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Clavero-Adell M, Ayerza-Casas A, Palanca-Arias D, López-Ramón M, Jiménez-Montañés L, Olmos S. Early assessment of cardiomyopathy in Duchenne patients by means of longitudinal strain echocardiography. Cardiol Young 2024; 34:151-156. [PMID: 37272541 DOI: 10.1017/s104795112300149x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The diagnosis of Duchenne-linked cardiomyopathy may be challenging. Conventional echocardiographic measurements typically show deterioration beyond the second decade. Global longitudinal strain has been proposed as an earlier marker than left ventricular ejection fraction. MATERIAL AND METHODS A prospective, observational, cross-sectional, case-control study was carried out. Both Duchenne patients and control subjects underwent transthoracic echocardiogram in order to assess left ventricle function. Bayesian linear regression was the main tool for inference. Age effects were parameterised by means of a spline function because of its simplicity to characterise continuous variables and smooth contributions. The posterior distribution of the marginal age effects was used to assess the earliest age of deterioration of each marker. RESULTS Sixteen Duchenne patients and twenty-two healthy male subjects were enrolled. On overage, cardiac function measures were found for ejection fraction and longitudinal strain among different groups. Age effects on global longitudinal strain are more reliably found at ages of 6 and above, while ejection fraction starts to deteriorate at an older age. Progressive left ventricular dysfunction in Duchenne patients is one of the key issues and starts at an early age with subtle symptoms. CONCLUSION This cross-sectional study provides supporting evidence that global longitudinal strain is an earlier marker of disease progression than ejection fraction in Duchenne patients.
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Affiliation(s)
- Marcos Clavero-Adell
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
- Dislipemias Primarias, IIS Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, Universidad de Zaragoza, Spain
| | - Ariadna Ayerza-Casas
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
- Faculty of Medicine, Universidad de Zaragoza, Spain
| | - Daniel Palanca-Arias
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
- Faculty of Medicine, Universidad de Zaragoza, Spain
| | - Marta López-Ramón
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Salvador Olmos
- Dislipemias Primarias, IIS Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
- Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain
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Siemionow M, Biegański G, Niezgoda A, Wachowiak J, Czarnota J, Siemionow K, Ziemiecka A, Sikorska MH, Bożyk K, Heydemann A. Safety and Efficacy of DT-DEC01 Therapy in Duchenne Muscular Dystrophy Patients: A 12 - Month Follow-Up Study After Systemic Intraosseous Administration. Stem Cell Rev Rep 2023; 19:2724-2740. [PMID: 37707670 PMCID: PMC10661797 DOI: 10.1007/s12015-023-10620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
Duchenne Muscular Dystrophy (DMD) is a progressive and fatal muscle-wasting disease with no known cure. We previously reported the preliminary safety and efficacy up to six months after the administration of DT-DEC01, a novel Dystrophin Expressing Chimeric (DEC) cell therapy created by fusion of myoblasts of DMD patient and the normal donor. In this 12-month follow-up study, we report on the safety and functional outcomes of three DMD patients after the systemic intraosseous administration of DT-DEC01. The safety of DT-DEC01 was confirmed by the absence of Adverse Events (AE) and Severe Adverse Events (SAE) up to 21 months after intraosseous DT-DEC01 administration. The lack of presence of anti-HLA antibodies and Donors Specific Antibodies (DSA) further confirmed DT-DEC01 therapy safety. Functional assessments in ambulatory patients revealed improvements in 6-Minute Walk Test (6MWT) and timed functions of North Star Ambulatory Assessment (NSAA). Additionally, improvements in PUL2.0 test and grip strength correlated with increased Motor Unit Potentials (MUP) duration recorded by Electromyography (EMG) in both ambulatory and non-ambulatory patients. DT-DEC01 systemic effect was confirmed by improved cardiac and pulmonary parameters and daily activity recordings. This follow-up study confirmed the safety and preliminary efficacy of DT-DEC01 therapy in DMD-affected patients up to 12 months after intraosseous administration. DT-DEC01 introduces a novel concept of personalized myoblast-based cellular therapy that is irrespective of the mutation type, does not require immunosuppression or the use of viral vectors, and carries no risk of off target mutations. This establishes DT-DEC01 as a promising and universally effective treatment option for all DMD patients.
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Affiliation(s)
- Maria Siemionow
- Chair and Department of Traumatology, Orthopedics and Surgery of the Hand, Poznan University of Medical Sciences, 61‑545, Poznan, Poland.
- Dystrogen Therapeutics Corp., Chicago, IL, 60609, USA.
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, 60612, USA.
| | - Grzegorz Biegański
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 60‑572, Poznan, Poland
| | - Adam Niezgoda
- Department of Neurology, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572, Poznan, Poland
| | | | - Krzysztof Siemionow
- Dystrogen Therapeutics Corp., Chicago, IL, 60609, USA
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | | | | | | | - Ahlke Heydemann
- Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL, 60612, USA
- Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, IL, 60612, USA
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Kerstens TP, van Everdingen WM, Habets J, van Dijk APJ, Helbing WA, Thijssen DHJ, Udink Ten Cate FEA. Left ventricular deformation and myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy. Int J Cardiol 2023; 388:131162. [PMID: 37433407 DOI: 10.1016/j.ijcard.2023.131162] [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] [Received: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Left ventricular (LV) strain and rotation are emerging functional markers for early detection of LV dysfunction and have been associated with the burden of myocardial fibrosis in several disease states. This study examined the association between LV deformation (i.e., LV strain and rotation) and extent and location of LV myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy (DMD). METHODS AND RESULTS 34 pediatric patients with DMD underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) to assess LV myocardial fibrosis. Offline CMR feature-tracking analysis was used to assess global and segmental longitudinal and circumferential LV strain, and LV rotation. Patients with fibrosis (n = 18, 52.9%) were older than those without fibrosis (14 ± 3 years (yrs) vs 11 ± 2 yrs., p = 0.01). There was no significant difference in LV ejection fraction (LVEF) between subjects with and without fibrosis (54 ± 6% vs 56 ± 4%, p = 0.18). However, lower endocardial global circumferential strain (GCS), but not LV rotation, was associated with presence of fibrosis (adjusted Odds Ratio 1.25 [95% CI 1.01-1.56], p = 0.04). Both GCS and global longitudinal strain correlated with the extent of fibrosis (r = .52, p = 0.03 and r = .75, p < 0.01, respectively). Importantly, segmental strain did not seem to correspond to location of fibrosis. CONCLUSION A lower global, but not segmental, strain is associated with presence and extent of LV myocardial fibrosis in pediatric DMD patients. Therefore, strain parameters might detect structural myocardial alterations, however currently more research is needed to evaluate its value (e.g., prognostic) in clinical practice.
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Affiliation(s)
- Thijs P Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands
| | - Wouter M van Everdingen
- Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands
| | - Jesse Habets
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, Lijnbaan 32, The Hague 2512 VA, the Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital, Dr Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Floris E A Udink Ten Cate
- Academic Center for Congenital Heart Disease (ACAHA), Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.
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Latorre-Pellicer A, Trujillano L, Del Rincón J, Peña-Marco M, Gil-Salvador M, Lucia-Campos C, Arnedo M, Puisac B, Ramos FJ, Ayerza-Casas A, Pié J. Heart Disease Characterization and Myocardial Strain Analysis in Patients with PACS1 Neurodevelopmental Disorder. J Clin Med 2023; 12:4052. [PMID: 37373745 DOI: 10.3390/jcm12124052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND PACS1 neurodevelopmental disorder (PACS1-NDD) (MIM# 615009) is a rare autosomal dominant disease characterized by neurodevelopmental delay, dysmorphic facial features, and congenital malformations. Heart disease (HD) is frequently present in individuals with PACS1-NDD, but a compressive review of these anomalies and an evaluation of cardiac function in a cohort of patients are lacking. METHODS (i) Cardiac evaluation in 11 PACS1-NDD patients was conducted using conventional echocardiography. (ii) Heart function was assessed by tissue Doppler imaging, and two-dimensional speckle tracking was performed in seven patients and matched controls. (iii) This systematic review focused on determining HD prevalence in individuals with PACS1-NDD. RESULTS In our cohort, 7 of 11 patients presented HD. (Among them, three cases of ascending aortic dilatation (AAD) were detected and one mitral valve prolapse (MVP).) None of the patients showed echocardiographic pathological values, and the left global longitudinal strain was not significantly different between patients and controls (patients -24.26 ± 5.89% vs. controls -20.19 ± 1.75%, p = 0.3176). In the literature review, almost 42% (42/100) of individuals with PACS1-NDD reportedly experienced HD. Septal defects were the most common malformation, followed by patent ductus arteriosus. CONCLUSIONS Our results show a high prevalence of HD in PACS1-NDD patients; in this way, AAD and MVP are reported for the first time in this syndrome. Furthermore, a detailed cardiac function evaluation in our cohort did not reveal evidence of cardiac dysfunction in individuals with PACS1-NDD. Cardiology evaluation should be included for all individuals with Schuurs-Hoeijmakers syndrome.
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Affiliation(s)
- Ana Latorre-Pellicer
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Laura Trujillano
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
- Department of Clinical and Molecular Genetics Hospital Vall d'Hebron, E-08035 Barcelona, Spain
| | - Julia Del Rincón
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Mónica Peña-Marco
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Marta Gil-Salvador
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Cristina Lucia-Campos
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - María Arnedo
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Beatriz Puisac
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Feliciano J Ramos
- Unit of Clinical Genetics, Department of Paediatrics, Service of Paediatrics, Hospital Clínico Universitario Lozano Blesa, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
| | - Ariadna Ayerza-Casas
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
- Unit of Paediatric Cardiology, Service of Paediatrics, Hospital Universitario Miguel Servet, E-50009 Zaragoza, Spain
| | - Juan Pié
- Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, Universidad de Zaragoza, CIBERER-GCV02 and IIS-Aragon, E-50009 Zaragoza, Spain
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Wang S, Lyu B. Are Current Prophylactic Programs Effective in Preventing Patellar Tendinopathy in Athletes and Recruits? A Meta-Analysis and Trial Sequential Analysis. Sports Health 2023; 15:382-385. [PMID: 36146934 PMCID: PMC10170222 DOI: 10.1177/19417381221121808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Patellar tendinopathy (PT), or jumper's knee, is a chronic painful overuse patellar tendon injury. For PT, prevention is more important than treatment. However, there is still a lack of strong evidence to confirm the effectiveness of prevention. OBJECTIVE This study will analyze by meta-analysis the effect of a prophylactic program on high PT risk people (but without PT) in reducing PT occurrence. DATA SOURCES PubMed, Embase, the Cochrane Library, Scopus, and Ebscohost, from inception to January 11, 2022. STUDY SELECTION A study comparing the effects of prophylactic programs and controls on the risk of PT was included in the analysis. After a database search with search terms ((patellar tendinopathy) OR (jumper's knee) OR (patellar tendinitis) OR (patellar tendinosis) OR (patellar tendonitis)) AND ((Prevent*) OR (prophyla*)), a total of 1444 items were obtained. Of these, 11 studies with 6091 participants were eligible for inclusion in this meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION The first author's name, publication year, study design, country, population, mean age, sex, prophylactic program, control, study duration, and the frequency or incidence of PT in each group were extracted. RESULTS A total of 11 articles were included in the analysis. Overall, no significant difference was considered in the risk of PT between the prophylactic program and control groups based on the random-effect model (odds ratio [OR], 0.85; 95% CI, 0.67, 1.08; P = 0.18). In the recruit subgroup, there was even a tendency to elevate the risk of PT occurrence after prophylaxis was executed (OR, 1.89; 95% CI, 0.68, 5.28; P = 0.22). In athletes, the prophylactic program tended to decrease the risk of PT compared with the control (OR, 0.81; 95% CI, 0.63, 1.04; P = 0.10); however, the difference was not statistically significant. Trial sequential analysis results suggested that prophylaxis may still be effective for athletes, but this needs to be confirmed with a larger sample size. CONCLUSION The risk of PT cannot be reduced with the current prophylactic program. However, for athletes, the negative results may be due to insufficient sample size.
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Affiliation(s)
- Shaowei Wang
- College of Physical Education, Hebei Normal
University, Hebei, People’s Republic of China
| | - Buwei Lyu
- Faculty of Public Physical Education, Hebei
Normal University, Hebei, People’s Republic of China
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Earl CC, Pyle VI, Clark SQ, Annamalai K, Torres PA, Quintero A, Damen FW, Hor KN, Markham LW, Soslow JH, Goergen CJ. Localized strain characterization of cardiomyopathy in Duchenne muscular dystrophy using novel 4D kinematic analysis of cine cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:14. [PMID: 36793101 PMCID: PMC9933368 DOI: 10.1186/s12968-023-00922-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/21/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Cardiomyopathy (CMP) is the most common cause of mortality in Duchenne muscular dystrophy (DMD), though the age of onset and clinical progression vary. We applied a novel 4D (3D + time) strain analysis method using cine cardiovascular magnetic resonance (CMR) imaging data to determine if localized strain metrics derived from 4D image analysis would be sensitive and specific for characterizing DMD CMP. METHODS We analyzed short-axis cine CMR image stacks from 43 DMD patients (median age: 12.23 yrs [10.6-16.5]; [interquartile range]) and 25 male healthy controls (median age: 16.2 yrs [13.3-20.7]). A subset of 25 male DMD patients age-matched to the controls (median age: 15.7 yrs [14.0-17.8]) was used for comparative metrics. CMR images were compiled into 4D sequences for feature-tracking strain analysis using custom-built software. Unpaired t-test and receiver operator characteristic area under the curve (AUC) analysis were used to determine statistical significance. Spearman's rho was used to determine correlation. RESULTS DMD patients had a range of CMP severity: 15 (35% of total) had left ventricular ejection fraction (LVEF) > 55% with no findings of myocardial late gadolinium enhancement (LGE), 15 (35%) had findings of LGE with LVEF > 55% and 13 (30%) had LGE with LVEF < 55%. The magnitude of the peak basal circumferential strain, basal radial strain, and basal surface area strain were all significantly decreased in DMD patients relative to healthy controls (p < 0.001) with AUC values of 0.80, 0.89, and 0.84 respectively for peak strain and 0.96, 0.91, and 0.98 respectively for systolic strain rate. Peak basal radial strain, basal radial systolic strain rate, and basal circumferential systolic strain rate magnitude values were also significantly decreased in mild CMP (No LGE, LVEF > 55%) compared to a healthy control group (p < 0.001 for all). Surface area strain significantly correlated with LVEF and extracellular volume (ECV) respectively in the basal (rho = - 0.45, 0.40), mid (rho = - 0.46, 0.46), and apical (rho = - 0.42, 0.47) regions. CONCLUSION Strain analysis of 3D cine CMR images in DMD CMP patients generates localized kinematic parameters that strongly differentiate disease from control and correlate with LVEF and ECV.
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Affiliation(s)
- Conner C Earl
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victoria I Pyle
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
| | - Sydney Q Clark
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karthik Annamalai
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
| | - Paula A Torres
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
| | - Alejandro Quintero
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
| | - Frederick W Damen
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kan N Hor
- The Heart Center, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Larry W Markham
- Division of Pediatric Cardiology, Riley Children's Hospital at Indiana University Health, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN, 47907, USA.
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Earl CC, Soslow JH, Markham LW, Goergen CJ. Myocardial strain imaging in Duchenne muscular dystrophy. Front Cardiovasc Med 2022; 9:1031205. [PMID: 36505382 PMCID: PMC9727102 DOI: 10.3389/fcvm.2022.1031205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
Cardiomyopathy (CM) is the leading cause of death for individuals with Duchenne muscular dystrophy (DMD). While DMD CM progresses rapidly and fatally for some in teenage years, others can live relatively symptom-free into their thirties or forties. Because CM progression is variable, there is a critical need for biomarkers to detect early onset and rapid progression. Despite recent advances in imaging and analysis, there are still no reliable methods to detect the onset or progression rate of DMD CM. Cardiac strain imaging is a promising technique that has proven valuable in DMD CM assessment, though much more work has been done in adult CM patients. In this review, we address the role of strain imaging in DMD, the mechanical and functional parameters used for clinical assessment, and discuss the gaps where emerging imaging techniques could help better characterize CM progression in DMD. Prominent among these emerging techniques are strain assessment from 3D imaging and development of deep learning algorithms for automated strain assessment. Improved techniques in tracking the progression of CM may help to bridge a crucial gap in optimizing clinical treatment for this devastating disease and pave the way for future research and innovation through the definition of robust imaging biomarkers and clinical trial endpoints.
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Affiliation(s)
- Conner C. Earl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jonathan H. Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Larry W. Markham
- Division of Pediatric Cardiology, Riley Children's Hospital, Indiana University Health, Indianapolis, IN, United States
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
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Neuromuscular diseases and their cardiac manifestations under the spectrum of cardiovascular imaging. Heart Fail Rev 2022; 27:2045-2058. [PMID: 35857244 DOI: 10.1007/s10741-022-10260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
Neuromuscular diseases (NMDs) include a broad spectrum of disorders that affect motor unit in every possible site, extending from the cell body of peripheral nerves to the muscle. The different lesion sites make this group of inherited disorders difficult to diagnose. Many NMDs, especially those involving skeletal muscles, can present significant cardiovascular complications, ranging from rhythm disturbances to the development of dilated or hypertrophic cardiomyopathy. Heart disease represents a major cause of morbidity and mortality among NMD patients, underlining the vital need for further familiarization with the pathogenesis and assessment of cardiac involvement. Cardiovascular imaging is the cornerstone for the evaluation of heart disorders in NMDs, with conventional echocardiography still offering a portable, affordable, and easily accessible solution. Meanwhile, newer echocardiographic techniques such as speckle tracking imaging in combination with cardiac magnetic resonance add new insights into further substrate characterization. The purpose of this review is to offer a brief presentation of the main NMDs and their cardiovascular complications, as well as the presentation of data that highlight the importance of cardiovascular imaging in early diagnosis, monitoring, and prognosis of these patients. Lastly, the authors provide a simple guide about which clinical features, imaging findings, and follow-up plan to adopt in each myopathic disorder.
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Kummitha K, Ramesh R, Mathew AA, Maganthi M, Palaniappan S. Cardiomyopathy in Duchenne Muscular Dystrophy: A Single-Center Experience. JACC. ASIA 2022; 2:209-210. [PMID: 36339128 PMCID: PMC9627795 DOI: 10.1016/j.jacasi.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | | | | | | | - Saravanan Palaniappan
- Institute of Cardiac Sciences, Bangalore Baptist Hospital, Bellary Road, Hebbal, Bangalore 560024, India @drplsaravanan
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Chetboul V, Concordet D, Tissier R, Vonfeld I, Poissonnier C, Alvarado MP, Passavin P, Gluntz M, Lefort S, Bourgeois A, Duby D, Hano C, Chai N. CardiOvascular examination in awake Orangutans (Pongo pygmaeus pygmaeus): Low-stress Echocardiography including Speckle Tracking imaging (the COOLEST method). PLoS One 2022; 17:e0254306. [PMID: 35073314 PMCID: PMC8786155 DOI: 10.1371/journal.pone.0254306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cardiovascular diseases have been identified as a major cause of mortality and morbidity in Borneo orangutans (Pongo pygmaeus pygmaeus). Transthoracic echocardiography is usually performed under anesthesia in great apes, which may be stressful and increase risks of peri-anesthetic complications in case of cardiac alteration. The aim of the present pilot study was hence to develop a quick and non-stressful echocardiographic method (i.e., the COOLEST method) in awake Borneo orangutans (CardiOvascular examination in awake Orangutans: Low-stress Echocardiography including Speckle Tracking imaging) and assess the variability of corresponding variables. Materials and methods Four adult Borneo orangutans trained to present their chest to the trainers were involved. A total of 96 TTE examinations were performed on 4 different days by a trained observer examining each orangutan 6 times per day. Each examination included four two-dimensional views, with offline assessment of 28 variables (i.e., two-dimensional (n = 12), M-mode and anatomic M-mode (n = 6), Doppler (n = 7), and speckle tracking imaging (n = 3)), representing a total of 2,688 measurements. A general linear model was used to determine the within-day and between-day coefficients of variation. Results Mean±SD (minimum-maximum) images acquisition duration was 3.8±1.6 minutes (1.3–6.3). All within-day and between-day coefficients of variation but one (n = 55/56, 98%) were <15%, and most (51/56, 91%) were <10% including those of speckle tracking systolic strain variables (2.7% to 5.4%). Discussion Heart morphology as well as global and regional myocardial function can be assessed in awake orangutans with good to excellent repeatability and reproducibility. Conclusions This non-stressful method may be used for longitudinal cardiac follow-up in awake orangutans.
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Affiliation(s)
- Valérie Chetboul
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- * E-mail:
| | - Didier Concordet
- Intheres, Université de Toulouse, INRA, ENVT, Toulouse Cedex 3, France
| | | | - Irène Vonfeld
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Camille Poissonnier
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Maria Paz Alvarado
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Peggy Passavin
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Mathilde Gluntz
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Solène Lefort
- École nationale vétérinaire d’Alfort, CHUVA, Unité de Cardiologie d’Alfort (UCA), Maisons-Alfort, France
| | - Aude Bourgeois
- Ménagerie, le Zoo du Jardin des Plantes, Muséum National d’Histoire Naturelle, Paris, France
| | - Dylan Duby
- Ménagerie, le Zoo du Jardin des Plantes, Muséum National d’Histoire Naturelle, Paris, France
| | - Christelle Hano
- Ménagerie, le Zoo du Jardin des Plantes, Muséum National d’Histoire Naturelle, Paris, France
| | - Norin Chai
- Ménagerie, le Zoo du Jardin des Plantes, Muséum National d’Histoire Naturelle, Paris, France
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Prakash N, Suthar R, Sihag BK, Debi U, Kumar RM, Sankhyan N. Cardiac MRI and Echocardiography for Early Diagnosis of Cardiomyopathy Among Boys With Duchenne Muscular Dystrophy: A Cross-Sectional Study. Front Pediatr 2022; 10:818608. [PMID: 35359887 PMCID: PMC8964060 DOI: 10.3389/fped.2022.818608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiomyopathy is an important cause of morbidity and mortality in boys with Duchenne muscular dystrophy (DMD). Early diagnosis is a prerequisite for timely institution of cardioprotective therapies. OBJECTIVE We compared cardiac MRI (CMRI) with transthoracic echocardiography (TTE) including tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for diagnosis of cardiomyopathy in early ambulatory boys with DMD. METHODOLOGY This cross-sectional study was conducted between June 2018 and December 2020. Consecutive boys between 7 and 15 years of age with DMD were enrolled. Percentage ejection fraction (EF), fractional shortening, wall motion abnormalities, early diastolic mitral annulus velocity (Ea), medial mitral annulus ratio (E/Ea), and global strain were measured with STE. CMRI-derived EF, segmental hypokinesia, and late gadolinium enhancement (LGE) were studied and compared. RESULTS A total of 38 ambulatory boys with DMD were enrolled. The mean age was 8.8 ± 1.6 years, and none had clinical features suggestive of cardiac dysfunction. In the TTE, EF was ≤55% in 5 (15%), FS was ≤28% in 3 (9%), and one each had left ventricular wall thinning and wall hypokinesia. In TDI, none had diastolic dysfunction, and STE showed reduced global strain of < 18% in 3 (9%) boys. CMRI-derived EF was ≤55% in 20 (53%) boys and CMRI showed the presence of left ventricular wall hypokinesia in 9 (24%) and LGE in 4 (11%) boys. CONCLUSION Cardiomyopathy remains clinically asymptomatic among early ambulatory boys with DMD. A significantly higher percentage of boys revealed early features of DMD-related cardiomyopathy in CMRI in comparison with echocardiography.
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Affiliation(s)
- Nidhi Prakash
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhupendra Kumar Sihag
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma Debi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rohit Manoj Kumar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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12
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Subclinical myocardial dysfunction is revealed by speckle tracking echocardiography in patients with Cornelia de Lange syndrome. Int J Cardiovasc Imaging 2022; 38:2291-2302. [PMID: 36434327 PMCID: PMC9700592 DOI: 10.1007/s10554-022-02612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/30/2022] [Indexed: 12/14/2022]
Abstract
This study assesses a possible cardiac dysfunction in individuals with Cornelia de Lange syndrome (CdLS) without diagnosed congenital heart disease (CHD) and its association with other factors. Twenty patients and 20 controls were included in the study divided into three age-dependent groups (A: < 10 yrs, B: 10-20 yrs, C: > 20 yrs), and were evaluated using conventional echocardiography, tissue doppler imaging (TDI), two-dimensional speckle tracking and genetic and biochemical analyses. The left ventricular global longitudinal strain (GLS) was altered (< 15.9%) in 55% of patients, being pathological in the older group (A: 19.7 ± 6.6; B: -17.2 ± 4.7; C: -13.6 ± 2.9). The speckle tracking technique revealed a downward trend in the values of strain, strain rate and velocity, especially in the oldest group. Likewise, the ejection fraction (LVEF) and shortening fraction (LVFS) values, although preserved, also showed a decreased with age (p < 0.05). The analytical markers of cardiovascular risk and cardiac function showed no alterations. The molecular analyses revealed 16 individuals carrying pathogenic variants in NIPBL, two with variants in SMC1A, one with a variant in RAD21 and one with a HDAC8 variant. This is the first systematic approach that demonstrates that individuals with CdLS may present early cardiomyopathy, which can be detected by speckle tracking technique even before the appearance of clinical symptoms and the alteration of other echocardiographic or analytical parameters. For all these reasons, cardiological followup is suggested even in the absence of CHD, especially from adolescence onwards.
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Liu K, Yu J, Song G. Global Myocardial Strain in Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Healthy Children: A Network Meta-Analysis. Front Pediatr 2022; 10:848306. [PMID: 35832589 PMCID: PMC9272823 DOI: 10.3389/fped.2022.848306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/30/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nearly 6,000 multisystem inflammatory syndrome in children (MIS-C) have been reported in the United States by November 2021. Left ventricular global myocardial strain has been proved to be one of the best evidence of the diagnostic and prognostic implications for cardiac dysfunction. The global myocardial strain change of MIS-C in the acute phase was still unclear. METHODS PubMed and other sources were searched. A network meta-analysis was conducted. MIS-C was divided into two groups according to left ventricular ejection fraction (LVEF): MIS-C with depressed ejection fraction (MIS-C dEF) and MIS-C with preserved ejection fraction (MIS-C pEF). Global longitudinal strain (GLS) and global circumferential strain (GCS) were compared among MIS-C, Kawasaki disease (KD), and healthy children. RESULTS In total, nine case-control studies were included, published between 2014 and 2021. These studies involved 107 patients with MIS-C, 188 patients with KD, and 356 healthy children. After Bayesian analysis, MIS-C dEF group was found to have a lower LVEF, higher GLS and GCS than the KD groups. Both MIS-C pEF and KD had similar GLS and GCS, which were higher than healthy controls. There was no difference of LVEF among MIS-C pEF, KD, and healthy controls. CONCLUSION MIS-C dEF was more severe than KD, both in LVEF and global myocardial strain. MIS-C pEF and KD were similar with mild impaired left ventricular myocardial strain compared with the healthy children. Global myocardial strain may be a monitoring index for MIS-C. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021264760].
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Affiliation(s)
- Kaiwei Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiahui Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Motamedi M, Ajami G, Mohammadi H, Amirhakimi G, Namdar ZM, Ilkhani H, Moravej H, Aslani A, Amirhakimi A. Uncovering Cardiac Involvement in Childhood Diabetes: Is it Time to Move Toward Speckle Tracking Echocardiography in Childhood Diabetes Management? J Cardiovasc Echogr 2021; 31:165-170. [PMID: 34900552 PMCID: PMC8603770 DOI: 10.4103/jcecho.jcecho_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022] Open
Abstract
Context: One of the most common endocrine disorders in children is diabetes which is the leading cause of premature cardiovascular disease in adulthood. Aims: This study is aimed to investigate the extend of cardiac involvement in diabetic children by speckle tracking echocardiography (STE) in comparison to two-dimensional (2D) echocardiography and routine laboratory data. Settings and Design: A cross-sectional study conducted on patients under 18 years of age who deal with type one diabetes mellitus for more than 5 years. Subjects and Methods: To compare the STE results, we included the STE data of 25 normal age-matched children. All patients underwent laboratory analysis for lipid profile, blood sugar, and 2D echocardiography plus STE. Statistical Analysis Used: Two-sample independent t-test, Chi-square test, logistic regression test, Spearman's rank correlation coefficient, and the Pearson correlation coefficient. Results: From March 2018 to 2019, we included 53 patients, mean age 15.8 ± 0.39 years and 52.8% female, and 25 nondiabetic control in this study. STE revealed global longitudinal strain (LS) −18.4 versus − 24.2 for patient (44 valid cases) versus control group, respectively, with significant statistical difference. Diabetic patients had lower LS in all segments compared to the control group. Conclusions: STE has very high sensitivity to detect cardiac involvement far earlier than 2D echocardiography. None of the routine biomarkers or demographic features can predict cardiac involvement based on segmental abnormalities of STE. Active investigation to clear the remote impact of STE abnormalities and its practical role in childhood diabetes management is highly recommended.
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Affiliation(s)
- Maryam Motamedi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamid Mohammadi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Homa Ilkhani
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Moravej
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Aslani
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anis Amirhakimi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Shehta M, Rayan MM, Fahmy NA, Onsy A, Bastawy I. Global longitudinal strain detects subtle left ventricular systolic dysfunction in Duchenne muscular dystrophy patients and carriers. Egypt Heart J 2021; 73:91. [PMID: 34665363 PMCID: PMC8526669 DOI: 10.1186/s43044-021-00214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/30/2021] [Indexed: 01/16/2023] Open
Abstract
Background With the continuous improvement of the respiratory care of Duchenne muscular dystrophy patients, cardiac manifestations (heart failure and arrhythmias) become the leading causes of morbidity and mortality. Early identification of cardiac muscle affection is crucial to start anti-failure drugs that reverse remodeling and improve prognosis. This study aimed to detect subtle cardiac changes in Duchenne muscular dystrophy patients and carriers using electrocardiography and echocardiography. Results This study included genetically diagnosed Duchenne muscular dystrophy patients (28 males) and carriers (25 females) and compared them to healthy gender-matched control groups. All study participants underwent clinical assessment, 12-lead electrocardiography, and global longitudinal strain augmented echocardiography. In the current study, Duchenne muscular dystrophy patients had higher heart rates, smaller left ventricular internal diameters, left atrial diameter, lower ejection fraction, and worse left ventricular global longitudinal strain in comparison with the control group. The global longitudinal strain inversely correlated with the age of Duchenne muscular dystrophy patients. The number of exon mutations did not affect electrocardiography and echocardiographic findings. Exon mutations 45–47 and 51–54 were significantly associated with an ejection fraction less than 60%. Duchenne muscular dystrophy carriers had smaller left ventricular wall diameters, left ventricular end-diastolic diameter, left atrial diameter, and worse left ventricular global longitudinal strain in comparison with the control group. Conclusions Left ventricular global longitudinal strain could detect subtle left ventricular systolic dysfunction in Duchenne muscular dystrophy patients and carriers before the decline of left ventricular ejection fraction. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00214-0.
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Affiliation(s)
- Mahmoud Shehta
- Department of Cardiology, Ain Shams University, 38 Ramsis Street, El Abbaseya, Cairo, Egypt
| | - Mona Mostafa Rayan
- Department of Cardiology, Ain Shams University, 38 Ramsis Street, El Abbaseya, Cairo, Egypt
| | | | - Ahmed Onsy
- Department of Cardiology, Ain Shams University, 38 Ramsis Street, El Abbaseya, Cairo, Egypt
| | - Islam Bastawy
- Department of Cardiology, Ain Shams University, 38 Ramsis Street, El Abbaseya, Cairo, Egypt.
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de Souza F, Bittar Braune C, Dos Santos Nucera APC. Duchenne muscular dystrophy: an overview to the cardiologist. Expert Rev Cardiovasc Ther 2020; 18:867-872. [PMID: 32985912 DOI: 10.1080/14779072.2020.1828065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, affecting approximately one in 3,500-5,000 liveborn boys. The main signs and symptoms include gait disturbances beginning in early childhood, with later onset of respiratory and cardiac function disorders, both directly affecting the prognosis. AREAS COVERED The recent improvement of mechanical ventilation increased the mean DMD survival age; however, there has been little progress in the treatment and prevention of cardiac complications, which currently predominantly impact survival. Cardiological evaluation with imaging methods, such as echocardiography and magnetic resonance imaging, can improve the understanding and detect changes in cardiac function early. EXPERT OPINION Close monitoring by the cardiologists and early treatment, with adequate heart disease stratification, may be the key to prolong the lives of these patients until more promising therapies are available and can predict DMD prognosis and progression more accurately. The objective of this brief review is to update the cardiologists by highlighting the most relevant aspects of treatment and follow-up, in a practical and concise way.
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Affiliation(s)
- Fabio de Souza
- Cardiology Section, Department of Specialized Medicine, School of Medicine and Surgery, Federal University of the State of Rio De Janeiro , Rio de Janeiro, Brazil
| | | | - Ana Paula Cassetta Dos Santos Nucera
- Cardiology Section, Department of Specialized Medicine, School of Medicine and Surgery, Federal University of the State of Rio De Janeiro , Rio de Janeiro, Brazil
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