:752-764. [PMID: 30351410 PMCID: PMC6432054 DOI: 10.1093/cvr/cvy257] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 01/08/2023] Open
Abstract
Aims Regional heterogeneities in contraction contribute to heart failure with reduced ejection fraction (HFrEF). We aimed to determine whether regional changes in myocardial relaxation similarly contribute to diastolic dysfunction in post-infarction HFrEF, and to elucidate the underlying mechanisms. Methods and results Using the magnetic resonance imaging phase-contrast technique, we examined local diastolic function in a rat model of post-infarction HFrEF. In comparison with sham-operated animals, post-infarction HFrEF rats exhibited reduced diastolic strain rate adjacent to the scar, but not in remote regions of the myocardium. Removal of Ca2+ within cardiomyocytes governs relaxation, and we indeed found that Ca2+ transients declined more slowly in cells isolated from the adjacent region. Resting Ca2+ levels in adjacent zone myocytes were also markedly elevated at high pacing rates. Impaired Ca2+ removal was attributed to a reduced rate of Ca2+ sequestration into the sarcoplasmic reticulum (SR), due to decreased local expression of the SR Ca2+ ATPase (SERCA). Wall stress was elevated in the adjacent region. Using ex vivo experiments with loaded papillary muscles, we demonstrated that high mechanical stress is directly linked to SERCA down-regulation and slowing of relaxation. Finally, we confirmed that regional diastolic dysfunction is also present in human HFrEF patients. Using echocardiographic speckle-tracking of patients enrolled in the LEAF trial, we found that in comparison with controls, post-infarction HFrEF subjects exhibited reduced diastolic train rate adjacent to the scar, but not in remote regions of the myocardium. Conclusion Our data indicate that relaxation varies across the heart in post-infarction HFrEF. Regional diastolic dysfunction in this condition is linked to elevated wall stress adjacent to the infarction, resulting in down-regulation of SERCA, disrupted diastolic Ca2+ handling, and local slowing of relaxation.
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Affiliation(s)
- Åsmund T Røe
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Marianne Ruud
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Emil K Espe
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ornella Manfra
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Stefano Longobardi
- Biomedical Engineering Department, The Rayne Institute, King's College, London, London, UK
| | - Jan M Aronsen
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,Bjørknes College, Oslo, Norway
| | - Einar Sjaastad Nordén
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Bjørknes College, Oslo, Norway
| | - Trygve Husebye
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Terje R S Kolstad
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Alessandro Cataliotti
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ole M Sejersted
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Steven A Niederer
- Biomedical Engineering Department, The Rayne Institute, King's College, London, London, UK
| | | | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - William E Louch
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
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Kırış T, Avcı E. Short-term effects of levosimendan on strain/strain rate markers in patients with nonischemic dilated cardiomyopathy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:527-532. [PMID: 30229927 DOI: 10.1002/jcu.22627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/05/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate whether repetitive measurements of speckle tracking echocardiography (STE)-derived strain (S) and strain rate (SR) could reveal changes in left ventricular function in patients with nonischemic dilated cardiomyopathy treated with levosimendan. METHODS We included 22 consecutive patients (age 53 ±12 years) with an ejection fraction (EF) below 35% and New York Heart Association (NYHA) class III-IV symptoms that required intravenous inotropic support despite optimal medical therapy. The absence of any occlusive coronary artery disease was identified via previous coronary angiography in all patients. Echocardiographic variables, including strain/strain rate, and NYHA functional class, were evaluated before and after levosimendan infusion at the 72nd hour and one month. RESULTS The strain and strain rate values for both left and right ventricles were observed to be increased NYHA functional class and left ventricular EF (P <.05). CONCLUSION STE can successfully completed conventional echocardiography in the evaluation of patients with decompensated heart failure who were treated with levosimendan.
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Affiliation(s)
- Tuncay Kırış
- Department of Cardiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Eyüp Avcı
- Cardiology Department, Balikesir University Faculty of Medicine, Balikesir, Turkey
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