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Tanisha, Amudha C, Raake M, Samuel D, Aggarwal S, Bashir ZMD, Marole KK, Maryam I, Nazir Z. Diagnostic Modalities in Heart Failure: A Narrative Review. Cureus 2024; 16:e67432. [PMID: 39314559 PMCID: PMC11417415 DOI: 10.7759/cureus.67432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Heart failure (HF) can present acutely or progress over time. It can lead to morbidity and mortality affecting 6.5 million Americans over the age of 20. The HF type is described according to the ejection fraction classification, defined as the percentage of blood volume that exits the left ventricle after myocardial contraction, undergoing ejection into the circulation, also called stroke volume, and is proportional to the ejection fraction. Cardiac catheterization is an invasive procedure to evaluate coronary artery disease leading to HF. Several biomarkers are being studied that could lead to early detection of HF and better symptom management. Testing for various biomarkers in the patient's blood is instrumental in confirming the diagnosis and elucidating the etiology of HF. There are various biomarkers elevated in response to increased myocardial stress and volume overload, including B-type natriuretic peptide (BNP) and its N-terminal prohormone BNP. We explored online libraries such as PubMed, Google Scholar, and Cochrane to find relevant articles. Our narrative review aims to extensively shed light on diagnostic modalities and novel techniques for diagnosing HF.
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Affiliation(s)
- Tanisha
- Department of Internal Medicine No. 4, O.O. Bogomolets National Medical University, Kyiv, UKR
| | - Chaithanya Amudha
- Department of Medicine and Surgery, Saveetha Medical College and Hospital, Chennai, IND
| | - Mohammed Raake
- Department of Surgery, Annamalai University, Chennai, IND
| | - Dany Samuel
- Department of Radiology, Medical University of Varna, Varna, BGR
| | | | - Zainab M Din Bashir
- Department of Medicine and Surgery, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Karabo K Marole
- Department of Medicine and Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Iqra Maryam
- Department of Radiology, Allama Iqbal Medical College, Lahore, PAK
| | - Zahra Nazir
- Department of Internal Medicine, Combined Military Hospital, Quetta, PAK
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Hughes JW, Somani S, Elias P, Tooley J, Rogers AJ, Poterucha T, Haggerty CM, Salerno M, Ouyang D, Ashley E, Zou J, Perez MV. Simple models vs. deep learning in detecting low ejection fraction from the electrocardiogram. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:427-434. [PMID: 39081946 PMCID: PMC11284011 DOI: 10.1093/ehjdh/ztae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 08/02/2024]
Abstract
Aims Deep learning methods have recently gained success in detecting left ventricular systolic dysfunction (LVSD) from electrocardiogram (ECG) waveforms. Despite their high level of accuracy, they are difficult to interpret and deploy broadly in the clinical setting. In this study, we set out to determine whether simpler models based on standard ECG measurements could detect LVSD with similar accuracy to that of deep learning models. Methods and results Using an observational data set of 40 994 matched 12-lead ECGs and transthoracic echocardiograms, we trained a range of models with increasing complexity to detect LVSD based on ECG waveforms and derived measurements. The training data were acquired from the Stanford University Medical Center. External validation data were acquired from the Columbia Medical Center and the UK Biobank. The Stanford data set consisted of 40 994 matched ECGs and echocardiograms, of which 9.72% had LVSD. A random forest model using 555 discrete, automated measurements achieved an area under the receiver operator characteristic curve (AUC) of 0.92 (0.91-0.93), similar to a deep learning waveform model with an AUC of 0.94 (0.93-0.94). A logistic regression model based on five measurements achieved high performance [AUC of 0.86 (0.85-0.87)], close to a deep learning model and better than N-terminal prohormone brain natriuretic peptide (NT-proBNP). Finally, we found that simpler models were more portable across sites, with experiments at two independent, external sites. Conclusion Our study demonstrates the value of simple electrocardiographic models that perform nearly as well as deep learning models, while being much easier to implement and interpret.
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Affiliation(s)
- John Weston Hughes
- Department of Computer Science, Stanford University, 353 Jane Stanford Way, Stanford, CA 94305, USA
| | - Sulaiman Somani
- Department of Medicine, Stanford University, 1265 Pasteur Dr, Stanford, CA 94305, USA
| | - Pierre Elias
- Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - James Tooley
- Department of Medicine, Stanford University, 1265 Pasteur Dr, Stanford, CA 94305, USA
| | - Albert J Rogers
- Department of Medicine, Stanford University, 1265 Pasteur Dr, Stanford, CA 94305, USA
| | - Timothy Poterucha
- Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - Christopher M Haggerty
- Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - Michael Salerno
- Department of Medicine, Stanford University, 1265 Pasteur Dr, Stanford, CA 94305, USA
| | - David Ouyang
- Cedars-Sinai Medical Center, Department of Cardiology, Smidt Heart Institute, 127 S San Vicente Blvd Pavilion, Suite A3600, Los Angeles, CA 90048, USA
| | - Euan Ashley
- Department of Medicine, Stanford University, 1265 Pasteur Dr, Stanford, CA 94305, USA
| | - James Zou
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, Stanford, CA 94305, USA
| | - Marco V Perez
- Department of Medicine, Stanford University, 1265 Pasteur Dr, Stanford, CA 94305, USA
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Alkhodari M, Khandoker AH, Jelinek HF, Karlas A, Soulaidopoulos S, Arsenos P, Doundoulakis I, Gatzoulis KA, Tsioufis K, Hadjileontiadis LJ. Circadian assessment of heart failure using explainable deep learning and novel multi-parameter polar images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 248:108107. [PMID: 38484409 DOI: 10.1016/j.cmpb.2024.108107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Heart failure (HF) is a multi-faceted and life-threatening syndrome that affects more than 64.3 million people worldwide. Current gold-standard screening technique, echocardiography, neglects cardiovascular information regulated by the circadian rhythm and does not incorporate knowledge from patient profiles. In this study, we propose a novel multi-parameter approach to assess heart failure using heart rate variability (HRV) and patient clinical information. METHODS In this approach, features from 24-hour HRV and clinical information were combined as a single polar image and fed to a 2D deep learning model to infer the HF condition. The edges of the polar image correspond to the timely variation of different features, each of which carries information on the function of the heart, and internal illustrates color-coded patient clinical information. RESULTS Under a leave-one-subject-out cross-validation scheme and using 7,575 polar images from a multi-center cohort (American and Greek) of 303 coronary artery disease patients (median age: 58 years [50-65], median body mass index (BMI): 27.28 kg/m2 [24.91-29.41]), the model yielded mean values for the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, normalized Matthews correlation coefficient (NMCC), and accuracy of 0.883, 90.68%, 95.19%, 0.93, and 92.62%, respectively. Moreover, interpretation of the model showed proper attention to key hourly intervals and clinical information for each HF stage. CONCLUSIONS The proposed approach could be a powerful early HF screening tool and a supplemental circadian enhancement to echocardiography which sets the basis for next-generation personalized healthcare.
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Affiliation(s)
- Mohanad Alkhodari
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering and Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates; Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Ahsan H Khandoker
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering and Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering and Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates; Biotechnology Center (BTC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Angelos Karlas
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany; Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany; Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Stergios Soulaidopoulos
- First Cardiology Department, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Arsenos
- First Cardiology Department, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A Gatzoulis
- First Cardiology Department, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Leontios J Hadjileontiadis
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering and Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates; Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Sleem B, El Rassi C, Zareef R, Bitar F, Arabi M. NT-proBNP cardiac value in COVID-19: a focus on the paediatric population. Cardiol Young 2024; 34:959-968. [PMID: 38528805 DOI: 10.1017/s1047951124000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
NT-proBNP is a peptide related to brain natriuretic peptide, a cardiac biomarker and a member of the natriuretic family of peptides. NT-proBNP has demonstrated its clinical utility in the assessment of a wide spectrum of cardiac manifestations. It is also considered a more precise diagnostic and prognostic cardiac biomarker than brain natriuretic peptide. With the appearance of the Severe Acute Respiratory Syndrome Coronavirus 2 virus and the subsequent COVID-19 pandemic, diagnosis of heart implications began to pose an increasing struggle for the physician. Echocardiography is considered a central means of evaluating cardiac disorders like heart failure, and it is considered a reliable method. However, other diagnostic methods are currently being explored, one of which involves the assessment of NT-proBNP levels. In the literature that involves the adult population, significant positive correlations were drawn between the levels of NT-proBNP and COVID-19 outcomes such as high severity and fatality. In the paediatric population, however, the literature is scarce, and most of the investigations assess NT-proBNP in the context of Multiple Inflammatory Syndrome in Children, where studies have shown that cohorts with this syndrome had elevated levels of NT-proBNP when compared to non-syndromic cohorts. Thus, more large-scale studies on existing COVID-19 data should be carried out in the paediatric population to further understand the prognostic and diagnostic roles of NT-proBNP.
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Affiliation(s)
- Bshara Sleem
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe El Rassi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Prana Jagannatha GN, Suastika LOS, Kosasih AM, de Liyis BG, Yusrika MU, Kamardi S, Adrian J, Pradnyana IWAS, Alamsyah AH, Cardia YMP, Darmawan R, Rumangu AV, Pertiwi PFK. Prognostic Value of Baseline Echocardiographic Parameters in Heart Failure With Improved vs Nonrecovered Ejection Fraction. CJC Open 2023; 5:859-869. [PMID: 38204844 PMCID: PMC10774083 DOI: 10.1016/j.cjco.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/19/2023] [Indexed: 01/12/2024] Open
Abstract
Background Ejection fraction (EF) is often used as a prognostic indicator and for classifying heart failure (HF) patients. This study evaluates the association of echocardiographic parameters with HF with improved EF (HFimpEF). Methods This single-centre study retrospectively included patients with HF with reduced EF (HFrEF) from a cohort of admitted patients over 2018-2020, who were then followed up prospectively until 2023. The control group was categorized as patients with non-recovered HFrEF, and the population group was categorized as patients with HFimpEF. Results A total of 176 patients with HFrEF were included in the study. Non-ischemic etiology was found to be the most prevalent cause of HFimpEF. The baseline echocardiography examination revealed that the HFimpEF group exhibited significantly higher values for tricuspid annular plane systolic excursion (TAPSE; P < 0.001) and inferior vena cava diameter (P < 0.001). The non-recovered HFrEF group demonstrated higher baseline left atrial volume index (LAVi) values (P < 0.001). In multivariate analysis, a higher value of TAPSE (odds ratio 3.071; P = 0.008) and a lower value of LAVi (odds ratio 2.034; P = 0.008) were independent echocardiography variables associated with HFimpEF. After a mean follow-up duration of 32.5 ± 9.1 months, the HFimpEF group had higher survival from rehospitalization due to worsening HF and lower all-cause mortality (log rank P < 0.001 and P = 0.005, respectively). Conclusions Higher TAPSE and lower LAVi in baseline were associated with the transition from HFrEF to HFimpEF. The HFimpEF group had better survival compared to those with non-recovered HFrEF.
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Affiliation(s)
- Gusti Ngurah Prana Jagannatha
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Luh Oliva Saraswati Suastika
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Anastasya Maria Kosasih
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Bryan Gervais de Liyis
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Mirani Ulfa Yusrika
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Stanly Kamardi
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Jonathan Adrian
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | | | - Alif Hakim Alamsyah
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Yosep Made Pius Cardia
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Rizky Darmawan
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | | | - Putu Febry Krisna Pertiwi
- Faculty of Medicine, Udayana University/Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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El-Husseiny HM, Mady EA, Usui T, Ishihara Y, Yoshida T, Kobayashi M, Sasaki K, Ma D, Yairo A, Mandour AS, Hendawy H, Doghish AS, Mohammed OA, Takahashi K, Tanaka R. Adipose Stem Cell-Seeded Decellularized Porcine Pericardium: A Promising Functional Biomaterial to Synergistically Restore the Cardiac Functions Post-Myocardial Infarction. Vet Sci 2023; 10:660. [PMID: 37999483 PMCID: PMC10675230 DOI: 10.3390/vetsci10110660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/19/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Myocardial infarction (MI) is a serious cardiovascular disease as the leading cause of death globally. Hence, reconstruction of the cardiac tissue comes at the forefront of strategies adopted to restore heart functions following MI. In this investigation, we studied the capacity of rat adipose-derived mesenchymal stem cells (r-AdMSCs) and decellularized porcine pericardium (DPP) to restore heart functions in MI animals. MI was induced in four different groups, three of which were treated either using DPP (MI-DPP group), stem cells (MI-SC group), or both (MI-SC/DPP group). Cardiac functions of these groups and the Sham group were evaluated using echocardiography, the intraventricular pressure gradient (IVPG) on weeks 2 and 4, and intraventricular hemodynamics on week 4. On day 31, the animals were euthanized for histological analysis. Echocardiographic, IVPG and hemodynamic findings indicated that the three treatment strategies shared effectively in the regeneration process. However, the MI-SC/DPP group had a unique synergistic ability to restore heart functions superior to the other treatment protocols. Histology showed that the MI-SC/DPP group presented the lowest (p < 0.05) degeneration score and fibrosis % compared to the other groups. Conclusively, stem cell-seeded DPP is a promising platform for the delivery of stem cells and restoration of heart functions post-MI.
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Affiliation(s)
- Hussein M. El-Husseiny
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh 13736, Elqaliobiya, Egypt
| | - Eman A. Mady
- Laboratory of Veterinary Physiology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan;
- Department of Animal Hygiene, Behavior and Management, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh 13736, Elqaliobiya, Egypt
| | - Tatsuya Usui
- Laboratory of Veterinary Pharmacology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (T.U.); (Y.I.)
| | - Yusuke Ishihara
- Laboratory of Veterinary Pharmacology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (T.U.); (Y.I.)
| | - Toshinori Yoshida
- Laboratory of Veterinary Pathology, Division of Animal Life Science, Institute of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi 183-8509, Tokyo, Japan; (T.Y.); (M.K.)
| | - Mio Kobayashi
- Laboratory of Veterinary Pathology, Division of Animal Life Science, Institute of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi 183-8509, Tokyo, Japan; (T.Y.); (M.K.)
| | - Kenta Sasaki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
| | - Danfu Ma
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
- College of Veterinary Medicine, Nanjing Agricultural University, No. 1 Wei-Gang, Xuanwu District, Nanjing 210095, China
| | - Akira Yairo
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
| | - Ahmed S. Mandour
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Ismailia, Egypt
| | - Hanan Hendawy
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Ismailia, Egypt
| | - Ahmed S. Doghish
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Badr City 11829, Cairo, Egypt;
- Department of Biochemistry, and Molecular Biology Faculty of Pharmacy (Boys), Al-Azhar University, Nasr City 11651, Cairo, Egypt
| | - Osama A. Mohammed
- Department of Clinical Pharmacology, College of Medicine, University of Bisha, Bisha 61922, Saudi Arabia;
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo 113-8421, Tokyo, Japan;
| | - Ryou Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai Cho, Fuchu-shi 183-8509, Tokyo, Japan; (K.S.); (D.M.); (A.Y.); (A.S.M.); (H.H.)
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Almigbal TH, Almunif DS, Aburisheh KH, Barhoush MM, Aldhahi RA, Anabi MJ, Alotaibi OA. Echocardiographic Changes in Saudi Patients with Type 2 Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1985. [PMID: 38004034 PMCID: PMC10673090 DOI: 10.3390/medicina59111985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Cardiovascular disease is one of the leading causes of morbidity and mortality among the diabetic population. Given the high prevalence of diabetes mellitus (DM) in Saudi Arabia and the high prevalence of heart failure in the diabetic population, this study assesses the echocardiographic changes in Saudi patients with type 2 DM (T2DM) compared with healthy controls. Materials and Methods: In this retrospective case-control study, 80 patients with diabetes (45 males, age: 58.78 ± 10.2 years) were compared with 80 controls (45 males, age: 58.6 ± 10 years) who underwent an echocardiographic study in the King Saud University Medical City, Riyadh, Saudi Arabia. Results: There were no significant differences between the patients with diabetes and controls in terms of aortic root diameter, left atrium diameter, posterior wall, interventricular wall thickness, left ventricular diameters and ejection fraction. However, diastolic dysfunction was statistically significantly higher in the diabetic group than in the control group (p < 0.05). Conclusions: This is the first case-control study in Saudi Arabia that assesses echocardiographic parameters in T2DM patients. DM is an independent risk factor for diastolic dysfunction regardless of its association with hypertension and dyslipidemia.
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Affiliation(s)
- Turky H. Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia; (D.S.A.)
| | - Dina S. Almunif
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia; (D.S.A.)
| | - Khaled H. Aburisheh
- University Diabetes Centre, King Saud University Medical City, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia; (K.H.A.)
| | - Mazen M. Barhoush
- University Diabetes Centre, King Saud University Medical City, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia; (K.H.A.)
| | - Reem A. Aldhahi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia; (D.S.A.)
| | - Mohammed J. Anabi
- King Abdulaziz University Hospital, King Saud University Medical City, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia
| | - Obeed A. Alotaibi
- University Diabetes Centre, King Saud University Medical City, King Saud University, Riyadh P.O. Box 11495, Saudi Arabia; (K.H.A.)
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8
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Kim WJC, Beqiri A, Lewandowski AJ, Puyol-Antón E, Markham DC, King AP, Leeson P, Lamata P. Beyond Simpson's Rule: Accounting for Orientation and Ellipticity Assumptions. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2476-2485. [PMID: 36137846 PMCID: PMC9810537 DOI: 10.1016/j.ultrasmedbio.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 06/16/2023]
Abstract
Simpson's biplane rule (SBR) is considered the gold standard method for left ventricle (LV) volume quantification from echocardiography but relies on a summation-of-disks approach that makes assumptions about LV orientation and cross-sectional shape. We aim to identify key limiting factors in SBR and to develop a new robust standard for volume quantification. Three methods for computing LV volume were studied: (i) SBR, (ii) addition of a truncated basal cone (TBC) to SBR and (iii) a novel method of basal-oriented disks (BODs). Three retrospective cohorts representative of the young, adult healthy and heart failure populations were used to study the impact of anatomical variations in volume computations. Results reveal how basal slanting can cause over- and underestimation of volume, with errors by SBR and TBC >10 mL for slanting angles >6°. Only the BOD method correctly accounted for basal slanting, reducing relative volume errors by SBR from -2.23 ± 2.21% to -0.70 ± 1.91% in the adult population and similar qualitative performance in the other two cohorts. In conclusion, the summation of basal oriented disks, a novel interpretation of SBR, is a more accurate and precise method for estimating LV volume.
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Affiliation(s)
- Woo-Jin Cho Kim
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Arian Beqiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Ultromics Ltd, Oxford, UK
| | - Adam J Lewandowski
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Esther Puyol-Antón
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Andrew P King
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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9
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The Role of Left Ventricular Ejection Fraction and Left Ventricular Outflow Tract Velocity-Time Integral in Assessing Cardiovascular Impairment in Septic Shock. J Pers Med 2022; 12:jpm12111786. [PMID: 36579502 PMCID: PMC9696803 DOI: 10.3390/jpm12111786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 02/01/2023] Open
Abstract
Background: the role of echocardiography in septic shock remains controversial, since depressed cardiac afterload may overestimate left ventricular (LV) systolic performance and mask septic cardiomyopathy (SC). We hypothesized that afterload-adjusted LV ejection fraction (LVEF) and LV outflow tract velocity-time integral (VTI) values for given systemic vascular resistances (SVR) could provide novel insights into recognizing and stratifying the severity of SC. Methods: in this observational, monocentric study, we prospectively included 14 mechanically-ventilated patients under septic-shock who all had a Pulse index Continuous Cardiac Output (PiCCO) system in place for hemodynamic monitoring. Echocardiographic and PiCCO longitudinal examinations (71 measurements overall) were performed simultaneously at the onset of septic shock and every 12 h for 60 h overall. Results: VTI-derived stroke volume (SV) and cardiac output (CO) were significantly correlated with PiCCO measurements (r ≥ 0.993, both p < 0.001). LVEF and VTI showed linear and exponential inverse correlation to SVR (R2 = 0.183 vs. 0.507 and p < 0.001 vs. p < 0.001, respectively). The equations LVEF = 86.168 − 0.011 × SVR and VTI = 41.23 × e(−0.0005×SVR) were found to provide “predicted” values for given SVR. Measured to predicted LVEF ratios (for given SVR), the afterload-adjusted LVEF defined the severity of SC (mild ≥ 90%, 80% ≤ moderate < 90% and severe < 80%). Mild SC demonstrated normal/supra-normal LVEF, normal VTI and SVR. Moderate SC showed lower LVEF and SVR, yet increased LV end-diastolic volume (LVEDV), VTI, SV and CO compared with mild SC (all p < 0.05). Severe SC was distinguished from moderate SC by markedly reduced LVEF, LVEDV, VTI, SV, CO and significantly increased SVR (all p < 0.05). LVEF and VTI decreased over time in mild SC, LVEF decreased in moderate SC, and LVEF and VTI increased over time in severe SC (p ≤ 0.038). LVEF and VTI demonstrated significant performance in identifying severe SC [cut-off < 61.5%, area under the curve (AUC) = 1 ± 0.0, sensitivity/specificity = 100/100, p < 0.001 vs. cut-off < 17.9 cm, AUC = 0.882 ± 0.042, sensitivity/specificity = 80/77, p < 0.001, respectively]. VTI but not LVEF demonstrated significant diagnostic performance in identifying both SVR < 800 dynes·s·cm−5 and SVR > 1500 dynes·s·cm−5 (cut-off > 24.46 cm, AUC = 0.889 ± 0.049, sensitivity/specificity = 75/100, p < 0.001; cut-off < 16.8, AUC = 0.0.857 ± 0.082, sensitivity/specificity = 83/86, p = 0.002, respectively).Conclusions: our study suggests that ICU bedside echocardiographic assessment of LVEF, VTI and their adjusted to corresponding SVR values provides valuable insights for the comprehension of SC phenotypes, underlying vasoplegia and cardiac output fluctuations in septic shock.
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10
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Ávila MR, Figueiredo PHS, Lima VP, Silva WT, Vianna MVA, Fernandes LHC, de Azevedo ACA, Lima MMO, de Carvalho Bastone A, do Carmo Pereira Nunes M, Mediano MFF, da Costa Rocha MO, Costa HS. Accuracy of health-related quality of life in identifying systolic dysfunction in patients with Chagas cardiomyopathy. Trop Med Int Health 2021; 26:936-942. [PMID: 33864407 DOI: 10.1111/tmi.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Systolic dysfunction is a well-established marker of mortality in patients with Chagas cardiomyopathy (CC). However, its diagnosis is expensive and useful tools for screening these patients are required. The evaluation of the health-related quality of life (HRQoL) detects the patient's perception of the disease's impact. However, its accuracy in identifying patients with CC and systolic dysfunction is unknown. The study aimed to verify the sensitivity, specificity and predictive values of the physical and mental components related to HRQoL in identifying patients with CC and systolic dysfunction. METHODS 75 patients with CC, aged 49 (95% confidence interval: 47-51) years, were evaluated by echocardiography and Short-Form of Health Survey (SF-36) questionnaire. Systolic dysfunction was defined by left ventricular ejection fraction <52% for men and <54% for women and left ventricular diastolic diameter >55 mm. RESULTS Most patients (73%) had systolic dysfunction, with lower HRQoL values in the physical functioning, physical role functioning and general health perceptions domains and in the physical component summary. The accuracy of identifying patients with systolic dysfunction by the scores of physical components was 73% and 62% of mental components. The optimal cut-off point was 46 for physical and 54 for mental components, with respective positive predictive values of 91% and 80%. CONCLUSION The evaluation of the HRQoL by the SF-36, a low-cost instrument, can be useful in identifying patients with systolic dysfunction, assisting in the screening and risk stratification of patients.
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Affiliation(s)
- Matheus Ribeiro Ávila
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vanessa Pereira Lima
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Whesley Tanor Silva
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Marcus Vinícius Accetta Vianna
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Laís Helena Carvalho Fernandes
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Alda Cristina Alves de Azevedo
- Postgraduate Program in Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Márcia Maria Oliveira Lima
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Alessandra de Carvalho Bastone
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Maria do Carmo Pereira Nunes
- Postgraduate Program in Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Manoel Otávio da Costa Rocha
- Postgraduate Program in Infectious Diseases and Tropical Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Silveira Costa
- Physical Therapy School, Healthy and Biological Sciences Faculty, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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11
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Monaco F, Ajello S, Calabrò MG, Melisurgo G, Landoni G, Arata A, Lerose CC, Fumagalli E, Tomasso ND, Frontera A, Scandroglio AM, Della Bella P, Zangrillo A. Left Ventricular Unloading With an IABP in Patients Undergoing Ventricular Tachycardia Ablation With ECMO Support. J Cardiothorac Vasc Anesth 2021; 35:2686-2693. [PMID: 33487532 DOI: 10.1053/j.jvca.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors investigated the preprocedural predictors of postprocedural intra-aortic balloon pump (IABP) need in patients undergoing transcatheter ventricular tachycardia (VT) ablation on venoarterial (VA) extracorporeal membrane oxygenation (ECMO). DESIGN Observational study. SETTING Hybrid operating room and intensive care unit of a teaching hospital. PATIENTS Participants were 121 consecutive patients with unstable VT undergoing transcatheter ablation with VA-ECMO. INTERVENTIONS In patients with postprocedural echocardiographic, radiographic, or hemodynamic signs of increased left ventricle afterload, an IABP was positioned. MEASUREMENTS AND MAIN RESULTS Patients in the IABP group were more frequently on angiotensin-converting enzyme inhibitors (58% v 37%; p = 0.03) and had lower median baseline ejection fraction (25% v 28% p = 0.05), larger end-diastolic diameter (69.7 mm ± 13.0 v 65.7 mm ± 11.3; p = 0.03), and more frequent ischemic etiology as the reason for dilated cardiomyopathy (76% v 47%; p = 0.04,) when compared with patients not requiring IABP. Postoperatively, the IABP group required longer mechanical ventilation (24 hours [20-56.5] v 23 hours [15-28]; p = 0.003), intensive care unit stay (78 hours [46-174] v 48 hours [24-72]; p < 0.001), and continuous renal replacement therapy (13.3% v 1.3%; p = 0.006). By multivariate analysis, end-diastolic diameter (odds ratio [OR]:1.08; confidence interval [CI]: 1.00-1.16; p = 0.049), ischemic dilated cardiomyopathy (OR: 8.40; CI: 2.15-32.88; p = 0.002), and more-than-moderate mitral regurgitation (OR: 4.83; CI: 1.22-19.22; p = 0.025) were independent predictors of need for IABP. CONCLUSIONS The need for an IABP to unload the left ventricle can be predicted by ventricular size, medium-severe mitral valvular defect, and ischemic etiology of the dilated cardiomyopathy.
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Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Giulio Melisurgo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Allegra Arata
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Caterina Cecilia Lerose
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Elisabetta Fumagalli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Nora Di Tomasso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Antonio Frontera
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU
| | - Anna Mara Scandroglio
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Twitter: @SRAnesthesiaICU; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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12
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Ge R, Yang G, Chen Y, Luo L, Feng C, Ma H, Ren J, Li S. K-Net: Integrate Left Ventricle Segmentation and Direct Quantification of Paired Echo Sequence. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1690-1702. [PMID: 31765307 DOI: 10.1109/tmi.2019.2955436] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The integration of segmentation and direct quantification on the left ventricle (LV) from the paired apical views(i.e., apical 4-chamber and 2-chamber together) echo sequence clinically achieves the comprehensive cardiac assessment: multiview segmentation for anatomical morphology, and multidimensional quantification for contractile function. Direct quantification of LV, i.e., to automatically quantify multiple LV indices directly from the image via task-aware feature representation and regression, avoids accumulative error from the inter-step target. This integration sequentially makes a stereoscopical reflection of cardiac activity jointly from the paired orthogonal cross views sequences, overcoming limited observation with a single plane. We propose a K-shaped Unified Network (K-Net), the first end-to-end framework to simultaneously segment LV from apical 4-chamber and 2-chamber views, and directly quantify LV from major- and minor-axis dimensions (1D), area (2D), and volume (3D), in sequence. It works via four components: 1) the K-Net architecture with the Attention Junction enables heterogeneous tasks learning of segmentation task of pixel-wise classification, and direct quantification task of image-wise regression, by interactively introducing the information from segmentation to jointly promote spatial attention map to guide quantification focusing on LV-related region, and transferring quantification feedback to make global constraint on segmentation; 2) the Bi-ResLSTMs distributed in K-Net layer-by-layer hierarchically extract spatial-temporal information in echo sequence, with bidirectional recurrent and short-cut connection to model spatial-temporal information among all frames; 3) the Information Valve tailing the Bi-ResLSTMs selectively exchanges information among multiple views, by stimulating complementary information and suppressing redundant information to make the efficient cross-flow for each view; 4) the Evolution Loss comprehensively guides sequential data learning, with static constraint for frame values, and dynamic constraint for inter-frame value changes. The experiments show that our K-Net gains high performance with a Dice coefficient up to 91.44% and a mean absolute error of the major-axis dimension down to 2.74mm, which reveal its clinical potential.
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13
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Santoro C, Galderisi M, Esposito R, Buonauro A, Monteagudo JM, Sorrentino R, Lembo M, Fernandez-Golfin C, Trimarco B, Zamorano JL. Global longitudinal strain is a hallmark of cardiac damage in mitral regurgitation: the Italian arm of the European Registry of mitral regurgitation (EuMiClip). Cardiovasc Ultrasound 2019; 17:28. [PMID: 31752893 PMCID: PMC6873488 DOI: 10.1186/s12947-019-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR. METHODS Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112). RESULTS LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR. CONCLUSIONS Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Josè Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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14
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Awwad ZM, El-Ganainy SO, ElMallah AI, Khattab MM, El-Khatib AS. Telmisartan and captopril ameliorate pregabalin-induced heart failure in rats. Toxicology 2019; 428:152310. [PMID: 31629013 DOI: 10.1016/j.tox.2019.152310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022]
Abstract
Pregabalin (PRG) is highly effective in the treatment of epilepsy, neuropathic pain and anxiety disorders. Despite its potential benefits, PRG administration has been reported to induce or exacerbate heart failure (HF). It has been previously documented that overactivation of the renin angiotensin system (RAS) is involved in HF pathophysiological mechanism. The target of the current study was to examine the possible cardioprotective effect of telmisartan (Tel), an angiotensin II type 1 receptor (AT1R) blocker, compared with that of captopril (Cap), an angiotensin converting enzyme (ACE) inhibitor, in ameliorating PRG-induced HF in rats by assessing morphometric, echocardiographic and histopathological parameters. Furthermore, to investigate the role of RAS blockade by the two drugs in guarding against PRG-induced changes in cardiac angiotensin 1-7 (Ang 1-7) and angiotensin II (Ang II) levels, in addition to myocardial expression of ACE2, ACE, Mas receptor (MasR) and AT1R. Results showed that PRG administration induced morphometric, echocardiographic and histopathological deleterious alterations and significantly elevated cardiac Ang II, ACE and AT1R levels, while reduced Ang 1-7, ACE2 and MasR cardiac levels. Concurrent treatment with either Tel or Cap reversed PRG-induced morphometric, echocardiographic and histopathological abnormalities and revealed prominent protection against PRG-induced HF via downregulation of ACE/Ang II/AT1R and upregulation of ACE2/Ang 1-7/MasR axes. These are the first findings to demonstrate that the potential benefits of Tel and Cap are mediated by counteracting the altered balance between the RAS axes induced by PRG. Hence; Tel and Cap may attenuate PRG-induced HF partially through stimulation of ACE2/Ang 1-7/MasR pathway.
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Affiliation(s)
- Zeinab M Awwad
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy and Drug Manufacturing, Pharos University in Alexandria, Alexandria, Egypt.
| | - Samar O El-Ganainy
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy and Drug Manufacturing, Pharos University in Alexandria, Alexandria, Egypt
| | - Ahmed I ElMallah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Mahmoud M Khattab
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Aiman S El-Khatib
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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15
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Schneider JE, Stojanovic I. Economic evaluation of cardiac magnetic resonance with fast-SENC in the diagnosis and management of early heart failure. HEALTH ECONOMICS REVIEW 2019; 9:13. [PMID: 31123926 PMCID: PMC6734300 DOI: 10.1186/s13561-019-0229-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 04/01/2019] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Heart failure (HF) is a major public health concern, prevalent in millions of people worldwide. The most widely-used HF diagnostic method, echocardiography, incurs a decreased diagnostic accuracy for heart failure disease progression when patients are asymptomatic compared to those who are symptomatic. The purpose of this study is to conduct a cost-effectiveness analysis of heart failure diagnosis comparing echocardiography to a novel myocardial strain assessment (Fast-SENC), which utilizes cardiac-tagged magnetic resonance imaging. METHODS We develop two models, one from the perspective of payers and one from the perspective of purchasers (hospitals). The payer model is a cost-effectiveness model composed of a 1-year short-term model and a lifetime horizon model. The hospital/purchaser model is a cost impact model where expected costs are calculated by multiplying cost estimates of each subcomponent by the accompanying probability. RESULTS The payer model shows lower healthcare costs for Fast-SENC in comparison to ECHO ($24,647 vs. $39,097) and a lifetime savings of 37% when utilizing Fast-SENC. Similarly, the hospital model revealed that the total cost per HF patient visit is $184 for ECHO and $209 for Fast-SENC, which results in hospital contribution margins of $81 and $115, respectively. CONCLUSIONS Fast-SENC is associated with higher quality-adjusted life years and lower accumulated expected healthcare costs than echocardiogram patients. Fast-SENC also shows a significant short-term and lifetime cost-savings difference and a higher hospital contribution margin when compared to echocardiography. These results suggest that early discovery of heart failure with methods like Fast-SENC can be cost-effective when followed by the appropriate treatment.
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Affiliation(s)
- John E. Schneider
- Avalon Health Economics, 26 Washington Street, 3rd Floor, Morristown, NJ 07960 USA
| | - Ivana Stojanovic
- Avalon Health Economics, 26 Washington Street, 3rd Floor, Morristown, NJ 07960 USA
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16
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Abstract
Heart failure is a heterogeneous clinical syndrome stemming from cardiac overload and injury that leads to considerable morbidity and mortality. This review highlights the many faces of heart failure, a major and growing public health problem, including its causes, classification, underlying pathophysiology, and variable progression. An individualized, patient-centered treatment approach that focuses on guideline-directed pharmacologic and device therapies is required for optimal management of this complex syndrome.
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17
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Kenzik KM, Mehta A, Richman JS, Kilgore M, Bhatia S. Congestive heart failure in older adults diagnosed with follicular lymphoma: A population-based study. Cancer 2018; 124:4221-4230. [DOI: 10.1002/cncr.31695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly M. Kenzik
- Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham; Birmingham Alabama
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama
| | - Amitkumar Mehta
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama
| | - Joshua S. Richman
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Meredith Kilgore
- Department of Health Care Organization and Policy; University of Alabama at Birmingham; Birmingham Alabama
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship; University of Alabama at Birmingham; Birmingham Alabama
- Division of Pediatric Hematology Oncology; University of Alabama at Birmingham; Birmingham Alabama
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18
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Kim SH, Kim HJ, Han S, Yoo BS, Choi DJ, Kim JJ, Jeon ES, Cho MC, Chae SC, Ryu KH. The limited prognostic role of echocardiograms in short-term follow-up after acute decompensated heart failure: An analysis of the Korean Heart Failure (KorHF) Registry. PLoS One 2017; 12:e0188938. [PMID: 29261675 PMCID: PMC5736190 DOI: 10.1371/journal.pone.0188938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prognostic values of the left ventricular ejection fraction (LVEF) and end-diastolic dimension (LVEDD) have primarily been shown among patients with chronic heart failure (HF), with little representation of patients with acute HF (AHF). Therefore, we investigated the value of these echocardiographic parameters in predicting clinical outcomes among patients in the Korean Heart Failure (KorHF) Registry. METHODS The KorHF Registry consists of 3,200 patients who were hospitalized with AHF from 2005 to 2009. The Kaplan-Meier method was used to estimate survival and readmission, and differences were assessed using the log-rank test. Predictors of survival were identified using univariate and multivariate Cox proportional hazards regression analyses. RESULTS Echocardiograms from 2,910 of the 3,200 patients (90.9%) were evaluated. The median LVEF and LVEDD (37% and 56 mm, respectively) were used as cut-offs for the binary transformation of each parameter. The cumulative death-free survival rates for all patients did not significantly differ based on LVEF or LVEDD quartiles; however, an LVEF greater than the median was associated with a better prognosis in ischemic HF patients (log-rank test; p = 0.039). Among ischemic HF patients, LVEF (dichotomized) was a significant predictor of death in a Cox model after adjusting for a history of HF, age, systolic blood pressure (SBP), serum sodium, sex, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), acute myocardial infarction (AMI), atrial fibrillation (Af) and anemia (hazard ratio (HR) 1.475, 95% confidence interval (CI) 1.099-1.979, p = 0.010). The cumulative readmission-free survival rates significantly differed among ischemic HF patients only when based on LVEDD quartiles (log-rank test; p = 0.001). In multivariate Cox proportional hazards regression analyses, LVEDD (dichotomized) remained a significant variable only among patients with ischemic HF after adjusting for sex, age, AMI, DM, COPD, serum sodium, SBP, blood urea nitrogen (BUN) and anemia (HR 1.401, 95% CI 1.067-1.841, p = 0.015). CONCLUSIONS Among ischemic AHF patients in the KorHF Registry, LVEF is associated with mortality, whereas LVEDD is only associated with readmission in a binary transformed form.
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Affiliation(s)
- Sung Hea Kim
- Department of Cardiology, Konkuk University School of Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hyun-Joong Kim
- Department of Cardiology, Konkuk University School of Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Seongwoo Han
- Department of Cardiology, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju Christian Hospital, Wonju, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Korea
| | - Myeong-Chan Cho
- Cardiology Department, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Kyu-Hyung Ryu
- Department of Cardiology, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
- * E-mail:
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Talwar S, Singh S, Sreenivas V, Kapoor KS, Gupta SK, Ramakrishnan S, Kothari SS, Saxena A, Juneja R, Choudhary SK, Airan B. Outcomes of Patients Undergoing Primary Fontan Operation Beyond First Decade of Life. World J Pediatr Congenit Heart Surg 2017; 8:487-494. [PMID: 28696879 DOI: 10.1177/2150135117713696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Studies on older patients undergoing primary Fontan operation (FO) are limited, with conflicting results. We review our experience with these patients beyond the first decade of life. PATIENTS AND METHODS Between January 2000 and December 2014, a total of 105 patients ≥10 years of age (mean 15.6 ± 4.9, range 10-31, median 15 years) underwent primary FO without a prior bidirectional superior cavopulmonary anastomosis (Bidirectional Glenn [BDG]). Mean preoperative New York Heart Association (NYHA) class was 2.2 ± 0.57. RESULTS Operative procedure was extra-cardiac FO in 62 patients (8 were fenestrated). Forty-three had a lateral tunnel FO (26 were fenestrated). There were 11 (10.5%) early deaths. Fourteen of the 94 early survivors experienced prolonged pleural effusions, 7 had arrhythmias, and 2 had thromboembolic events. Two patients underwent Fontan takedown. On univariate analysis, NYHA functional class III, mean pulmonary artery (PA) pressure ≥15 mm Hg, hematocrit ≥60%, preoperative ventricular dysfunction, and atrioventricular valve regurgitation (AVVR) were associated with early mortality. Median follow-up was 78 (mean 88.9 ± 6.3) months. In 94 survivors, 6 (6.4%) late deaths were encountered. At last follow-up, 81 (86.2%) survivors were in NYHA class I. Actuarial survival was 84.7% ± 3.7% at 5, 10, and 15 years. CONCLUSION Carefully selected adolescents and young adults can safely undergo the primary FO. However, persistent pleural effusions, arrhythmias, thromboembolic events, and the need for reoperation mandate regular follow-up in such patients. Preoperative NYHA functional class III, mean PA pressure ≧ 15 mm Hg, hematocrit ≥ 60%, ventricular dysfunction, and AVVR were associated with early mortality, suggesting that primary FO should be avoided in such patients.
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Affiliation(s)
- Sachin Talwar
- 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnubhatla Sreenivas
- 2 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kulwant Singh Kapoor
- 2 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shyam Sunder Kothari
- 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sergi C, Shen F, Lim DW, Liu W, Zhang M, Chiu B, Anand V, Sun Z. Cardiovascular dysfunction in sepsis at the dawn of emerging mediators. Biomed Pharmacother 2017; 95:153-160. [PMID: 28841455 DOI: 10.1016/j.biopha.2017.08.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/03/2017] [Accepted: 08/13/2017] [Indexed: 12/14/2022] Open
Abstract
Subcellular dysfunction and impaired metabolism derived from the complex interaction of cytokines and mediators with cellular involvement are on the basis of the cardiovascular response to sepsis. The lethal consequences of an infection are intimately related to its ability to spread to other organ sites and the immune system of the host. About one century ago, William Osler (1849-1919), a Canadian physician, remarkably defined the sequelae of the host response in sepsis: "except on few occasions, the patient appears to die from the body's response to infection rather than from it." Cardiac dysfunction has received considerable attention to explain the heart failure in patients progressing from infection to sepsis, but our understanding of the processes remains limited. In fact, most concepts are linked to a mechanical concept of the sarcomeric structure, and physiological data seems to be often disconnected. Cytokines, prostanoids, and nitric oxide release are high direct impact factors, but coronary circulation and cardiomyocyte physiology also play a prominent role in modulating the effects of monocyte adhesion and infiltration. Damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs) are involved in the host response. The identification of microRNAs, as well as the cyclic activation of the inflammatory cascade, has further added complexity to the scene. In this review, we delineate the current concepts of cellular dysfunction of the cardiomyocyte in the setting of sepsis and consider potential therapeutic strategies.
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Affiliation(s)
- Consolato Sergi
- Institute of Biomedical and Pharmaceutical Sciences, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei Provincial Cooperative Innovation Center of Industrial Fermentation, Hubei Key Laboratory of Industrial Microbiology, Hubei University of Technology, Wuhan, 430068, PR China; Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, PR China; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; Stollery Children's Hospital, University Alberta Hospital, Edmonton, AB, Canada.
| | - Fan Shen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - David W Lim
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Weiyong Liu
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Mingyong Zhang
- Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, PR China
| | - Brian Chiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Vijay Anand
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ziyong Sun
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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Fabiani I, Pugliese NR, La Carrubba S, Conte L, Antonini-Canterin F, Colonna P, Benedetto F, Calogero E, Barletta V, Carerj S, Buralli S, Taddei S, Romano MF, Di Bello V. Incremental prognostic value of a complex left ventricular remodeling classification in asymptomatic for heart failure hypertensive patients. ACTA ACUST UNITED AC 2017; 11:412-419. [DOI: 10.1016/j.jash.2017.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/06/2017] [Accepted: 05/16/2017] [Indexed: 01/19/2023]
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Abdi AH, Luong C, Tsang T, Allan G, Nouranian S, Jue J, Hawley D, Fleming S, Gin K, Swift J, Rohling R, Abolmaesumi P. Automatic Quality Assessment of Echocardiograms Using Convolutional Neural Networks: Feasibility on the Apical Four-Chamber View. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1221-1230. [PMID: 28391191 DOI: 10.1109/tmi.2017.2690836] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Echocardiography (echo) is a skilled technical procedure that depends on the experience of the operator. The aim of this paper is to reduce user variability in data acquisition by automatically computing a score of echo quality for operator feedback. To do this, a deep convolutional neural network model, trained on a large set of samples, was developed for scoring apical four-chamber (A4C) echo. In this paper, 6,916 end-systolic echo images were manually studied by an expert cardiologist and were assigned a score between 0 (not acceptable) and 5 (excellent). The images were divided into two independent training-validation and test sets. The network architecture and its parameters were based on the stochastic approach of the particle swarm optimization on the training-validation data. The mean absolute error between the scores from the ultimately trained model and the expert's manual scores was 0.71 ± 0.58. The reported error was comparable to the measured intra-rater reliability. The learned features of the network were visually interpretable and could be mapped to the anatomy of the heart in the A4C echo, giving confidence in the training result. The computation time for the proposed network architecture, running on a graphics processing unit, was less than 10 ms per frame, sufficient for real-time deployment. The proposed approach has the potential to facilitate the widespread use of echo at the point-of-care and enable early and timely diagnosis and treatment. Finally, the approach did not use any specific assumptions about the A4C echo, so it could be generalizable to other standard echo views.
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da Silva JS, Gabriel-Costa D, Sudo RT, Wang H, Groban L, Ferraz EB, Nascimento JHM, Fraga CAM, Barreiro EJ, Zapata-Sudo G. Adenosine A 2A receptor agonist prevents cardiac remodeling and dysfunction in spontaneously hypertensive male rats after myocardial infarction. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:553-562. [PMID: 28293100 PMCID: PMC5345997 DOI: 10.2147/dddt.s113289] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background This work evaluated the hypothesis that 3,4-methylenedioxybenzoyl-2-thienylhydrazone (LASSBio-294), an agonist of adenosine A2A receptor, could be beneficial for preventing cardiac dysfunction due to hypertension associated with myocardial infarction (MI). Methods Male spontaneously hypertensive rats (SHR) were randomly divided into four groups (six animals per group): sham-operation (SHR-Sham), and myocardial infarction rats (SHR-MI) were treated orally either with vehicle or LASSBio-294 (10 and 20 mg.kg−1.d−1) for 4 weeks. Echocardiography and in vivo hemodynamic parameters measured left ventricle (LV) structure and function. Exercise tolerance was evaluated using a treadmill test. Cardiac remodeling was accessed by LV collagen deposition and tumor necrosis factor α expression. Results Early mitral inflow velocity was significantly reduced in the SHR-MI group, and there was significant recovery in a dose-dependent manner after treatment with LASSBio-294. Exercise intolerance observed in the SHR-MI group was prevented by 10 mg.kg−1.d−1 of LASS-Bio-294, and exercise tolerance exceeded that of the SHR-Sham group at 20 mg.kg−1.d−1. LV end-diastolic pressure increased after MI, and this was prevented by 10 and 20 mg.kg−1.d−1 of LASSBio-294. Sarcoplasmic reticulum Ca2+ ATPase levels were restored in a dose-dependent manner after treatment with LASSBio-294. Fibrosis and inflammatory processes were also counteracted by LASSBio-294, with reductions in LV collagen deposition and tumor necrosis factor α expression. Conclusion In summary, oral administration of LASSBio-294 after MI in a dose-dependent manner prevented the development of cardiac dysfunction, demonstrating this compound’s potential as an alternative treatment for heart failure in the setting of ischemic heart disease with superimposed chronic hypertension.
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Affiliation(s)
- Jaqueline S da Silva
- Research Program Development of Drugs, Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniele Gabriel-Costa
- Research Program Development of Drugs, Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto T Sudo
- Research Program Development of Drugs, Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hao Wang
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leanne Groban
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emanuele B Ferraz
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Hamilton M Nascimento
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Alberto M Fraga
- Research Program Development of Drugs, Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliezer J Barreiro
- Research Program Development of Drugs, Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gisele Zapata-Sudo
- Research Program Development of Drugs, Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Howard-Quijano K, Salem A, Barkulis C, Mazor E, Scovotti JC, Ho JK, Shemin RJ, Grogan T, Elashoff D, Mahajan A. Preoperative Three-Dimensional Strain Imaging Identifies Reduction in Left Ventricular Function and Predicts Outcomes After Cardiac Surgery. Anesth Analg 2017; 124:419-428. [DOI: 10.1213/ane.0000000000001440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Subclinical pulmonary congestion is prevalent in nephrotic syndrome. Kidney Int 2017; 89:421-8. [PMID: 26444027 DOI: 10.1038/ki.2015.279] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 12/26/2022]
Abstract
In patients with nephrotic syndrome (NS), the lung is considered an organ protected from the risk of edema. However, data on objectively measured lung water in NS patients is lacking. Here we measured lung water by an ultrasound (US) technique as well as by transthoracic impedance in 42 asymptomatic patients with active NS, in 14 stage G5D CKD patients on chronic hemodialysis, and in 21 healthy individuals. In patients with active NS, the median number of US-B lines (a metric of lung water) after 5 min in a supine position was significantly higher (12; interquartile range: 7-25) compared with that in healthy individuals (4; 2-9) but similar to that in hemodialysis patients (23; 10-39). The difference between NS patients and healthy individuals was significantly amplified (16; 10-35 vs. 4; 2-9) after 60 min of supine resting and significantly attenuated after 5 min of standing (10; 7-25 vs. 3; 1-6). Posture-dependent changes in lung water in patients with active NS were significantly accentuated compared with both hemodialysis patients and healthy individuals. After NS remission, the number of US-B lines was significantly reduced to 5 (4-18) at 5 min and to 6 (5-22) at 60 min approaching the normal range. Lung congestion in patients with active NS was confirmed by transthoracic impedance. Thus, asymptomatic pulmonary congestion is pervasive in patients with NS. A clinical trial is needed to assess the utility of lung US for the management of patients with NS.
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Pugliese NR, Fabiani I, La Carrubba S, Conte L, Antonini-Canterin F, Colonna P, Caso P, Benedetto F, Santini V, Carerj S, Romano MF, Citro R, Di Bello V. Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure. Am J Cardiol 2017; 119:71-77. [PMID: 27776801 DOI: 10.1016/j.amjcard.2016.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 01/18/2023]
Abstract
Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13 years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction <50%) and 483 diastolic dysfunction. According to the CRC, 891 patients were normals or presented with physiologic hypertrophy, 273 concentric remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29 mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p <0.001). After a median follow-up of 21 months, Kaplan-Meier analysis showed different survival distribution (p <0.001) of the CRC patterns. In multivariate Cox regression (adjusted for age, gender, history of stable ischemic heart disease, classic remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (p = 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.
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Myocardial inotropic reserve: An old twist that constitutes a reliable index in the modern era of heart failure. Hellenic J Cardiol 2016; 57:311-314. [PMID: 28087308 DOI: 10.1016/j.hjc.2016.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2015] [Indexed: 01/08/2023] Open
Abstract
Current national and international guidelines, including those of the European Society of Cardiology, recognize that the assessment of prognosis should be a part of the standard management for patients with chronic heart failure (CHF). However, these same guidelines recognize the inherent difficulty of this process. A variety of factors contribute to this difficulty, including the varying etiology, frequent co-morbidity and, perhaps most importantly, huge inter-individual variability in the disease progression and outcome. Although CHF is chronic, it is also a condition in which significant proportions of patients experience apparently 'sudden' death, which almost certainly contributes to our difficulty in assessing individual patient prognosis. A useful tool for the risk stratification of heart failure patients is dobutamine stress echocardiography (DSE), which determines the myocardial viability in ischemic cardiomyopathy and myocardial contractile reserve in idiopathic cardiomyopathy.
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Andrade CDM, Câmara ACJD, Nunes DF, Guedes PMDM, Pereira WO, Chiari E, Diniz RVZ, Galvão LMDC. Chagas disease: morbidity profile in an endemic area of Northeastern Brazil. Rev Soc Bras Med Trop 2016; 48:706-15. [PMID: 26676495 DOI: 10.1590/0037-8682-0235-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/05/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). METHODS This cross-sectional study included 186 adults who were evaluated using electrocardiography, echocardiography, chest radiography, and contrast radiography of the esophagus and colon. A clinical-epidemiological questionnaire was also used. RESULTS The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Heart failure (functional classes I-IV) was detected in 7.5% (14/186) of the participants, and 36.4% (24/66), 30.3% (20/66), 15.2% (10/66), 13.6% (9/66), and 4.5% (3/66) of the patients were at stage A, B1, B2, C, and D, respectively. Dilated cardiomyopathy and electrocardiographic changes were detected in 10.2% (19/186) and 48.1% (91/186) of the participants, respectively. Apical aneurysm was diagnosed in 10.8% (20/186) of the participants, and other changes in the segmental myocardial contractility of the left ventricle were diagnosed in 33.9% (63/186) of the participants. Megaesophagus (groups I-IV) was observed in 7% (13/186) of the participants, megacolon (grades 1-3) was detected in 12.9% (24/186) of the participants, and both organs were affected in 29.2% (7/24) of the megacolon cases. CONCLUSIONS We detected various clinical forms of Chagas disease (including the digestive form). Our findings indicate that clinical symptoms alone may not be sufficient to exclude or confirm cardiac and/or digestive damage, and the number of patients with symptomatic clinical forms may be underestimated.
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Affiliation(s)
- Cléber de Mesquita Andrade
- Programa de Pós-Graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Antônia Cláudia Jácome da Câmara
- Departamento de Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Daniela Ferreira Nunes
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Marcos da Matta Guedes
- Departamento de Microbiologia e Parasitologia, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Wogelsanger Oliveira Pereira
- Faculdade de Ciências da Saúde, Universidade do Estado do Rio Grande do Norte, Mossoró, Rio Grande do Norte, Brazil
| | - Egler Chiari
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosiane Viana Zuza Diniz
- Programa de Pós-Graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lúcia Maria da Cunha Galvão
- Programa de Pós-Graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Scali MC, Simioniuc A, Dini FL, Marzilli M. The potential value of integrated natriuretic peptide and echo-guided heart failure management. Cardiovasc Ultrasound 2014; 12:27. [PMID: 25037453 PMCID: PMC4114095 DOI: 10.1186/1476-7120-12-27] [Citation(s) in RCA: 10] [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: 04/10/2014] [Accepted: 07/07/2014] [Indexed: 01/06/2023] Open
Abstract
There is increasing interest in guiding Heart Failure (HF) therapy with Brain Natriuretic Peptide (BNP) or N-terminal prohormone of Brain Natriuretic Peptide (NT-proBNP), with the goal of lowering concentrations of these markers (and maintaining their suppression) as part of the therapeutic approach in HF. However, recent European Society of Cardiology (ESC) and American Heart Association/ American College of Cardiology (AHA/ACC) guidelines did not recommend biomarker-guided therapy in the management of HF patients. This has likely to do with the conceptual, methodological, and practical limitations of the Natriuretic Peptides (NP)-based approach, including biological variability, slow time-course, poor specificity, cost and venipuncture, as well as to the lack of conclusive scientific evidence after 15 years of intensive scientific work and industry investment in the field. An increase in NP can be associated with accumulation of extra-vascular lung water, which is a sign of impending acute heart failure. If this is the case, an higher dose of loop diuretics will improve symptoms. However, if no lung congestion is present, diuretics will show no benefit and even harm. It is only a combined clinical, bio-humoral (for instance with evaluation of renal function) and echocardiographic assessment which may unmask the pathophysiological (and possibly therapeutic) heterogeneity underlying the same clinical and NP picture. Increase in B-lines will trigger increase of loop diuretics (or dialysis); the marked increase in mitral insufficiency (at baseline or during exercise) will lead to increase in vasodilators and to consider mitral valve repair; the presence of substantial inotropic reserve during stress will give a substantially higher chance of benefit to beta-blocker or Cardiac Resynchronization Therapy (CRT). To each patient its own therapy, not with a "blind date" with symptoms and NP and carpet bombing with drugs, but with an open-eye targeted approach on the mechanism predominant in that individual patient. A monocular, specialistic, unidimensional approach to HF can miss its pathogenetic and clinical complexity, which only can be overcome with an integrated, versatile and tailored approach.
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Affiliation(s)
- Maria Chiara Scali
- Unità Operativa Malattie Cardiovascolari 1, Dipartimento Cardio-Toracico e Vascolare, Azienda Ospedaliera-Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy.
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Todaro MC, Khandheria BK, Paterick TE, Umland MM, Thohan V. The Practical Role of Echocardiography in Selection, Implantation, and Management of Patients Requiring LVAD Therapy. Curr Cardiol Rep 2014; 16:468. [DOI: 10.1007/s11886-014-0468-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ciampi Q, Pratali L, Citro R, Villari B, Picano E, Sicari R. Additive value of severe diastolic dysfunction and contractile reserve in the identification of responders to cardiac resynchronization therapy. Eur J Heart Fail 2014; 13:1323-30. [DOI: 10.1093/eurjhf/hfr132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital; Viale Principe di Napoli, 12; I-82100 Benevento Italy
| | | | - Rodolfo Citro
- Division of Cardiology; San Leonardo Hospital; Salerno Italy
| | - Bruno Villari
- Division of Cardiology, Fatebenefratelli Hospital; Viale Principe di Napoli, 12; I-82100 Benevento Italy
| | | | - Rosa Sicari
- CNR; Institute of Clinical Physiology; Pisa Italy
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Grossgasteiger M, Hien MD, Graser B, Rauch H, Motsch J, Gondan M, Rosendal C. Image quality influences the assessment of left ventricular function: an intraoperative comparison of five 2-dimensional echocardiographic methods with real-time 3-dimensional echocardiography as a reference. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:297-306. [PMID: 24449733 DOI: 10.7863/ultra.33.2.297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Transesophageal echocardiography has become a standard tool for evaluating left ventricular function during cardiac surgery. However, the image quality varies widely between patients and examinations. The aim of this study was to investigate the influence of the image quality on 5 commonly used 2-dimensional methods. METHODS Transesophageal real-time 3-dimensional echocardiography (3DE) served as a reference. Left ventricular function was evaluated in 63 patients with sufficient real-time 3DE image quality. The image quality was rated using the ratio of the visualized border divided by the total endocardial border. These ratings were used to generate groups of poor (0%-40%), fair (41%-70%), and good (71%-100%) image quality. The ejection fraction (EF), end-diastolic volume, and end-systolic volume were analyzed by the Simpson method of disks (biplane and monoplane), eyeball method, Teichholz method, and speckle-tracking method. Furthermore, the fractional area change was determined. Each correlation with real-time 3DE was evaluated. RESULTS Correlations of the EF and volumes, respectively, as determined by long-axis view methods increased with improving image quality: the Simpson biplane method was found to be the most accurate method, with good image quality for the EF (r = 0.946) and volumes (end-diastolic volume, r = 0.962; end-systolic volume, r = 0.989). Correlations of the EF and fractional area change by short-axis view methods decreased with improving image quality, with the Teichholz EF found to be most accurate with poor (r = 0.928) in contrast to good (r = 0.699) image quality. CONCLUSIONS With good image quality, the Simpson biplane method is the most accurate 2-dimensional method for assessing the left ventricular EF. Short-axis view methods, especially the Teichholz method yield better correlations with poor image quality. The eyeball method was unaffected by image quality.
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Affiliation(s)
- Manuel Grossgasteiger
- Cand.med, Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Grossgasteiger M, Hien MD, Graser B, Rauch H, Gondan M, Motsch J, Rosendal C. Assessment of left ventricular size and function during cardiac surgery. An intraoperative evaluation of six two-dimensional echocardiographic methods with real time three-dimensional echocardiography as a reference. Echocardiography 2013; 30:672-81. [PMID: 23405969 DOI: 10.1111/echo.12116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Transesophageal echocardiography is recommended to monitor left ventricular (LV) size and function in various operations. Generally, two-dimensional (2D) methods are applied intraoperatively. The aim of this study was to compare the accuracy and feasibility of 6 commonly used 2D methods to assess LV function during surgery. LV function in 120 consecutive patients was evaluated. Real time three-dimensional transesophageal echocardiograpy (3DTEE) served as reference. End-diastolic and end-systolic volumes and ejection fraction (EF) were analyzed with Simpson's method of discs (monoplane [MP] and biplane [BP]), eyeball method, Teichholz' method, and speckle tracking (ST) methods. Furthermore, fractional area change (FAC) and peak systolic pressure rise (dP/dt) were determined. Each 2D method was evaluated regarding correlation and agreement with 3DE, intra- and interobserver variability and the time required for evaluation. Simpson BP showed the strongest correlation and best agreement with 3DE for EF (limits of agreement 3.7 ± 11.6%) and volumes. Simpson MP showed similar agreement with 3DE compared to ST (2.8 ± 14.5% vs. 2.0 ± 15.3% and 3.8 ± 14.4% vs. 1.9 ± 15.6%, respectively). Both the eyeball method and Teichholz' method showed wide limits of agreement (-1.5 ± 18.2% and 5.2 ± 22.1%, respectively). DP/dt did not correlate with 3DE. FAC and ST FAC showed similar agreement. Application of 3DE (429 ± 108 seconds) took the longest time, and the eyeball method took the shortest time (8 ± 5 seconds) for analysis. Simpson BP is the most accurate intraoperative 2D method to evaluate LV function, followed by long-axis MP evaluations. Short-axis views were less accurate but may be suited for monitoring. We do not recommend using dP/dt.
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Affiliation(s)
- Manuel Grossgasteiger
- Research Training Group 1126: Intelligent Surgery, University of Heidelberg, Heidelberg, Germany.
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Kajimoto K, Madeen K, Nakayama T, Tsudo H, Kuroda T, Abe T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012; 10:49. [PMID: 23210515 PMCID: PMC3527194 DOI: 10.1186/1476-7120-10-49] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/29/2012] [Indexed: 11/25/2022] Open
Abstract
Background Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting is a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, improve functional capacity, and decrease mortality. In the present study, we examined the screening potential of rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating acute heart failure syndromes (AHFS) from primary pulmonary disease in patients with acute dyspnea in the emergency setting. Methods Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1 ± 9.9 years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30 minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room. Results The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively. Conclusions Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting.
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Baik R, Yu R, Lee YM, Kang HC, Lee JS, Kim HD. Early cardiac evaluation in children with non-specific mitochondrial disease with isolated mitochondrial respiratory chain complex I defect. J Paediatr Child Health 2012; 48:1016-20. [PMID: 23038991 DOI: 10.1111/j.1440-1754.2012.02585.x] [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] [Indexed: 11/28/2022]
Abstract
AIMS We evaluated echocardiography and electrocardiography (ECG) results in children with non-specific mitochondrial disease (MD) in order to study early cardiac involvement, a well-known complication of the disease. METHODS Among non-specific MD children whose isolated mitochondrial respiratory chain complex I defect was confirmed by muscle biopsy and satisfied the criteria of MD, 27 who had no cardiac symptoms were evaluated by echocardiography and ECG. RESULTS Three (11.1%) out of the 27 non-specific MD patients had left ventricular ejection fraction of less than 55% and two of them (7.4%) had fractional shortening of less than 26%. ECG abnormalities were observed in 16 of the non-specific MD patients (59.3%). Prolongation of heart rate-corrected QT interval was seen in 11 (40.7%) and widening of the QRS interval in eight (29.6%). Left ventricular ejection fraction and fractional shortening of the patients were significantly decreased compared with those in the control group while heart rate-corrected QT interval was prolonged in the former group. QRS interval was more widened in non-specific MD patients, but without statistical significance. CONCLUSION The potentially severe cardiac involvement observed in our subjects suggests that early cardiac evaluation after confirming the diagnosis of MD and regular follow-up tests should be strongly recommended in children even in cases without typical cardiac manifestations.
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Affiliation(s)
- Ran Baik
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Imaging in heart failure: role of preoperative imaging and intraoperative transesophageal echocardiography for heart failure surgery. Int Anesthesiol Clin 2012; 50:55-82. [PMID: 22735720 DOI: 10.1097/aia.0b013e31825d8d80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ciampi Q, Pratali L, Porta MD, Petruzziello B, Manganiello V, Villari B, Picano E, Sicari R. Tissue Doppler systolic velocity change during dobutamine stress echocardiography predicts contractile reserve and exercise tolerance in patients with heart failure. Eur Heart J Cardiovasc Imaging 2012; 14:102-9. [DOI: 10.1093/ehjci/jes096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maekawa E, Inomata T, Watanabe I, Yanagisawa T, Mizutani T, Shinagawa H, Koitabashi T, Takeuchi I, Tokita N, Inoue Y, Izumi T. Prognostic significance of right ventricular dimension on acute decompensation in chronic left-sided heart failure. Int Heart J 2011; 52:119-26. [PMID: 21483173 DOI: 10.1536/ihj.52.119] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent long-term outcome in patients with chronic left-sided HF.We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≥ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences.RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters.
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Affiliation(s)
- Emi Maekawa
- Department of Cardio-Angiology, Kitasato University School of Medicine
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Ciampi Q, Pratali L, Citro R, Villari B, Picano E, Sicari R. Clinical and prognostic role of pressure-volume relationship in the identification of responders to cardiac resynchronization therapy. Am Heart J 2010; 160:906-14. [PMID: 21095279 DOI: 10.1016/j.ahj.2010.07.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 07/13/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND The identification of responders remains challenging in cardiac resynchronization therapy (CRT). Pressure-volume relationship (PVR) is a method to evaluate left ventricular myocardial contractility during stress. The aim of the study was to assess the role of PVR to identify responders to CRT. METHODS Seventy-two patients (57% with ischemic etiology) referred to CRT: ejection fraction ≤ 35%, New York Heart Association ≥ III and QRS duration ≥ 120 milliseconds, underwent dobutamine stress echocardiography (up to 40 μg/kg per minute). PVR was defined as systolic cuff pressure/end-systolic volume index difference between rest-peak dobutamine stress echocardiography. Responders were identified by clinical and/or echocardiographic (end-systolic volume decrease ≥ 15%) follow-up criteria. We divided retrospectively the patient population into 2 groups, accordingly to the presence of myocardial contractile reserve that was set at the value of PVR (0.72 mm Hg/mL per square meter) obtained by a receiver operating characteristic analysis. RESULTS During a median follow-up of 12 months, 8 patients (11%) died. Patients with lower PVR, showed higher brain natriuretic peptide levels (853 ± 1211 vs 342 ± 239, P = .044) larger left ventricular end-diastolic (196 ± 82 mL vs 152 ± 39 mL, P = .005) and end-systolic (147 ± 66 vs 112 ± 30 mL, P = .006) volumes. Intraventricular dyssynchrony was similar in the 2 groups (88 ± 45 vs 70 ± 32 milliseconds, P = .175). Patients with higher PVR presented a larger incidence of clinical (86% vs 46% P < .001), and echocardiographic responders to CRT (79% vs 40%, P = .002). Event-free survival was significantly better in patients with higher PVR (log rank = 5.78, P = .01). CONCLUSION Patients with preserved contractility, assessed by PVR during stress echocardiography show a favor clinical outcome and left ventricular reverse remodeling after CRT. In particular, PVR may have a significant clinical role in patients undergoing CRT, providing critical information for risk stratification.
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What we know and do not know about sex and cardiac disease. J Biomed Biotechnol 2010; 2010:562051. [PMID: 20445744 PMCID: PMC2860154 DOI: 10.1155/2010/562051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/16/2010] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) remains the single leading cause of death in both men and women. A large proportion of the population with CVD will die with a diagnosis of congestive heart failure (CHF). It is becoming increasingly recognized that sex differences exist in the etiology, development, and outcome of CHF. For example, compared to male counterparts, women that present with CHF are typically older and have systolic cardiac function that is not impaired. Despite a growing body of literature addressing the underlying mechanisms of sex dimorphisms in cardiac disease, there remain significant inconsistencies reported in these studies. Given that the development of CHF results from the complex integration of genetic and nongenetic cues, it is not surprising that the elucidation and subsequent identification of molecular mechanisms remains unclear. In this review, key aspects of sex differences in CVD and CHF will be highlighted with an emphasis on some of the unanswered questions regarding these differences. The contention is presented that it becomes critical to reference cellular mechanisms within the context of each sex to better understand these sex dimorphisms.
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Ciampi Q, Pratali L, Bombardini T, Della Porta M, Petruzziello B, Villari B, Picano E, Sicari R. Pressure-Volume Relationship During Dobutamine Stress Echocardiography Predicts Exercise Tolerance in Patients with Congestive Heart Failure. J Am Soc Echocardiogr 2010; 23:71-8. [DOI: 10.1016/j.echo.2009.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Indexed: 11/16/2022]
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Ciampi Q, Pratali L, Citro R, Piacenti M, Villari B, Picano E. Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography. Eur J Heart Fail 2009; 11:489-96. [PMID: 19324921 DOI: 10.1093/eurjhf/hfp039] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders. METHODS AND RESULTS Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction < or =35%, New York Heart Association > or =III, and QRS duration > or =120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 microg/kg/min: CR was defined as a wall motion score index (WMSI) variation > or =0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease > or =15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P = 0.001) and in 69% with reverse remodelling (P = 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest-stress changes in ESV (r = 0.439, P = 0.003) and in WMSI (r = 0.450, P = 0.001), but not with DYS. CR (OR = 6.2, 95% CI = 1.4-27.6, P = 0.015) was the best predictor of response to CRT. CONCLUSION Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response.
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Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, Benevento, Italy.
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Sicari R, Rigo F, Gherardi S, Galderisi M, Cortigiani L, Picano E. The prognostic value of Doppler echocardiographic-derived coronary flow reserve is not affected by concomitant antiischemic therapy at the time of testing. Am Heart J 2008; 156:573-9. [PMID: 18760143 DOI: 10.1016/j.ahj.2008.04.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 04/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND When wall motion abnormality is the diagnostic end point, concomitant antiischemic therapy heavily modulates the prognostic value of dipyridamole echocardiography test (DET). A negative test result is less benign, and a positive test result is more malignant if performed under therapy. Recently, coronary flow reserve (CFR) was added to wall motion in dual imaging DET. The aim of the study was to determine whether antianginal medications affect the prognostic value of Doppler echocardiographic-derived CFR in patients with known or suspected coronary artery disease undergoing DET. METHODS In a prospective, multicenter, observational study, we evaluated 1,779 patients (1,072 males; 64 +/- 11 years) who underwent high-dose dipyridamole (0.84 mg/kg for 6 minutes) stress echo with CFR evaluation of left anterior descending (LAD) artery by Doppler. RESULTS Seven hundred thirty-three (41%) patients were on antiischemic therapy at time of testing (nitrates and/or calcium antagonists and/or beta-blockers). Mean CFR was 2.3. +/- 0.6. At individual patient analysis, 1,141 patients had normal (CFR >2.0) and 638 had abnormal (CFR <or=2.0) CFR on LAD. During a median follow-up of 36 months, 263 events occurred as follows: 36 deaths and 59 ST-elevation myocardial infarctions (STEMIs) and 168 non-STEMIs (NSTEMIs). Survival was highest in patients with normal CFR and lowest in patients with abnormal CFR (87% vs 34%, P = .0001). Survival was comparable in patients with normal CFR on and off therapy and in patients with abnormal CFR on and off therapy. At multivariable analysis, hypertension (hazard ratio [HR] 1.5, 95% CI 1.0-1.9, P = .010), DET positivity for regional wall motion abnormalities (HR 5.7, 95% CI 4.3-7.4, P = .000), an abnormal CFR on LAD (HR 3.3, 95% CI 2.5-4.4, P = .000) were independent prognostic predictors of hard cardiac events. CONCLUSION Ongoing antiischemic therapy at the time of testing does not modulate the prognostic value of Doppler echocardiographic-derived coronary flow reserve.
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Ciampi Q, Bianchi S, Porta MD, Petruzziello B, Caputo S, Pezza B, Villari B. Role of dobutamine stress echocardiography in resynchronization therapy in a patient with heart failure secondary to radiotherapy for Hodgkin's disease and ventilatory and inotropic dependence. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2008; 14:149-152. [PMID: 18550926 DOI: 10.1111/j.1751-7133.2008.08015.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Fatebenefratelli Hospital, Benevento, Italy.
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Pratali L, Otasevic P, Neskovic A, Molinaro S, Picano E. Prognostic Value of Pharmacologic Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy: A Prospective, Head-to-Head Comparison Between Dipyridamole and Dobutamine Test. J Card Fail 2007; 13:836-42. [DOI: 10.1016/j.cardfail.2007.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/06/2007] [Accepted: 07/30/2007] [Indexed: 11/26/2022]
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