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Bolliger D, Poltera C, Cheung AT, Couture P, Michaux I, Poelaert J, Preisman S, Skarvan K, Buse GL, Seeberger MD. Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery. Turk J Anaesthesiol Reanim 2017; 45:367-373. [PMID: 29359077 PMCID: PMC5772417 DOI: 10.5152/tjar.2017.25483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Normative values of left ventricular (LV) end-diastolic area and diameter (EDA and EDD) for intraoperative transoesophageal echocardiography (TEE) have not been established. We aimed to define the ranges of LV EDA and EDD for intraoperative TEE examinations in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS A MEDLINE search for studies reporting LV EDA and EDD in CABG patients was performed. Individual-level dataset from 333 anaesthetised and mechanically ventilated patients with preserved LV function (study population) were received from 8 studies. EDA and calculated EDD values in the study population were compared with summary mean EDD values obtained by transthoracic echocardiography (TTE) in 2 studies of 500 awake patients with coronary artery disease (CAD). Further, the influence of prespecified factors on EDD was evaluated through a multivariate regression model. RESULTS LV EDA and EDD values measured by TEE in anaesthetised CABG patients were 16.7±4.7 cm2 and 4.6±0.6 cm, respectively. EDD values measured by TEE in anaesthetised patients were 10% to 13% less those measured by TTE in 2 studies of awake patients (p<0.001). Body surface area, age and fractional area change but not sex were factors that affected LV EDD. CONCLUSION LV EDD values measured by intraoperative TEE in anaesthetised and mechanically ventilated CABG patients were 10% to 13% less than those measured by TTE in awake CAD patients. This finding indicates that independent normative values specific for intraoperative TEE should be established for guiding intraoperative clinical decisions.
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Affiliation(s)
- Daniel Bolliger
- Department of Anesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Corsin Poltera
- Department of Anesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Albert T. Cheung
- Department of Anesthesia, University of Pennsylvania, Philadelphia, USA
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institution, University of Montréal, Montréal, Quebec, Canada
| | - Isabelle Michaux
- Department of Intensive Care Medicine, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium
| | - Jan Poelaert
- Department of Anesthesiology and Perioperative Medicine, University Hospital-Free University of Brussels, Brussels, Belgium
| | - Sergey Preisman
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Karl Skarvan
- Department of Anesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Giovanna Lurati Buse
- Department of Anesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Manfred D. Seeberger
- University of Basel, Medical School, Basel, Switzerland; and Institute for Anesthesiology and Intensive Care Medicine, Klinik Hirslanden, Zurich, Switzerland
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Abstract
BACKGROUND The A1166C polymorphism is located within the microRNA-155 binding site of the human angiotensin II (Ang II) type-1 receptor (AGTR1) gene. The C allele interferes with the base-pairing complementariness between AGTR1 mRNA and microRNA-155 and thereby increases AGTR1 protein expression in vitro. We hypothesized that left ventricular (LV) mass is associated with the AGTR1 A1166C polymorphism. METHODS Among 708 individuals (mean age, 49.4 years; 51.8% women) randomly recruited in a white European population, we measured LV structure by two-dimensional guided M-mode echocardiography, the AGTR1 A1166C polymorphism and the 24-h urinary aldosterone. We applied a mixed model to assess phenotype-genotype associations while adjusting for covariables and accounting for relatedness. RESULTS The AA (49.1%), AC (42.8%), and CC (8.1%) genotypes were in Hardy-Weinberg equilibrium. Using a recessive model, CC homozygotes compared to A-allele carriers showed significant increases (P < 0.021) in LV mass index (+5.78 ± 2.25 g/m(2)), mean wall thickness (MWT) (+0.48 ± 0.15 mm), interventricular septum (IVS) (+0.60 ± 0.18 mm) and posterior wall thickness (PWT) (+0.34 ± 0.15 mm), but lower 24-h urinary aldosterone excretion (geometric mean, 22.4 vs. 19.0 nmol; P = 0.050). Sensitivity analyses in 552 participants untreated for hypertension were confirmatory. CONCLUSIONS LV mass index is associated with the AGTR1 A1166C polymorphism. Further research should clarify to what extent this association might be mediated via different expression of AGTR1 as modulated by microRNA-155.
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Yu Jin, Kuznetsova T, Thijs L, Richart T, Stolarz-Skrzypek K, Yanping Liu, Fagard R, Manunta P, Bianchi G, Staessen JA. Association of echocardiographic left ventricular structure with the ACE D/I polymorphism: a meta-analysis. J Renin Angiotensin Aldosterone Syst 2011; 12:243-53. [DOI: 10.1177/1470320310387178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In a previous meta-analysis, we derived pooled estimates for the association of left ventricular mass (LVM) and hypertrophy (LVH), as diagnosed by electrocardiography or echocardiography, with the ACE D/I polymorphism. We updated this meta-analysis until May 2009 only considering echocardiographic phenotypes. Methods: We computed pooled estimates from a random-effects model. Results: Across 38 studies, both DD homozygotes ( n = 2440) and DI heterozygotes ( n = 4310) had higher ( p ≤ 0.002) LVM or LVM index than II homozygotes ( n = 2229). Across 21 studies with available data, this was due to increased mean wall thickness (MWT) with no difference in left ventricular internal diameter (LVID). Standardised differences (DD versus II) were 0.39 ( p < 0.001) for LVM, 0.34 ( p = 0.009) for MWT, and 0.066 ( p = 0.26) for LVID. Across 16 studies (4894 participants), the pooled odds ratios of LVH (versus II homozygotes) were 1.11 ( p = 0.29) and 1.02 ( p = 0.88) for the DD and DI genotypes, respectively. Sensitivity analyses were confirmatory. Conclusions: Our meta-analysis supports the hypothesis that the enhanced ACE activity associated with the D allele is associated with higher LV mass. Smaller sample size might explain the lack of significant association with LVH.
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Affiliation(s)
- Yu Jin
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Tom Richart
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium, Genetic Epidemiology Unit, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Katarzyna Stolarz-Skrzypek
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium, First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Yanping Liu
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium, Department of Ultrasonography, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Robert Fagard
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Paolo Manunta
- Divisione di Nefrologia, Dialisi e Ipertensione, Università Vita-Salute, Milan, Italy
| | - Giuseppe Bianchi
- Divisione di Nefrologia, Dialisi e Ipertensione, Università Vita-Salute, Milan, Italy
| | - Jan A Staessen
- Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium, Genetic Epidemiology Unit, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands or
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Daugherty A, Poduri A, Chen X, Lu H, Cassis LA. Genetic variants of the Renin Angiotensin system: effects on atherosclerosis in experimental models and humans. Curr Atheroscler Rep 2010; 12:167-73. [PMID: 20425255 PMCID: PMC2857789 DOI: 10.1007/s11883-010-0109-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The renin angiotensin system (RAS) has profound effects on atherosclerosis development in animal models, which is partially complimented by evidence in the human disease. Although angiotensin II was considered to be the principal effector of the RAS, a broader array of bioactive angiotensin peptides have been identified that have increased the scope of enzymes and receptors in the RAS. Genetic interruption of the synthesis of these peptides has not been extensively performed in experimental or human studies. A few studies demonstrate that interruption of a component of the angiotensin peptide synthesis pathway reduces experimental lesion formation. The evidence in human studies has not been consistent. Conversely, genetic manipulation of the RAS receptors has demonstrated that AT1a receptors are profoundly involved in experimental atherosclerosis. Few studies have reported links of genetic variants of angiotensin II receptors to human atherosclerotic diseases. Further genetic studies are needed to define the role of RAS in atherosclerosis.
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Affiliation(s)
- Alan Daugherty
- Saha Cardiovascular Research Center, University of Kentucky, BBSRB, Room B-243, Lexington, KY 40536-0509, USA.
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Ozturk O, Ozturk U, Bilici A. The Effect of Angiotensin II Type-1 Receptor Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients with Myocardial Infarction. Echocardiography 2006; 23:536-41. [PMID: 16911325 DOI: 10.1111/j.1540-8175.2006.00258.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Genetic influence on Doppler blood flow parameters of carotid and brachial arteries (BA) is uncertain. We investigated the relationship between the angiotensin II type-1 receptor (AT1R) gene polymorphism and the blood flow characteristics of common carotid arteries (CCA) and BA by color Doppler ultrasound (CDUS) in patients with a first anterior acute myocardial infarction (AMI). METHODS AND RESULTS Sixty-seven patients (15 women and 52 men), aged 25-77 years, with anterior AMI were studied. The AT1R genotypes were established. Based on the polymorphism of the AT1R, they were classified into three groups: AT1R AA genotype (Group1, n = 42 patients), AT1R AC genotype (Group 2, n = 17 patients), and AT1R CC genotype (Group 3, n = 8 patients). Peak-systolic velocity (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCA were measured by CDUS. All results evaluated statistically. The AT1R genotypes were distributed as follows: 63% AA, 25% AC, and 12% CC. PSV of BA and both CCA were higher in patients with CC and AC than AA (P < 0.05). Also, IMT of both CCA were also higher in the same groups (P < 0.05). CONCLUSIONS Our results suggest that AT1R gene polymorphism influences Doppler blood flow parameters of both BA and CCA, and IMT of CCA. Although further studies are required.
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Affiliation(s)
- Onder Ozturk
- Department of Cardiology, Dicle University School of Medicine, Diyarbakir, Turkey.
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