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Teodorovich N, Fabrikant Y, Gandelman G, Swissa M, Jonas M, George J, Shimoni S. The Additive Effect of Left Ventricular Filling Pressure and Renal Function on Long-Term Prognosis of High-Risk Patients Undergoing Coronary Angiography. Cardiorenal Med 2023; 13:271-281. [PMID: 37604117 PMCID: PMC10664344 DOI: 10.1159/000533589] [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: 09/05/2022] [Accepted: 06/27/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Impaired relaxation is the earliest manifestation of ischemic cascade. Risk factors and renal function abnormalities are associated with coronary disease and diastolic dysfunction as well. We aimed to study the association of noninvasive assessment of left ventricular filling pressures and renal function with mortality in high-risk patients undergoing coronary angiography. PATIENTS AND METHODS An observational prospective study of 564 consecutive patients undergoing coronary angiography was conducted. The median follow-up was 2,293 days. Patients were categorized into 2 groups according to presence of significant diastolic dysfunction: group 1, 382 patients, with normal and group 2, 182 patients, with elevated filling pressure. Renal insufficiency was determined as calculated glomerular filtration rate <60 mL/min. Patients demographic, clinical, echocardiography, laboratory, and angiographic data were prospectively collected. RESULTS Fifty-three percent of patients underwent angiography due to acute coronary syndrome (ACS), 85.5% had coronary artery disease, 53.4% had reduced (<50%) left ventricular ejection fraction (LVEF), and 47.4% had abnormal renal function. The mortality during the follow-up period was 30.0%. Patients with elevated filling pressure had significantly higher mortality (50.5% vs. 20.2%, p < 0.0001). Impaired renal failure as well, was associated with higher mortality (48% vs. 15%, p < 0.001). The association remained significant in subgroups of patients with and without ACS and reduced and preserved LVEF. In Cox regression model which combined elevated filling pressure, renal insufficiency, age, diabetes mellitus, hypertension, presence of atrial fibrillation, LVEF, and anemia, elevated filling pressure and renal function impairment were independently associated with higher mortality (HR: 3.717, CI: 1.623-8.475, p < 0.0001 and HR: 0.972, CI: 0.958-0.985, p = 0.0001, respectively). There was an incremental prognostic value of elevated filling pressures and renal function impairment on mortality. CONCLUSIONS Advanced diastolic dysfunction and impaired renal function are signals toward worse outcomes and are associated with mortality in high-risk patients undergoing coronary angiography.
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Affiliation(s)
- Nicholay Teodorovich
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yakov Fabrikant
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gera Gandelman
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Swissa
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Jonas
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jacob George
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sara Shimoni
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Lv L, Ma X, Xu Y, Zhang Q, Kan S, Chen X, Liu H, Wang H, Wang C, Ma J. The constricting effect of reduced coronary artery compliance on the left ventricle is an important cause of reduced diastolic function in patients with coronary heart disease. BMC Cardiovasc Disord 2022; 22:375. [PMID: 35978296 PMCID: PMC9382726 DOI: 10.1186/s12872-022-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies of left ventricular diastolic function (LVDF) have focused on the decrease in active and passive diastolic function due to ischemic factors but have not investigated if the decrease in compliance of the coronary arteries that bypass the surface of the heart and travel between the myocardium could cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis. Methods and Results 581 patients diagnosed with coronary heart disease (CHD) were divided into A group (patients are the control group), B group (patients with less than 50% coronary artery stenosis), C group (patients with coronary artery stenosis between 50 and 75%), D group (patients with coronary artery stenosis greater than 75%) according to the degree of coronary stenosis. The diastolic function of the ventricle is reflected by applying the relaxation time constant T value, which refers to the time between peak dp/dt and end-diastolic pressure in the left ventricle. It was concluded that there was a statistical difference in Gensini scores between patients in groups B, C and D (P < 0.001). And multiple linear regression analysis showed that T was correlated with Gensini score and C-dp/dtmax (R = 0.711, P < 0.001). Grouping according to the site of stent implantation and the number of stents implanted, it was found out that the changes in T values before and after left anterior descending artery (LAD) stent implantation were greater than left circumflex artery (LCX) and right coronary artery (RCA) (P < 0.001). And multiple linear regression revealed a correlation between T values and stent length, ventricular stiffness, and C-dp/dtmax (P = 0.001). Conclusions The decrease in compliance of the coronary arteries bypassing the surface of the heart and travelling between the myocardium would cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.
Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02809-0.
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Affiliation(s)
- Liang Lv
- The Third Affiliated Hospital, Southern Medical University or The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xianghe Ma
- Shanghai Maritime University, Shanghai, China
| | - Yannan Xu
- Anhui University of Science and Technology, Huainan, Anhui, China
| | - Qiong Zhang
- Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China
| | - Shanshan Kan
- Anhui University of Science and Technology, Huainan, Anhui, China
| | - Xiaoming Chen
- Anhui University of Science and Technology, Huainan, Anhui, China
| | - Huajin Liu
- Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China
| | - Hongwei Wang
- Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China
| | - Changhua Wang
- TengZhou City Central People Hospital, Affiliated to Jining Medical University, Jining, Shandong, China
| | - Jiangwei Ma
- The Third Affiliated Hospital, Southern Medical University or The Third School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China. .,Anhui University of Science and Technology, Huainan, Anhui, China. .,Department of Cardiology, Fengxian Branch of Shanghai 6th People's Hospital, Nanfeng Road 6600#, Shanghai, 201400, China.
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Mondal S, Faraday N, Gao WD, Singh S, Hebbar S, Hollander KN, Metkus TS, Goeddel LA, Bauer M, Bush B, Cho B, Cha S, Ibekwe SO, Mladinov D, Rolleri NS, Lester L, Steppan J, Sheinberg R, Hensley NB, Kapoor A, Dodd-o JM. Selected Transesophageal Echocardiographic Parameters of Left Ventricular Diastolic Function Predict Length of Stay Following Coronary Artery Bypass Graft-A Prospective Observational Study. J Clin Med 2022; 11:jcm11143980. [PMID: 35887745 PMCID: PMC9319456 DOI: 10.3390/jcm11143980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. (2) Objective: To determine if selected TEE parameters of diastolic dysfunction are associated with length of hospital stay after coronary artery bypass surgery (CAB). (3) Design: Prospective observational study. (4) Setting: A single tertiary academic medical center. (5) Participants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. (6) Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. (7) Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. (8) Results: The study included 176 participants (mean age 65.2 ± 9.2 years, 73% male); 105 (60.2%) had LV diastolic dysfunction based on selected TEE parameters. Median time to hospital discharge was significantly longer for subjects with selected parameters of diastolic dysfunction (9.1/IQR 6.6−13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3−9.7 days) (p < 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47−0.93) for subjects with diastolic dysfunction based on selected TEE parameters, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose−response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction based on those selected TEE parameters was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay. (9) Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction based on selected TEE parameters is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications. The diagnosis of diastolic dysfunction can be made by TEE.
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Affiliation(s)
- Samhati Mondal
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Correspondence: ; Tel.: +1-410-328-1748
| | - Nauder Faraday
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Wei Dong Gao
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | | | - Sachidanand Hebbar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Kimberly N. Hollander
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Thomas S. Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Lee A. Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Maria Bauer
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Brian Bush
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Brian Cho
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Stephanie Cha
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Stephanie O. Ibekwe
- Department of Anesthesiology, Cardiovascular Division, BTGH, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Domagoj Mladinov
- Department of Anesthesiology and Critical Care Medicine, University of Alabama, Birmingham, AL 35233, USA;
| | - Noah S. Rolleri
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Laeben Lester
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Rosanne Sheinberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Nadia B. Hensley
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
| | - Anubhav Kapoor
- Department of Anesthesiology, Mercy General Hospital, Sacramento, CA 95819, USA;
| | - Jeffrey M. Dodd-o
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA; (N.F.); (W.D.G.); (S.H.); (L.A.G.); (M.B.); (B.B.); (B.C.); (S.C.); (L.L.); (J.S.); (R.S.); (N.B.H.); (J.M.D.-o.)
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Ge H. Is diastolic dysfunction a new windsock in the risk stratification of patients with coronary heart disease? Int J Cardiol 2022; 346:103-104. [PMID: 34800592 DOI: 10.1016/j.ijcard.2021.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Heng Ge
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, No. 160 Pujian Road, 200127 Shanghai, China.
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Lee SH, Choi KH, Yang JH, Song YB, Lee JM, Park TK, Hahn JY, Choi JH, Choi SH, Gwon HC. Association Between Preexisting Elevated Left Ventricular Filling Pressure and Clinical Outcomes of Future Acute Myocardial Infarction. Circ J 2021; 86:660-667. [PMID: 34321375 DOI: 10.1253/circj.cj-21-0312] [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: 11/09/2022]
Abstract
BACKGROUND Because no data were available regarding the effect of preexisting left ventricular filling pressure (LVFP) on clinical outcomes in patients with acute myocardial infarction (AMI), we evaluated whether preexisting high LVFP can determine outcomes of subsequent AMI events.Methods and Results:Among 399,613 subjects who underwent echocardiography for various reason from August 2004 to June 2019, 231 had experienced subsequent AMI and were stratified according to preexisting LVFP: low LVFP (E/e' ≤14) and high LVFP (E/e' >14). The primary outcome was cardiac death at 30 days and 1 year after AMI. Overall, 19.5% had high LVFP prior to AMI events. Preexisting high LVFP was associated with an increased risk of cardiac death at 30 days (3.8% vs. 11.6%; adjusted hazard ratio (HR) 4.56, 95% confidence interval (CI) 1.20-17.24, P=0.026) and 1 year after AMI (7.9% vs. 35.9%; adjusted HR 4.14, 95% CI 1.79-9.57, P<0.001). Preexisting E/e' as a continuous value was significantly associated with 1-year risk of cardiac death (adjusted HR 1.08, 95% CI 1.02-1.15, P=0.007). Follow-up echocardiography showed that patients with high LVFP did not show improvement in systolic or diastolic function. CONCLUSIONS Preexisting high LVFP was associated with poor clinical course and 1-year cardiac death after subsequent AMI, as well as no improvement in systolic or diastolic function.
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Chonnam National University Hospital.,Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Yuda S. Worsening of Left Ventricular Diastolic Function Is Associated With Adverse Outcomes in Patients With Coronary Artery Disease. Circ J 2019; 83:1838-1839. [PMID: 31316034 DOI: 10.1253/circj.cj-19-0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Yuda
- Department of Cardiology, Teine Keijinkai Hospital
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