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Das KM, Baskaki UMA, Pulinchani A, Ali HM, Almanssori TM, Gorkom KV, Das A, Dewedar H, Sharma S. Significance of Cardiac Magnetic Resonance Feature Tracking of the Right Ventricle in Predicting Subclinical Dysfunction in Patients with Thalassemia Major. Diagnostics (Basel) 2022; 12:diagnostics12081920. [PMID: 36010270 PMCID: PMC9406855 DOI: 10.3390/diagnostics12081920] [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: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/19/2023] Open
Abstract
In patients with thalassemia major (TM), cardiac magnetic resonance feature-tracking (CMR-FT) has been shown to be an effective method for diagnosing subclinical left ventricular (LV) dysfunction. This study aimed to determine whether CMR-FT could detect abnormal RV dysfunction in patients with a normal right ventricular ejection fraction (RVEF). We performed a retrospective analysis of TM patients admitted to Dubai’s Rashid Hospital between July 2019 and March 2021. The inclusion criteria were TM patients with SSFP cine with T2* (T2*-weighted imaging), while exclusion criteria included any other cardiovascular disease. When there was no myocardial iron overload (MIO) (T2* ≥ 20 ms) and when there was significant MIO (T2* < 20 ms), the CMR-FT was used to correlate with EF. Among the 89 participants, there were 46 men (51.7%) and 43 women (48.3%), with a mean age of 26.14 ± 7.4 years (range from 10 to 48 years). Forty-six patients (51.69%) did not have MIO, while 43 individuals did (48.31%). Thirty-nine patients (32.6%) were diagnosed with severe MIO, while seventeen (19.1%) were diagnosed with mild to moderate MIO. A significant correlation existed between RVEF and T2* values (r = 0.274, p = 0.014) and between left ventricular ejection fraction (LVEF) and T2* values (r = 0.256, p = 0.022). Using a multiple logistic regression model with predictors such as right ventricular longitudinal strain (RVGLS), LV ejection fraction (LV EF), and hemoglobin, abnormal myocardial iron overload can be predicted. This model demonstrates an AUC of 78.3%, a sensitivity of 72%, and a specificity of 76%. In the group with preserved RVEF > 53%, the left ventricular radial strain (LVGRS) (p = 0.001), right ventricular radial strain (RVGRS) (p = 0.000), and right ventricular basal circumferential strain (RVGCS-basal) (p = 0.000) CMR-FT strain values are significantly lower than those of the control group (p > 0.05). There was no significant correlation between the LVGLS and T2*. RVGLS was ranked among the most accurate predictors of abnormal myocardial iron overload. The LVGRS, RVGRS, and RVGCS-basal CMR-FT strain values were the best predictors of subclinical RV dysfunction in the group with preserved RVEF. The most accurate way to diagnose MIO is still T2*, but FT-strain can help us figure out how MIO affects the myocardium from a pathophysiological point of view.
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Affiliation(s)
- Karuna M. Das
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
- Correspondence:
| | | | - Anisha Pulinchani
- Department of Data Science, PSPH, Manipal Academy of Higher Education, Manipal 576104, India
| | | | - Taleb M. Almanssori
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Klaus Van Gorkom
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates
| | - Amrita Das
- Brighton College, Al Ain P.O. Box 17666, United Arab Emirates
| | - Hany Dewedar
- Thalassemia Center, Dubai P.O. Box 9115, United Arab Emirates
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Tsipis A, Petropoulou E. Echocardiography in the Evaluation of the Right Heart. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2021.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The significance of the right ventricle (RV) as a predictor of outcome in a series of cardiac conditions has recently been recognized. Consequently, more studies are now focusing on improving the assessment of the RV. Its primary function is to support adequate pulmonary perfusion pressure in different circulatory and loading situations and to ensure that there is a low systemic venous pressure. Echocardiography is the first-line method of choice due to its accuracy when assessing RV structure and function, as well as its wide availability. The geometry of the RV is complex and its evaluation can be difficult. Integrating and combining multiple parameters may be a more reliable way to determine normal or abnormal function. Novel techniques are increasingly being performed more routinely in clinical practice and are facilitating diagnosis and treatment choices.
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Affiliation(s)
- Angelos Tsipis
- Department of Cardiology, Metropolitan General Hospital, Athens, Greece
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3
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Todo S, Tanaka H, Yamauchi Y, Yokota S, Mochizuki Y, Shiraki H, Yamashita K, Shono A, Suzuki M, Sumimoto K, Tanaka Y, Hirota Y, Ogawa W, Hirata KI. Association of left ventricular longitudinal myocardial function with subclinical right ventricular dysfunction in type 2 diabetes mellitus. Cardiovasc Diabetol 2021; 20:212. [PMID: 34688280 PMCID: PMC8542339 DOI: 10.1186/s12933-021-01404-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background Left ventricular (LV) involvement in diabetic cardiomyopathy has been reported; however, only limited data exist on right ventricular (RV) involvement. Therefore, our purpose was to investigate RV systolic dysfunction and its association with LV longitudinal myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM) and preserved LV ejection fraction (LVEF). Methods We studied 177 T2DM patients with preserved LVEF and 79 age-, sex-, and LVEF-matched healthy volunteers. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS), and RV systolic function was assessed as RV free-wall strain, and predefined cutoff values for subclinical dysfunction were set at GLS < 18% and RV free-wall strain < 20%, respectively. Results RV free-wall strain in T2DM patients was significantly lower than that in normal controls (19.3% ± 4.8% vs. 24.4% ± 5.1%; P < 0.0001). RV free-wall strain in T2DM patients and LV longitudinal dysfunction was similar compared to that in T2DM patients without (19.0 ± 4.5% vs. 19.6 ± 5.0%, P = 0.40). Furthermore, multivariate logistic regression analyses showed that GLS was independently associated with RV systolic dysfunction as well as mitral inflow E and mitral e′ annular velocities ratio (odds ratio, 1.16; 95% confidence interval: 1.03–1.31; P < 0.05). Sequential logistic models evaluating the association of RV systolic dysfunction in T2DM patients showed an improvement in clinical variables (χ2 = 6.2) with the addition of conventional echocardiographic parameters (χ2 = 13.4, P < 0.001) and a further improvement with the addition of GLS (χ2 = 20.8, P < 0.001). Conclusion RV subclinical systolic dysfunction was observed in T2DM patients with preserved LVEF and was associated with LV longitudinal myocardial dysfunction. Our findings may provide additional findings for the management of T2DM patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01404-5.
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Affiliation(s)
- Saki Todo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuki Yamauchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shun Yokota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yasuhide Mochizuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroaki Shiraki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kentaro Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ayu Shono
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makiko Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keiko Sumimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yusuke Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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4
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López Y López G, Tepox Galicia AY, Atonal Flores F, Flores Hernández J, Pérez Vizcaino F, Villa Mancera AE, Miguél GG, Reynoso Palomar A. Echocardiographic follow-up to right ventricular modifications in secondary pulmonary hypertension to diabetes in rats. Clin Exp Hypertens 2021; 43:242-253. [PMID: 33349077 DOI: 10.1080/10641963.2020.1860077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
Clinical studies suggest that diabetes is a risk factor in the development of pulmonary arterial hypertension. The increase in blood pressure in the pulmonary area is characterized by the increase in the afterload and hypertrophy of the right ventricle. The objective of this study was to conduct a longitudinal follow-up of the morphological and functional changes in the right ventricle in a rat model with pulmonary arterial hypertension secondary to diabetes. Male Sprague Dawley rats were randomly divided into a control group (saline solution) and a diabetic group (60 mg/kg with streptozotocin). For 12 weeks, an echocardiography for longitudinal (in vivo) image analysis of the pulmonary pressure was performed at the same time as the evaluation of myocardial remodeling and right ventricular. After this period, the pulmonary pressure was measured by means of a pulmonary artery catheterization, and the presence of hypertrophy was determined by means of the Fulton index. The plasma concentration of brain natriuretic peptide was measured by means of the ELISA technique. It was found that the diabetic rats showed an increase in pressure in the pulmonary arteries, an increase in the Fulton index, and an increase in brain natriuretic peptide. The echocardiographic follow-up showed that the diabetic rats presented an increase in the pulmonary artery from the fourth week, while hypertrophy and right ventricular systolic dysfunction occurred until the twelfth week. In conclusion, pulmonary arterial hypertension induced by experimental diabetes generated hypertrophy and systolic dysfunction of the right ventricle.
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Affiliation(s)
- Gustavo López Y López
- Clinical Pharmacy Laboratory, Faculty of Chemical Sciences, University City, Autonomous University of Puebla , Mexico
| | - Ana Yessica Tepox Galicia
- Clinical Pharmacy Laboratory, Faculty of Chemical Sciences, University City, Autonomous University of Puebla , Mexico
| | - Fausto Atonal Flores
- Department of Physiology, Faculty of Medicine, Autonomous University of Puebla , Mexico
| | | | | | - Abel E Villa Mancera
- Research Laboratory in Physiology and Pharmacology, Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Puebla , Mexico
| | - García González Miguél
- Clinical Pharmacy Laboratory, Faculty of Chemical Sciences, University City, Autonomous University of Puebla , Mexico
| | - Alejandro Reynoso Palomar
- Research Laboratory in Physiology and Pharmacology, Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Puebla , Mexico
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Negahban Z, Rezaei M, Daei MM, Mirzadeh M. Evaluation of the Systolic and Diastolic Right Ventricular Function: A Comparison Between Diabetes, Prediabetes and Normal Patients Without Coronary Artery Disease. Curr Probl Cardiol 2021; 46:100817. [PMID: 33765491 DOI: 10.1016/j.cpcardiol.2021.100817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Diabetes mellitus is a well-known dangerous factor for cardiovascular disease with high rate of comorbidities. Patients suffering from this disease have represented more heart failures which is entangled with Ischemic heart disease or high blood pressure. Thus, depending on the recent scientific facts, diabetes mellitus as a separate factor which is independent from CAD, Arterial blood pressure or other factors, is claimed to culminate in advance heart failure. Previous studies have concentrated on the impacts of diabetes and prediabetes on the performance of the left ventricular which leaves right ventricular uncovered. Consequently, the aim of this article is to analyze and compare the systolic and diastolic function of the right ventricular in normal patients and the ones with diabetes and prediabetes without any coronary artery disease.
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Affiliation(s)
- Zahra Negahban
- Department of Cardiology, Boali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahdokht Rezaei
- Department of Cardiology, Boali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Mohammad Mahdi Daei
- Department of Cardiology, Boali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Monirsadat Mirzadeh
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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6
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Factors Associated with the Remission of Type 1 Diastolic Dysfunction after Dapagliflozin Treatment in Patients with Type 2 Diabetes. J Clin Med 2020; 9:jcm9113779. [PMID: 33238573 PMCID: PMC7700333 DOI: 10.3390/jcm9113779] [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: 10/31/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
Patients with type 2 diabetes (T2DM) are at high risk of developing cardiovascular disease and heart failure (HF), both with preserved and reduced ejection fraction of the left ventricle. Previous research demonstrated that dapagliflozin treatment is associated with the remission of type 1 diastolic dysfunction (DD1) in patients with T2DM. The main aim of this study was to evaluate the possible baseline predictors associated with the remission of DD1 in patients with T2D after one year of dapagliflozin treatment. In this prospective and observational study, 45 patients with T2DM were evaluated before and after one year of treatment with 10 mg dapagliflozin daily added to their background therapy. In the studied group, 73.3% (33/45) of the patients had DD1 at baseline. The primary outcome of this research was DD1 remission. DD1 remission was associated with improvement of liver stiffness, an increase in estimated glomerular filtration rate (eGFR), and a decrease in hemoglobin A1c (HbA1c). Independent predictors for the remission of DD1 were a more than 0.4 kPa difference in the initial stiffness score and the 1-year assessment fibrosis score and a duration of diabetes ≤8 years. Age, body mass index (BMI), or patient weight after one year did not influence the DD1 outcome. Patients with a T2DM duration of less than eight years have the additional benefit of DD1 remission associated with dapagliflozin treatment beyond the conventional benefits such as improvements in glycemic control, cardiovascular, renal, and hepatic risk reductions. In patients with T2DM, the remission of DD1 was associated with decrease of liver stiffness.
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7
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Agrawal V, Lahm T, Hansmann G, Hemnes AR. Molecular mechanisms of right ventricular dysfunction in pulmonary arterial hypertension: focus on the coronary vasculature, sex hormones, and glucose/lipid metabolism. Cardiovasc Diagn Ther 2020; 10:1522-1540. [PMID: 33224772 PMCID: PMC7666935 DOI: 10.21037/cdt-20-404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare, life-threatening condition characterized by dysregulated metabolism, pulmonary vascular remodeling, and loss of pulmonary vascular cross-sectional area due to a variety of etiologies. Right ventricular (RV) dysfunction in PAH is a critical mediator of both long-term morbidity and mortality. While combinatory oral pharmacotherapy and/or intravenous prostacyclin aimed at decreasing pulmonary vascular resistance (PVR) have improved clinical outcomes, there are currently no treatments that directly address RV failure in PAH. This is, in part, due to the incomplete understanding of the pathogenesis of RV dysfunction in PAH. The purpose of this review is to discuss the current understanding of key molecular mechanisms that cause, contribute and/or sustain RV dysfunction, with a special focus on pathways that either have led to or have the potential to lead to clinical therapeutic intervention. Specifically, this review discusses the mechanisms by which vessel loss and dysfunctional angiogenesis, sex hormones, and metabolic derangements in PAH directly contribute to RV dysfunction. Finally, this review discusses limitations and future areas of investigation that may lead to novel understanding and therapeutic interventions for RV dysfunction in PAH.
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Affiliation(s)
- Vineet Agrawal
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tim Lahm
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Anna R. Hemnes
- Division of Allergy, Pulmonology and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Linssen PBC, Veugen MGJ, Henry RMA, van der Kallen CJH, Kroon AA, Schram MT, Brunner-La Rocca HP, Stehouwer CDA. Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study. Cardiovasc Diabetol 2020; 19:88. [PMID: 32539792 PMCID: PMC7296751 DOI: 10.1186/s12933-020-01055-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Backgrounds The role of right ventricular (RV) and atrial (RA) structure and function, in the increased heart failure risk in (pre)diabetes is incompletely understood. The purpose of this study is to investigate the associations between (pre)diabetes and RV and RA structure and function, and whether these are mediated by left ventricular (LV) alterations or pulmonary pressure. Methods Participants of the Maastricht Study; a population-based cohort study (426 normal glucose metabolism (NGM), 142 prediabetes, 224 diabetes), underwent two-dimensional and tissue Doppler echocardiography. Multiple linear regression analyses with pairwise comparisons of (pre)diabetes versus NGM, adjusted for cardiovascular risk factors, and mediation analyses were used. Results In general, differences were small. Nevertheless, in individuals with prediabetes and diabetes compared to NGM; RA volume index was lower (both p < 0.01, ptrend < 0.01), RV diameter was lower (both p < 0.01, ptrend < 0.01) and RV length was significantly smaller in diabetes (p = 0.67 and p = 0.03 respectively, ptrend = 0.04), TDI S′RV was lower (p = 0.08 and p < 0.01 respectively, ptrend < 0.01), TDI E′RV was lower (p = 0.01 and p = 0.02 respectively, ptrend = 0.01) and TDI A′RV was lower (p < 0.01 and p = 0.07 respectively, ptrend = 0.04). Only the differences in RA volume index (7.8%) and RV diameter (6.2%) were mediated by the maximum tricuspid gradient, but no other LV structure and function measurements. Conclusions (Pre)diabetes is associated with structural RA and RV changes, and impaired RV systolic and diastolic function, independent of cardiovascular risk factors. These associations were largely not mediated by indices of LV structure, LV function or pulmonary pressure. This suggests that (pre)diabetes affects RA and RV structure and function due to direct myocardial involvement.
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Affiliation(s)
- Pauline B C Linssen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marja G J Veugen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald M A Henry
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carla J H van der Kallen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Abraham A Kroon
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Miranda T Schram
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands. .,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
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9
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Zaidi A, Knight DS, Augustine DX, Harkness A, Oxborough D, Pearce K, Ring L, Robinson S, Stout M, Willis J, Sharma V. Echocardiographic assessment of the right heart in adults: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2020. [PMID: 32105053 PMCID: PMC7077526 DOI: 10.1530/erp-19-0051] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatomy of the right ventricle requires special considerations and echocardiographic techniques, which are set out in this document. The clinical relevance of right ventricular diastolic function is introduced, with practical guidance for its assessment. Finally, the relatively novel techniques of three-dimensional right ventricular echocardiography and right ventricular speckle tracking imaging are described. Despite these techniques holding considerable promise, issues relating to reproducibility and inter-vendor variation have limited their clinical utility to date.
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Affiliation(s)
| | | | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - David Oxborough
- Liverpool John Moores University, Research Institute for Sports and Exercise Science, Liverpool, UK
| | | | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Vishal Sharma
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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10
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Jensen MT, Fung K, Aung N, Sanghvi MM, Chadalavada S, Paiva JM, Khanji MY, de Knegt MC, Lukaschuk E, Lee AM, Barutcu A, Maclean E, Carapella V, Cooper J, Young A, Piechnik SK, Neubauer S, Petersen SE. Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy. Circ Cardiovasc Imaging 2019; 12:e009476. [PMID: 31522551 PMCID: PMC7099857 DOI: 10.1161/circimaging.119.009476] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. METHODS Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. RESULTS A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; P=0.065), LV mass (-0.13 g/m2 [-1.6 to 1.3], P=0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], P=0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2: -3.46 mL/m2 [-5.8 to -1.2], P=0.003, right ventricular end-diastolic volume/m2: -4.2 mL/m2 [-6.8 to -1.7], P=0.001, LV stroke volume/m2: -3.0 mL/m2 [-4.5 to -1.5], P<0.001; right ventricular stroke volume/m2: -3.8 mL/m2 [-6.5 to -1.1], P=0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P=0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], P=0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], P=0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P=0.045). CONCLUSIONS In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.
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Affiliation(s)
- Magnus T. Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
- Department of Cardiology, Copenhagen University Hospital Herlev- Gentofte, Hellerup, Denmark (M.T.J.)
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (M.T.J.)
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mohammed Y. Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Martina C. de Knegt
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Ahmet Barutcu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Edd Maclean
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Alistair Young
- Department of Biomedical Engineering, King’s College London, United Kingdom (A.Y.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
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11
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Hu BY, Wang J, Yang ZG, Ren Y, Jiang L, Xie LJ, Liu X, Gao Y, Shen MT, Xu HY, Shi K, Li ZL, Xia CC, Peng WL, Deng MY, Li H, Guo YK. Cardiac magnetic resonance feature tracking for quantifying right ventricular deformation in type 2 diabetes mellitus patients. Sci Rep 2019; 9:11148. [PMID: 31366951 PMCID: PMC6668453 DOI: 10.1038/s41598-019-46755-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 02/05/2023] Open
Abstract
To determine the feasibility of deformation analysis in the right ventricle (RV) using cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) in type 2 diabetes mellitus (T2DM) patients. We enrolled 104 T2DM patients, including 14 with impaired right ventricular ejection fraction (RVEF) and 90 with preserved RVEF, and 26 healthy controls in this prospective study. CMR was used to determine RV feature-tracking parameters. RV strain parameters were compared among the controls, patients with preserved and reduced RVEF. Binary logistic regression was used to predict RV dysfunction. Receiver operating characteristic analysis was used to assess the diagnostic accuracy. The agreement was tested by Bland-Altman analysis. Compared with controls, longitudinal and circumferential global peak strain (PS) and PS at mid-ventricular, apical slices were significantly decreased in T2DM patients with or without reduced RVEF (p < 0.05). Within the T2DM patients, the global longitudinal PS (GLPS) and the longitudinal PS at mid-ventricular segments were significantly reduced in the reduced RVEF group than in preserved RVEF groups (p < 0.05). GLPS was an independent predictor of RV dysfunction (odds ratio: 1.246, 95% CI: 1.037-1.496; p = 0.019). The GLPS demonstrated greater diagnostic accuracy (area under curve: 0.716) to predict RV dysfunction. On Bland-Altman analysis, global circumferential PS and GLPS had the best intra- and inter-observer agreement, respectively. In T2DM patients, CMR-FT could quantify RV deformation and identify subclinical RV dysfunction in those with normal RVEF. Further, RV strain parameters are potential predictors for RV dysfunction in T2DM patients.
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Affiliation(s)
- Bi-Yue Hu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Wan-Lin Peng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ming-Yan Deng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Hong Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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12
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Sciacqua A, Perticone M, Miceli S, Pinto A, Cassano V, Succurro E, Andreozzi F, Hribal ML, Sesti G, Perticone F. Elevated 1-h post-load plasma glucose is associated with right ventricular morphofunctional parameters in hypertensive patients. Endocrine 2019; 64:525-535. [PMID: 30790176 DOI: 10.1007/s12020-019-01873-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Emerging data demonstrate that type 2 diabetes mellitus (T2DM) is associated with right ventricular (RV) dysfunction. A cutoff point of 155 mg/dL for the 1-hour (h) post-load plasma glucose, during oral glucose tolerance test (OGTT), identifies patients with normal glucose tolerance (NGT) at high risk to develop T2DM and cardiovascular (CV) disease. We investigated if 1-h post-load glucose may affect RV geometry and function in a group of never-treated hypertensive individuals. METHODS We enrolled 446 Caucasian newly diagnosed hypertensive outpatients. All patients underwent an OGTT and a standard echocardiography. The tricuspid annular plane systolic excursion (TAPSE) and the RV fractional area change (RVFAC) were measured together with systolic pulmonary arterial pressure (s-PAP) and pulmonary vascular resistances (PVR). Insulin sensitivity was evaluated using the Matsuda index. RESULTS Among all partecipants, 296 had NGT, 100 impaired glucose tolerance (IGT), and 50 T2DM. Considering the cutoff point of 155 mg/dl for 1-h glucose, NGT subjects were stratified into two groups: NGT < 155 (n = 207), NGT ≥ 155 (n = 89). Subjects NGT ≥ 155 presented a worse metabolic and inflammatory profile than NGT < 155. RV functional parameters (TAPSE, RVFAC, TAPSE/s-PAP, and TAPSE/PVR) were significantly reduced in NGT ≥ 155 subjects compared with NGT < 155 patients. On the contrary, s-PAP and PVR were significantly higher. At multiple regression analysis, 1-h glucose was the strongest predictor of TAPSE in NGT ≥ 155, IGT, and T2DM. CONCLUSIONS The presence of RV impairment in hypertensive NGT ≥ 155 subjects further complicates their CV burden and it may, at least in part, justify the worse clinical outcome in this setting of patients.
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Affiliation(s)
- Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy.
| | - Maria Perticone
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Angelina Pinto
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
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13
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Zairi I, Mzoughi K, Kamoun S, Moussa FB, Rezgallah R, Maatoug J, Mazigh S, Kraiem S. Impairment of left and right ventricular longitudinal strain in asymptomatic children with type 1 diabetes. Indian Heart J 2019; 71:249-255. [PMID: 31543198 PMCID: PMC6796627 DOI: 10.1016/j.ihj.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/13/2019] [Accepted: 04/26/2019] [Indexed: 01/20/2023] Open
Abstract
Aim The relationship between type 1 diabetes (T1DM) and cardiac function in children is not well established. The purpose of this study was to investigate whether children and adolescents with T1DM present early asymptomatic abnormalities of left ventricular (LV) and right ventricular (RV) function. In addition, we evaluated the relationship of any such abnormalities with glycemic control and diabetes duration. Methods This was a prospective study. Standard echocardiography, tissue Doppler imaging, and two-dimensional strain analysis were performed prospectively in 52 children with T1DM. The results were compared with those from 52 healthy children matched for age and sex. Results There were no significant differences between the two groups in LV ejection fraction or RV systolic function. There was a difference between the two study groups in transtricuspid flow: the E-wave and A-wave velocities were significantly higher in the diabetic group. Left ventricular global longitudinal strain (LV GLS) was significantly lower in children with T1DM (−20.01 ± 1.86% vs. −22.99 ± 0.98%, respectively; P < .001), as was RV free-wall longitudinal strain (RV FWLS) (−29.13 ± 1.85% vs. −30.22 ± 1.53%, respectively; P = .002). LV GLS was correlated with diabetes duration (r = 0.444, P < .001) and glycated hemoglobin (HbA1c) (r = 0.683, P < .001); however, no correlation was found between RV FWLS and HbA1c or diabetes duration. Conclusions Our findings suggest that LV GLS and RV FWLS are impaired in children with T1DM and that the decrease in LV GLS is correlated with diabetes duration and HbA1c levels.
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Affiliation(s)
- Ihsen Zairi
- Department of Cardiology, Habib Thameur Hospital, Bab el falah, 2004, Tunis, Tunisia.
| | - Khadija Mzoughi
- Department of Cardiology, Habib Thameur Hospital, Bab el falah, 2004, Tunis, Tunisia.
| | - Sofien Kamoun
- Department of Cardiology, Habib Thameur Hospital, Bab el falah, 2004, Tunis, Tunisia.
| | - Fethia Ben Moussa
- Department of Cardiology, Habib Thameur Hospital, Bab el falah, 2004, Tunis, Tunisia.
| | | | - Jihen Maatoug
- Departement of epidemiology, Farhat hached Hospital sousse, Tunisia
| | - Sonia Mazigh
- Department of Pediatrics, Bab Saadoun Hospital, Tunisia.
| | - Sondos Kraiem
- Department of Cardiology, Habib Thameur Hospital, Bab el falah, 2004, Tunis, Tunisia.
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14
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Kang Y, Wang S, Huang J, Cai L, Keller BB. Right ventricular dysfunction and remodeling in diabetic cardiomyopathy. Am J Physiol Heart Circ Physiol 2019; 316:H113-H122. [DOI: 10.1152/ajpheart.00440.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The increasing prevalence of diabetic cardiomyopathy (DCM) is an important threat to health worldwide. While left ventricular (LV) dysfunction in DCM is well recognized, the accurate detection, diagnosis, and treatment of changes in right ventricular (RV) structure and function have not been well characterized. The pathophysiology of RV dysfunction in DCM may share features with LV diastolic and systolic dysfunction, including pathways related to insulin resistance and oxidant injury, although the RV has a unique cellular origin and composition and unique biomechanical properties and is coupled to the lower-impedance pulmonary vascular bed. In this review, we discuss potential mechanisms responsible for RV dysfunction in DCM and review the imaging approaches useful for early detection, protection, and intervention strategies. Additional data are required from animal models and clinical trials to better identify the onset and features of altered RV and pulmonary vascular structure and function during the onset and progression of DCM and to determine the efficacy of early detection and treatment of RV dysfunction on clinical symptoms and outcomes.
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Affiliation(s)
- Yin Kang
- Department of Anesthesiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Sheng Wang
- Department of Anesthesiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, and Department of Anesthesiology, Jewish Hospital, Louisville, Kentucky
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Bradley B. Keller
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Kosair Charities Pediatric Heart Research Program, Cardiovascular Innovation Institute, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
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15
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Bakovic M, Filipovic N, Ferhatovic Hamzic L, Kunac N, Zdrilic E, Vitlov Uljevic M, Kostic S, Puljak L, Vukojevic K. Changes in neurofilament 200 and tyrosine hydroxylase expression in the cardiac innervation of diabetic rats during aging. Cardiovasc Pathol 2017; 32:38-43. [PMID: 29175663 DOI: 10.1016/j.carpath.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022] Open
Abstract
Changes in sensory and sympathetic innervation during diabetes mellitus (DM) can be a predictor of arrhythmias, silent myocardial ischemia, and chronic heart failure, but knowledge about these changes is still unsatisfactory. We analyzed whether prolonged DM induces changes in density of sensory and sympathetic nerve terminals of rat's heart and whether it contributes to cardiomyopathy during aging. DM was induced by i/p injecting 55 mg/kg streptozotocin to male Sprague-Dawley rats, while a control group received a citrate buffer. DM in the rats was validated by measuring blood glucose level. Animals were sacrificed after 2 weeks, 2 months, 6 months, and 12 months. Five areas of cardiac sections were analyzed. Antibodies raised against tyrosine hydroxylase (TH) and neurofilament 200 kDa (NF 200) were used to detect sympathetic and sensory fibers. TH immunoreactive fiber density increased in DM groups 2 weeks after induction, reaching a peek after 2 months, while in the later stages of DM (6 and 12 months), there was no significant difference compared to control. NF 200 immunoreactive fiber density increased 2 weeks after induction compared to control. There was no consistent pattern of change during the given period in both the DM or control groups. In the DM group, we found thickening of the left ventricle wall (P<.05) as the sign of cardiomyopathy. Our findings suggest that hyperglycemia as a hallmark of DM in early stages can lead to proliferation of sympathetic and sensory nerve terminals. This finding can contribute to a better understanding of the occurrence of arrhythmias and silent myocardial ischemia in DM.
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Affiliation(s)
- Marija Bakovic
- Laboratory for Neurocardiology, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Natalija Filipovic
- Laboratory for Neurocardiology, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Lejla Ferhatovic Hamzic
- Laboratory for Pain Reaserch, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Nenad Kunac
- Department of Pathology, Citology and Forensic medicine, University Hospital Split, Spinciceva 1, 21000 Split, Croatia
| | - Elena Zdrilic
- Laboratory for Early Human Development, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Marija Vitlov Uljevic
- Laboratory for Neurocardiology, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Sandra Kostic
- Laboratory for Microscopy, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Livia Puljak
- Laboratory for Pain Reaserch, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Katarina Vukojevic
- Laboratory for Neurocardiology, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia; Laboratory for Early Human Development, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia; Laboratory for Microscopy, Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia.
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16
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Zencirci E, Yeşilaltay A, Yağız V, Değirmencioğlu A, Zencirci AE, Buturak A. Myocardial functional abnormalities and serum N-terminal pro-brain natriuretic peptide in type II diabetes mellitus patients with cardiovascular autonomic neuropathy. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-016-0484-7] [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: 10/22/2022] Open
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17
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Tadic M, Vukomanovic V, Cuspidi C, Suzic-Lazic J, Pencic-Popovic B, Radojkovic J, Babic R, Celic V. The relationship between right ventricular deformation and heart rate variability in asymptomatic diabetic patients. J Diabetes Complications 2017; 31:1152-1157. [PMID: 28456356 DOI: 10.1016/j.jdiacomp.2017.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/26/2017] [Accepted: 04/08/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate heart rate variability (HRV) and right ventricular (RV) remodeling in asymptomatic diabetic patients, as well as the relationship between HRV indices and RV structure, function and deformation. METHOD This cross-sectional study included 59 asymptomatic patients with type 2 diabetes and 45 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). RESULTS RV diastolic function and longitudinal deformation were significantly impaired in diabetic individuals comparing with controls. RV global longitudinal strain and layer-specific longitudinal strains were significantly decreased in diabetic group. The same trend of changes in RV deformation was observed for global RV and lateral wall. All parameters of time and frequency domain of HRV were reduced in diabetic subjects. RV endocardial longitudinal strain together with LV mass index, mitral E/e' ratio and HbA1c correlated with HRV parameters. However, multivariate linear regression analysis showed that only RV endocardial longitudinal strain and LV mass index are associated with HRV parameters independently of age, BMI, HbA1c, RV free wall thickness and pulmonary artery pressure. CONCLUSIONS RV subendocardial strain is independently associated with HRV parameters in the whole study population. This reveals potentially important role of determination of layer-specific RV longitudinal function as important marker of preclinical cardiac damage, but also indirectly show the impairment of cardiac autonomic function in diabetic patients.
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MESH Headings
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/pathology
- Arrhythmias, Cardiac/physiopathology
- Asymptomatic Diseases
- Autonomic Pathways/physiopathology
- Biomarkers/blood
- Cross-Sectional Studies
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetic Cardiomyopathies/diagnosis
- Diabetic Cardiomyopathies/diagnostic imaging
- Diabetic Cardiomyopathies/pathology
- Diabetic Cardiomyopathies/physiopathology
- Early Diagnosis
- Echocardiography, Doppler
- Electrocardiography, Ambulatory
- Female
- Glycated Hemoglobin/analysis
- Heart Rate
- Heart Ventricles/diagnostic imaging
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Humans
- Male
- Middle Aged
- Organ Size
- Ventricular Dysfunction, Right/complications
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Remodeling
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
| | - Vladan Vukomanovic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy
| | - Jelena Suzic-Lazic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Biljana Pencic-Popovic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Jana Radojkovic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Rade Babic
- Institute of Cardiovascular Diseases Dedinje, Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Vera Celic
- University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
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18
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Aloia E, Cameli M, D'Ascenzi F, Sciaccaluga C, Mondillo S. TAPSE: An old but useful tool in different diseases. Int J Cardiol 2016; 225:177-183. [DOI: 10.1016/j.ijcard.2016.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023]
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19
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Tadic M, Cuspidi C, Vukomanovic V, Ilic S, Celic V, Obert P, Kocijancic V. The influence of type 2 diabetes and arterial hypertension on right ventricular layer-specific mechanics. Acta Diabetol 2016; 53:791-7. [PMID: 27311687 DOI: 10.1007/s00592-016-0874-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/30/2016] [Indexed: 12/22/2022]
Abstract
AIMS The aim of the investigation was to evaluate layer-specific right ventricular (RV) deformation in normotensive and hypertensive subjects with type 2 diabetes mellitus (DM). METHODS This cross-sectional study included 129 subjects (40 controls, 42 normotensive DM and 47 hypertensive DM patients) who underwent complete two-dimensional echocardiographic examination (2DE) including multilayer strain analysis. RESULTS 2DE RV global and free wall longitudinal strains were reduced in normotensive and hypertensive DM subjects than in controls. RV global longitudinal layer-specific strains (endo-, mid- and epicardial) were lower in normotensive and hypertensive DM patients than in controls. On the other side, layer-specific strains of RV free wall were lower in hypertensive DM patients than in controls, without significant difference between controls and normotensive DM subjects. Parameters of DM control (fasting glucose and glycosylated hemoglobin) were associated with 2DE RV global longitudinal endo- and mid-myocardial layer strain. CONCLUSIONS Diabetes and hypertension significantly influence RV mechanics assessed by 2DE conventional and 2DE multilayer strain. Hypertension has an additive unfavorable influence on RV deformation in diabetic patients. Laboratory parameters of diabetic control were associated with RV structure, diastolic function and mechanics assessed with complex 2DE strain analysis.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia.
- Faculty of Medicine, Doktora Subotica 6, Belgrade, 11000, Serbia.
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy
| | - Vladan Vukomanovic
- Department of Cardiology, University Hospital "Dr Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia
| | - Sanja Ilic
- Department of Endocrinology, University Hospital "Dr Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia
| | - Vera Celic
- Department of Cardiology, University Hospital "Dr Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia
- Faculty of Medicine, Doktora Subotica 6, Belgrade, 11000, Serbia
| | - Philippe Obert
- Faculty of Health Sciences, LAPEC EA4278, Avignon University, 84000, Avignon, France
| | - Vesna Kocijancic
- Department of Cardiology, University Hospital "Dr Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia
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20
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Kowsari AA, Hosseinsabet A. Evaluation of the Right Ventricular Function in Prediabetes: A 2-D Speckle Tracking Echocardiographic Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1321-1329. [PMID: 26996526 DOI: 10.1016/j.ultrasmedbio.2016.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 01/03/2016] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
Pre-diabetes is a common condition associated with cardiovascular changes. The aim of our study was to evaluate the right ventricular (RV) function as assessed by 2-D speckle tracking echocardiography in pre-diabetic patients. This study recruited 94 patients (33 normal patients, 31 pre-diabetic patients and 30 diabetic patients). The absolute amount of the global peak systolic strain, the systolic strain rate and the early diastolic strain rate of the RV free wall (RVFW) was higher in the control group than in the pre-diabetic and diabetic groups. These indices were not different between the pre-diabetic and diabetic groups. The global late diastolic strain rate of RVFW was the same between the three groups. Also, pre-diabetes and diabetes were the independent predictors of the RVFW global peak systolic strain, systolic strain rate and diastolic strain rate. Our study demonstrated that the RV systolic and diastolic functions were impaired in the pre-diabetic and diabetic patients without obstructive coronary artery disease. Also, pre-diabetes and diabetes were independent predictors of systolic and diastolic functions of the RV.
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Affiliation(s)
- Ali-Asghar Kowsari
- Cardiology Department, Gerash Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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21
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Suran D, Sinkovic A, Naji F. Tissue Doppler imaging is a sensitive echocardiographic technique to detect subclinical systolic and diastolic dysfunction of both ventricles in type 1 diabetes mellitus. BMC Cardiovasc Disord 2016; 16:72. [PMID: 27102111 PMCID: PMC4840968 DOI: 10.1186/s12872-016-0242-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/08/2016] [Indexed: 01/18/2023] Open
Abstract
Background Subclinical left (LV) and right ventricular (RV) dysfunction has been demonstrated in type 2 diabetes mellitus and evidence indicates impaired LV diastolic function in type 1 diabetes mellitus (T1DM) as well. The aim of our study was to evaluate the role of tissue Doppler imaging (TDI) in assessment of global LV and RV function in T1DM patients. Methods A detailed two-dimensional, pulsed wave Doppler and pulsed wave TDI analysis was performed in 53 normotensive middle-aged T1DM patients and compared to healthy controls. Results In T1DM patients TDI analysis revealed reduced mean mitral septal and lateral E’ velocities as well as reduced mean tricuspid E˙t velocity compared to healthy controls (E’sept 8.89 ± 1.89 cm/s vs. 11.50 ± 2.41 cm/s, p < 0.001; E’lat 12.29 ± 2.58 cm/s vs.15.30 ± 2.95 cm/s, p < 0,001; E’t 13.56 ± 2.91 cm/s vs. 15.60 ± 2.99 cm/s, p = 0.001). Mean ratios E/E’sept, E/E’lat and E/E’t were significantly higher in diabetics with cutoff value of 7.4 for E/E’sept and 3.4 for E/E’t, differentiating diabetics with LV and RV diastolic impairement from matched healthy controls (sensitivity 76.5 %, specificity 73.8 % for E/E’sept and sensitivity 72.1 %, specificity 66.7 % for E/E’t). Myocardial acceleration during isovolumetric contraction (IVA) measured at the septal mitral (LV IVA) and lateral tricuspid annulus (RV IVA) was the only parameter indicating reduced contractility of both ventricles in diabetics compared to controls (LV IVA 230.70 ± 61.26 cm/s2 vs. 283.32 ± 59.74 cm/s2, p < 0,001; RV IVA 275.48 ± 68.08 cm/s2 vs. 316.86 ± 80.95 cm/s2, p = 0.011). LV IVA had better diagnostic accuracy than RV IVA to predict early contractile impairement in T1DM patients (area under the curve 0.758, p < 0.001 for LV IVA and 0.648, p = 0.017 for RV IVA). Conclusions TDI is essential to detect subclinical diastolic deterioration of both ventricles in T1DM patients. TDI-derived IVA might be useful to assess early systolic alterations of both ventricles in T1DM patients.
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Affiliation(s)
- David Suran
- Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
| | - Andreja Sinkovic
- Department of Medical Intensive Care, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Franjo Naji
- Department of Cardiology and Angiology, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
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22
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Skali H, Shah A, Gupta DK, Cheng S, Claggett B, Liu J, Bello N, Aguilar D, Vardeny O, Matsushita K, Selvin E, Solomon S. Cardiac structure and function across the glycemic spectrum in elderly men and women free of prevalent heart disease: the Atherosclerosis Risk In the Community study. Circ Heart Fail 2015; 8:448-54. [PMID: 25759458 DOI: 10.1161/circheartfailure.114.001990] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Individuals with diabetes mellitus and pre-diabetes mellitus are at particularly high risk of incident heart failure or death, even after accounting for known confounders. Nevertheless, the extent of impairments in cardiac structure and function in elderly individuals with diabetes mellitus and pre-diabetes mellitus is not well known. We aimed to assess the relationship between echocardiographic measures of cardiac structure and function and dysglycemia. METHODS AND RESULTS We assessed measures of cardiac structure and function in 4419 participants without prevalent coronary heart disease or heart failure who attended the Atherosclerosis Risk In the Community (ARIC) visit 5 examination (2011-2013) and underwent transthoracic echocardiography (age, 75±6 years; 61% women, 23% black). Subjects were grouped across the dysglycemia spectrum as normal (39%), pre-diabetes mellitus (31%), or diabetes mellitus (30%) based on medical history, antidiabetic medication use, and glycated hemoglobin levels. Glycemic status was related to measures of cardiac structure and function. Worsening dysglycemia was associated with increased left ventricular mass, worse diastolic function, and subtle reduction in left ventricular systolic function (P≤0.01 for all). For every 1% higher glycated hemoglobin, left ventricular mass was higher by 3.0 g (95% confidence interval, 1.5-4.6 g), E/E' by 0.5 (95% confidence interval, 0.4-0.7), and global longitudinal strain by 0.3% (95% confidence interval, 0.2-0.4) in multivariable analyses. CONCLUSIONS In a large contemporary biracial cohort of elderly subjects without prevalent cardiovascular disease or heart failure, dysglycemia was associated with subtle and subclinical alterations of cardiac structure, and left ventricular systolic and diastolic function. It remains unclear whether these are sufficient to explain the heightened risk of heart failure in individuals with diabetes mellitus.
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Affiliation(s)
- Hicham Skali
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
| | - Amil Shah
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Deepak K Gupta
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Susan Cheng
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Brian Claggett
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Jiankang Liu
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Natalie Bello
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - David Aguilar
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Orly Vardeny
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Kunihiro Matsushita
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Elizabeth Selvin
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Scott Solomon
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
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23
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Tadic M, Celic V, Cuspidi C, Ilic S, Pencic B, Radojkovic J, Ivanovic B, Stanisavljevic D, Kocabay G, Marjanovic T. Right heart mechanics in untreated normotensive patients with prediabetes and type 2 diabetes mellitus: a two- and three-dimensional echocardiographic study. J Am Soc Echocardiogr 2015; 28:317-27. [PMID: 25560484 DOI: 10.1016/j.echo.2014.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. METHODS This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. RESULTS Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8 mL/m(2), P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4 vs 22 ± 4 mL/m(2), P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. CONCLUSIONS RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia.
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia; Faculty of Medicine, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Sanja Ilic
- Department of Endocrinology, University Clinical Hospital Center "Dr Dragisa Misovic", Belgrade, Serbia
| | - Biljana Pencic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia
| | - Jana Radojkovic
- Department of Endocrinology, University Clinical Hospital Center "Dr Dragisa Misovic", Belgrade, Serbia
| | - Branislava Ivanovic
- Faculty of Medicine, Belgrade, Serbia; Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejana Stanisavljevic
- Faculty of Medicine, Belgrade, Serbia; Institute for Medical Statistics and Informatics, Belgrade, Serbia
| | - Gonenc Kocabay
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Tamara Marjanovic
- Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia
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24
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Tadic M, Cuspidi C. The influence of type 2 diabetes on left atrial remodeling. Clin Cardiol 2014; 38:48-55. [PMID: 25403642 DOI: 10.1002/clc.22334] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/02/2014] [Accepted: 08/12/2014] [Indexed: 01/18/2023] Open
Abstract
The influence of type 2 diabetes mellitus on cardiac remodeling has been evaluated for decades; however, the majority of investigations were focused only on the left ventricle. The impact of diabetes on the left atrial (LA) function is less researched. LA enlargement has been shown as an independent predictor of cardiovascular morbidity and mortality in the general and diabetic population; however, LA dysfunction has been proven to be an independent predictor only in the general population. There are not much follow-up data about the influence of diabetes on LA function. New echocardiographic techniques, such as 2-dimensional speckle tracking imaging, provide more accurate, sensitive, and reliable information about LA function than traditional, volumetric methods. The aim of this review was to summarize the most recent reports about the influence of diabetes on LA function, as well as to discuss the possible mechanisms and potential clinical implications of the relationship between diabetes and LA remodeling.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje,", Belgrade, Serbia
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25
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Changes in cardiac innervation during maturation in long-term diabetes. Exp Gerontol 2013; 48:1473-8. [DOI: 10.1016/j.exger.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/08/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
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26
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Tadic M, Ivanovic B, Cuspidi C. Metabolic syndrome and right ventricle: an updated review. Eur J Intern Med 2013; 24:608-16. [PMID: 24001437 DOI: 10.1016/j.ejim.2013.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 12/19/2022]
Abstract
The cluster of metabolic and hemodynamic abnormalities which characterize the metabolic syndrome (MS) is responsible for subclinical cardiac and extra-cardiac damage such as left ventricular hypertrophy, diastolic dysfunction, carotid atherosclerosis and microalbuminuria. The development of different non-invasive imaging methods enabled a detail investigation of right ventricular structure and function, and revealed that right ventricular remodeling followed changes in the left ventricular structure and function in patients with arterial hypertension, diabetes or obesity. Previous investigations also reported that the coexistence of two components of the MS induced more significant cardiac remodeling than the presence of only one MS risk-factor. The relationship between different components of the MS (increased blood pressure, abdominal obesity, increased fasting glucose level and dyslipidemia) and right ventricular remodeling could be explained by several hemodynamic and non-hemodynamic mechanisms. However, the association between right ventricular remodeling and the MS has not been sufficiently investigated so far. The aim of this article was to review recent articles focusing on the association between metabolic syndrome components and the metabolic syndrome itself with impairments in right ventricular structure and function assessed by different imaging techniques.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dr Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
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27
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Widya RL, van der Meer RW, Smit JWA, Rijzewijk LJ, Diamant M, Bax JJ, de Roos A, Lamb HJ. Right ventricular involvement in diabetic cardiomyopathy. Diabetes Care 2013; 36:457-62. [PMID: 23139371 PMCID: PMC3554276 DOI: 10.2337/dc12-0474] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare magnetic resonance imaging-derived right ventricular (RV) dimensions and function between men with type 2 diabetes and healthy subjects, and to relate these parameters to left ventricular (LV) dimensions and function. RESEARCH DESIGN AND METHODS RV and LV volumes and functions were assessed in 78 men with uncomplicated type 2 diabetes and 28 healthy men within the same range of age using magnetic resonance imaging. Steady-state free precession sequences were used to assess ventricular dimensions. Flow velocity mapping across the pulmonary valve and tricuspid valve was used to assess RV outflow and diastolic filling patterns, respectively. Univariate general linear models were used for statistical analyses. RESULTS RV end-diastolic volume was significantly decreased in patients compared with healthy subjects after adjustment for BMI and pulse pressure (177 ± 28 mL vs. 197 ± 47 mL, P < 0.01). RV systolic function was impaired: peak ejection rate across the pulmonary valve was decreased (433 ± 54 mL/s vs. 463 ± 71 mL/s, P < 0.01) and pulmonary flow acceleration time was longer (124 ± 17 ms vs. 115 ± 25 ms, P < 0.05). Indexes of RV diastolic function were impaired: peak filling rate and peak deceleration gradient of the early filling phase were 315 ± 63 mL/s vs. 356 ± 90 mL/s (P < 0.01) and 2.3 ± 0.8 mL/s(2) × 10(-3) vs. 2.8 ± 0.8 mL/s(2) × 10(-3) (P < 0.01), respectively. All RV parameters were strongly associated with its corresponding LV parameter (P < 0.001). CONCLUSIONS Diabetic cardiomyopathy affects the right ventricle, as demonstrated by RV remodeling and impaired systolic and diastolic functions in men with type 2 diabetes, in a similar manner as changes in LV dimensions and functions. These observations suggest that RV impairment might be a component of the diabetic cardiomyopathy phenotype.
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Affiliation(s)
- Ralph L Widya
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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28
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Abstract
The term diabetic cardiomyopathy was initially introduced in the 1980s when evidence was found that diabetes leads to a distinct cardiomyopathy, independent of coronary artery disease or hypertension. The detection of diabetic cardiomyopathy using echocardiography is challenging because no pathognomonic signs exist; however, it is the merit especially of the newer echocardiographic techniques, such as deformation imaging, that it is now possible to describe the morphology and function of diabetic hearts. Unfortunately, no long-term echocardiography studies are available describing disease progression in detail. Therefore, staging and differential diagnosis of diabetic cardiomyopathy remains challenging. This review tries to fill this gap by presenting a possible echocardiographic staging algorithm. Early stages of diabetic cardiomyopathy are marked by a deterioration of longitudinal systolic function and a compensative elevated radial function. Diastolic dysfunction is another early sign. When the disease progresses the functional deterioration is accompanied by morphological changes, such as left ventricular concentric hypertrophy and fibrosis. End stage disease is characterized by reduced ejection fraction and ventricular dilatation. Very late stage can mimic dilative cardiomyopathy.
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Sethumadhavan S, Vasquez-Vivar J, Migrino RQ, Harmann L, Jacob HJ, Lazar J. Mitochondrial DNA variant for complex I reveals a role in diabetic cardiac remodeling. J Biol Chem 2012; 287:22174-82. [PMID: 22544750 DOI: 10.1074/jbc.m111.327866] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Myocardial remodeling and dysfunction are serious complications of type 2 diabetes mellitus (T2DM). Factors controlling their development are not well established. To specifically address the role of the mitochondrial genome, we developed novel conplastic rat strains, i.e. strains with the same nuclear genome but a different mitochondrial genome. The new animals were named T2DN(mtFHH) and T2DN(mtWistar), where the acronym T2DN denotes their common nuclear genome (type 2 diabetic nephropathy (T2DN) rats) and mtFHH or mtWistar the origin of their mitochondria, Fawn Hooded Hypertensive (FHH) or Wistar rats, respectively. The T2DN(mtFHH) and T2DN(mtWistar) showed a similar progression of diabetes as determined by HbA1c, cholesterol, and triglycerides with normal blood pressure, thus enabling investigation of the specific role of the mitochondrial genome in cardiac function without the confounding effects of obesity or hypertension found in other models of diabetes. Echocardiographic analysis of 12-week-old animals showed no abnormalities, but at 12 months of age the T2DN(mtFHH) showed left ventricular remodeling that was verified by histology. Decreased complex I and complex IV but not complex II activity within the electron transport chain was found only in T2DN(mtFHH), which was not explained by differences in protein content. Decreased cardiac ATP levels in T2DN(mtFHH) were in agreement with a lower ATP synthetic capacity by isolated mitochondria. Together, our data provide experimental evidence that mtDNA sequence variations have an additional role in energetic heart deficiency. The mitochondrial DNA background may explain the increased susceptibility of certain T2DM patients to develop myocardial dysfunction.
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Affiliation(s)
- Savitha Sethumadhavan
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Abdelaziz AA, Daoud EM. Assessment of right ventricular function by myocardial performance index in diabetic patients. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tayyareci Y, Yurdakul S, Tayyareci G, Nisanci Y, Umman B, Buğra Z. Impact of Myocardial Acceleration during Isovolumic Contraction in Evaluating Subclinical Right Ventricular Systolic Dysfunction in Type 2 Diabetes Mellitus Patients. Echocardiography 2010; 27:1211-8. [DOI: 10.1111/j.1540-8175.2010.01237.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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van den Brom CE, Bosmans JWAM, Vlasblom R, Handoko LM, Huisman MC, Lubberink M, Molthoff CFM, Lammertsma AA, Ouwens MD, Diamant M, Boer C. Diabetic cardiomyopathy in Zucker diabetic fatty rats: the forgotten right ventricle. Cardiovasc Diabetol 2010; 9:25. [PMID: 20550678 PMCID: PMC2898761 DOI: 10.1186/1475-2840-9-25] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 06/15/2010] [Indexed: 01/30/2023] Open
Abstract
Background In patients with myocardial infarction or heart failure, right ventricular (RV) dysfunction is associated with death, shock and arrhythmias. In patients with type 2 diabetes mellitus, structural and functional alterations of the left ventricle (LV) are highly prevalent, however, little is known about the impact of diabetes on RV characteristics. The purpose of the present study was to investigate whether LV changes are paralleled by RV alterations in a rat model of diabetes. Methods Zucker diabetic fatty (ZDF) and control (ZL) rats underwent echocardiography and positron emission tomography (PET) scanning using [18F]-2-fluoro-2-deoxy-D-glucose under hyperinsulinaemic euglycaemic clamp conditions. Glucose, insulin, triglycerides and fatty acids were assessed from trunk blood. Another group of rats received an insulin or saline injection to study RV insulin signaling. Results ZDF rats developed hyperglycaemia, hyperinsulinaemia and dyslipidaemia (all p < 0.05). Echocardiography revealed depressed LV fractional shortening and tricuspid annular plane systolic excursion (TAPSE) in ZDF vs. ZL rats (both p < 0.05). A decrease in LV and RV insulin-mediated glucose utilisation was found in ZDF vs. ZL rats (both p < 0.05). LV associated with RV with respect to systolic function (r = 0.86, p < 0.05) and glucose utilisation (r = 0.74, p < 0.05). TAPSE associated with RV MRglu (r = 0.92, p < 0.05) and M-value (r = 0.91, p < 0.0001) and RV MRglu associated with M-value (r = 0.77, p < 0.05). Finally, reduced RV insulin-stimulated phosphorylation of Akt was found in ZDF vs. ZL (p < 0.05). Conclusions LV changes were paralleled by RV alterations in insulin-stimulated glucose utilisation and RV systolic function in a rat model of diabetes, which may be attributed to ventricular interdependence as well as to the uniform effect of diabetes. Since diabetic patients are prone to develop diabetic cardiomyopathy and myocardial ischaemia, it might be suggested that RV dysfunction plays a central role in cardiac abnormalities in this population.
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Affiliation(s)
- Charissa E van den Brom
- Department of Internal Medicine/Diabetes Centre, VU University Medical Centre, Amsterdam, the Netherlands.
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Cottrell C, Kirkpatrick JN. Echocardiographic strain imaging and its use in the clinical setting. Expert Rev Cardiovasc Ther 2010; 8:93-102. [PMID: 20030024 DOI: 10.1586/erc.09.165] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of echocardiography has grown tremendously over the past several years. It is used routinely for diagnosis, prognosis and monitoring changes of cardiac function in coronary artery disease, heart failure, pulmonary hypertension, arrhythmias, pericardial disease and valvular disease, as well as congenital conditions. In recent years, the advancing technology used to evaluate the heart by ultrasound has allowed physicians to understand the mechanics of the heart muscle and the contribution of abnormalities in myocardial movement to heart disease. This review will discuss novel echocardiographic strain imaging techniques, placing them in the context of myocardial mechanics and describing current and future applications.
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Affiliation(s)
- Caroline Cottrell
- University of Pennsylvania, Echocardiography Laboratory, 9021 Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Rendina D, De Bonis S, Gallotta G, Piedimonte V, Mossetti G, De Filippo G, Farina F, Vargas G, Barbella MR, Postiglione A, Strazzullo P. Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism. Intern Emerg Med 2010; 5:53-9. [PMID: 19937481 DOI: 10.1007/s11739-009-0330-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 10/19/2009] [Indexed: 11/27/2022]
Abstract
Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic instability and cardiogenic shock. Aim of this case-control study was to determine the clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with acute PE involving the main or segmental pulmonary arteries (central PE) and without hemodynamic instability on admission to the Emergency Department (ED) (non-massive PE). From January 1, 2002 to December 31, 2005, 211 patients with central PE were admitted to the Department of Emergency Medicine of the "Antonio Cardarelli" Hospital (Naples, Italy). One hundred eighteen of them had echocardiographic evidence of right ventricular dysfunction on admission to the ED. A history of type 2 diabetes mellitus and chronic obstructive pulmonary disease were significantly associated with an increased risk of this PE-related complication. Compared to patients without right ventricular dysfunction, those with right ventricular dysfunction showed higher levels of markers of cardiac damage, and a significant impairment of respiratory function. Echocardiographic evidence of right ventricular dysfunction on admission to the ED was significantly associated with the occurrence of hemodynamic instability and cardiogenic shock during the PE clinical course. The study results indicate that a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease are significantly associated with the occurrence of right ventricular dysfunction in patients with non-massive and central PE independent of age, gender and other historical and clinical variables detectable on admission to the ED.
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Affiliation(s)
- Domenico Rendina
- Department of Clinical and Experimental Medicine, Federico II University Medical School, via S. Pansini, 5, 80131, Naples, Italy.
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Salem M, El Behery S, Adly A, Khalil D, El Hadidi E. Early predictors of myocardial disease in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2009; 10:513-21. [PMID: 19708908 DOI: 10.1111/j.1399-5448.2009.00517.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The spectrum of diabetic heart disease involves a progression from normal heart to preclinical left ventricular diastolic and systolic dysfunction followed by overt echocardiographic evidence of left ventricular (LV) dysfunction and finally symptomatic heart failure. OBJECTIVE To compare the value of tissue Doppler imaging (TDI) over the conventional echocardiography in the assessment of early myocardial dysfunction in type 1 diabetics in correlation with serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP), state of metabolic control, and diabetes duration. METHODS Sixty subjects were included; 40 type 1 diabetics (aged 12-18 years). Twenty matched subjects served as controls. They were subjected to clinical examination with assessment of cardiovascular reflexes for autonomic neuropathy. Laboratory investigations included mean random blood sugar (MRBS), hemoglobin A1c (HbA1c), urinary microalbumin, and serum determination of NT-pro-BNP. Echocardiography for chamber dimensions, systolic and diastolic function, Tie index, and longitudinal myocardial global biventricular function by pulsed TDI of 6 LV walls and right ventricle (RV) free wall. RESULTS All diabetics and controls had normal LV dimensions, LV mass index and systolic functions except for higher left ventricular posterior wall (LVPW) in diabetics (P < 0.05). LV and RV diastolic dysfunction diagnosed in 25% of diabetics by conventional Doppler with higher peak A (P < 0.05, P < 0.05) and lower E/A (P < 0.05, P < 0.05) compared to controls. Diabetics had larger Tie index (P < 0.05). TDI showed delayed myocardial relaxation in 52.5% of diabetics with lower LV and RV peak Em (P < 0.05, P < 0.01) and Em/Am (P < 0.01, P < 0.001) compared to controls. NT-pro-BNP was elevated in diabetics (P < 0.01) with best cut-off value = 62.5 Fmol/mL, sensitivity (82%), and specificity (95%) for detection of isolated diastolic dysfunction in diabetics. It was correlated negatively with LV Em (P < 0.05), Em/Am (P < 0.01) and positively with Am (P < 0.01), impaired diastolic velocities were associated with higher HbA1c. CONCLUSION Asymptomatic diabetics had evidence of subtle right and LV dysfunction with delayed myocardial relaxation which was related to metabolic control. Tissue Doppler (TD) has an additional value in evaluating ventricular filling. NT-pro-BNP is considered a sensitive, specific, and predictive marker for diastolic dysfunction.
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Affiliation(s)
- Mona Salem
- Paediatrics Department, Ain Shams University, Cairo, Egypt.
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Kamalesh M. Heart Failure in Diabetes and Related Conditions. J Card Fail 2007; 13:861-73. [DOI: 10.1016/j.cardfail.2007.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 07/19/2007] [Accepted: 07/24/2007] [Indexed: 02/07/2023]
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Kosmala W, Przewlocka-Kosmala M, Mazurek W. Subclinical right ventricular dysfunction in diabetes mellitus--an ultrasonic strain/strain rate study. Diabet Med 2007; 24:656-63. [PMID: 17367309 DOI: 10.1111/j.1464-5491.2007.02101.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS While left ventricular dysfunction has been recognized to be a common complication of diabetes mellitus, data regarding right ventricular (RV) performance in patients with diabetes are incomplete. The aim of the study was to determine the preclinical effects of diabetes on regional RV systolic and diastolic function in asymptomatic persons with diabetes using the echocardiographic strain/strain rate technique. METHODS Groups studied consisted of 33 subjects with diabetes only (DM; aged 57.3 +/- 12.9 years) and 40 subjects with coexisting diabetes and hypertension (DMHT; aged 57.5 +/- 10.5 years). In all patients with diabetes, coronary artery disease and pulmonary hypertension were excluded. Thirty-six healthy age-matched persons served as control subjects. In each patient an echocardiographic study with strain/strain rate imaging was performed. Analysis of RV deformation data included assessment of systolic strain, peak systolic strain rate (SRs) and peak early diastolic strain rate (SRe) obtained from the basal and apical segments of the RV free wall. RESULTS Significantly lower values of systolic strain and SRs in the basal and apical segment of the RV free wall in the DM and DMHT groups as compared with control subjects indicated impairment of RV systolic function. Similarly, decreased SRe in patients with diabetes in both RV segments examined reflected abnormalities of RV diastolic performance. The systolic defects were more pronounced in the apical than in the basal segment. All measured parameters were similar in the two groups with diabetes. CONCLUSION Diabetes mellitus is associated with subclinical RV systolic and diastolic dysfunction, regardless of coexisting hypertension.
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Affiliation(s)
- W Kosmala
- Cardiology Department of Medical University, Wroclaw, Poland.
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Karamitsos TD, Karvounis HI, Dalamanga EG, Papadopoulos CE, Didangellos TP, Karamitsos DT, Parharidis GE, Louridas GE. Early diastolic impairment of diabetic heart: The significance of right ventricle. Int J Cardiol 2007; 114:218-23. [DOI: 10.1016/j.ijcard.2006.02.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 01/22/2006] [Accepted: 02/03/2006] [Indexed: 02/01/2023]
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Colonna P, Pinto FJ, Sorino M, Bovenzi F, D'Agostino C, de Luca I. The emerging role of echocardiography in the screening of patients at risk of heart failure. Am J Cardiol 2005; 96:42L-51L. [PMID: 16399092 DOI: 10.1016/j.amjcard.2005.09.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A large number of patients without symptoms of heart failure (HF) have asymptomatic left ventricular (LV) dysfunction owing to the compensatory mechanisms acting through the autonomic nervous system and neurohormones. In the setting of screening for prevention, one must identify the subgroup of these patients at high risk for symptomatic HF to establish appropriate therapy. As a first step to identify the subgroup of patients at high risk, clinical screening scores and natriuretic peptide measurements are used. Second, the definite diagnosis of asymptomatic LV dysfunction must be confirmed with echocardiography, occasionally with the help of new technologic developments to establish prompt, appropriate treatment to prevent disease progression. Therefore, the screening role of echocardiography is the early identification of patients with structural cardiopathy who are at risk of developing symptomatic HF and detection of those without LV dysfunction (diabetic and hypertensive) whose condition is prone to advance rapidly to structural cardiopathy or to symptomatic HF.
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Affiliation(s)
- Paolo Colonna
- Department of Cardiology, Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
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Current literature in diabetes. Diabetes Metab Res Rev 2005; 21:382-9. [PMID: 15959871 DOI: 10.1002/dmrr.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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