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Minocha PK, Englund EK, Friesen RM, Fujiwara T, Smith SA, Meyers ML, Browne LP, Barker AJ. Reference Values for Fetal Cardiac Dimensions, Volumes, Ventricular Function and Left Ventricular Longitudinal Strain Using Doppler Ultrasound Gated Cardiac Magnetic Resonance Imaging in Healthy Third Trimester Fetuses. J Magn Reson Imaging 2024; 60:365-374. [PMID: 37855630 PMCID: PMC11026299 DOI: 10.1002/jmri.29077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Recent advances in hardware and software permit the use of cardiac MRI of late gestation fetuses, however there is a paucity of MRI-based reference values. PURPOSE To provide initial data on fetal cardiac MRI-derived cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain in healthy developing fetuses >30 weeks gestational age. STUDY TYPE Prospective. POPULATION Twenty-five third trimester (34 ± 1 weeks, range of 32-37 weeks gestation) women with healthy developing fetuses. FIELD STRENGTH/SEQUENCE Studies were performed at 1.5 T and 3 T. Cardiac synchronization was achieved with a Doppler ultrasound device. The protocol included T2 single shot turbo spin echo stacks for fetal weight and ultrasound probe positioning, and multiplanar multi-slice cine balanced steady state free precession gradient echo sequences. ASSESSMENT Primary analyses were performed by a single observer. Weight indexed right ventricular (RV) and left ventricular (LV) volumes and function were calculated from short axis (SAX) stacks. Cardiac dimensions were calculated from the four-chamber and SAX stacks. Single plane LV longitudinal strain was calculated from the four-chamber stack. Interobserver variability was assessed in 10 participants. Cardiac MRI values were compared against available published normative fetal echocardiogram data using z-scores. STATISTICAL TESTS Mean and SDs were calculated for baseline maternal/fetal demographics, cardiac dimensions, volumes, ventricular function, and left ventricular longitudinal strain. Bland-Altman and intraclass correlation coefficient analysis was performed to test interobserver variability. RESULTS The mean gestational age was 34 ± 1.4 weeks. The mean RV and LV end diastolic volumes were 3.1 ± 0.6 mL/kg and 2.4 ± 0.5 mL/kg respectively. The mean RV cardiac output was 198 ± 49 mL/min/kg while the mean LV cardiac output was 173 ± 43 mL/min/kg. DATA CONCLUSION This paper reports initial reference values obtained by cardiac MRI in healthy developing third trimester fetuses. MRI generally resulted in slightly larger indexed values (by z-score) compared to reports in literature using fetal echocardiography. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Prashant K. Minocha
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, USA
| | - Erin K. Englund
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Richard M. Friesen
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, USA
| | - Takashi Fujiwara
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Sarah A. Smith
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Mariana L. Meyers
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Lorna P. Browne
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
| | - Alex J. Barker
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, USA
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Hasan A, Dahan N, Ayeni A, Chhabra M, McGrory P. Accuracy of Pediatric Interventricular Septal Thickness Measurement Obtained Via Point-of-Care Ultrasound: A Prospective Study. Pediatr Emerg Care 2024; 40:434-437. [PMID: 38316020 DOI: 10.1097/pec.0000000000003067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a genetic, life-threatening cardiovascular disease that often goes unidentified in pediatric patients. Patients are often asymptomatic and neither history or physical examination are reliable to detect the disease. The only reliable method to diagnose hypertrophic cardiomyopathy is with echocardiography to look at interventricular septal thickness. Emerging literature has shown that cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians is as effective and accurate compared with cardiac echocardiography performed by pediatric cardiologists. OBJECTIVE The objective of the study was to determine the diagnostic accuracy of POCUS performed by ultrasound-trained PEM physicians in measuring the interventricular septum end diastole (IVSd) thickness in the pediatric emergency department. METHODS We conducted a prospective, single-center, observational, diagnostic accuracy study to examine the diagnostic accuracy of POCUS in measuring IVSd thickness in pediatric patients who presented to the pediatric emergency department with symptoms that prompted a cardiac POCUS. Cardiac POCUS findings were interpreted by a PEM physician at the bedside and retrospectively by a pediatric cardiologist. Diagnostic concordance of the measurements obtained by the PEM physician and cardiologist was assessed. RESULTS Forty-eight patients were enrolled. Median patient age was 13.4 years. There was excellent diagnostic agreement on the measurement of the IVSd thickness between PEM physicians and the pediatric cardiologist (81.25% of cases; 39/48). Disagreement was seen in 18.75% of the cases (9/48). The mean error of disagreement was -0.32, with a 95% confidence interval of -0.37 to -0.28. Overall, the mean error of both agreement and disagreement was -0.046, with 95% confidence interval of -0.08 to -0.01 and P value of 0.008. CONCLUSIONS Point-of-care ultrasound performed by ultrasound-trained PEM physicians to measure pediatric IVSd thickness has a high diagnostic accuracy with excellent agreement with a pediatric cardiologist.
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Affiliation(s)
- Ahmed Hasan
- From the NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, NY
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Donthula R, Li W, Duvvada A, Dyer D, Uppu SC. Normative Computed Tomography Angiography Values of the Aortic Root, Aorta and Aortic arch in Children. RESEARCH SQUARE 2024:rs.3.rs-4406785. [PMID: 38798643 PMCID: PMC11118707 DOI: 10.21203/rs.3.rs-4406785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Purpose Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data are not currently available for ECG-gated Computed Tomography Angiography (CTA). We sought to establish ECG-gated CTA derived normative values for the aortic root, aorta and aortic arch in children. Methods and Results Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface areaAE (BSAAE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. Conclusion Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta and aortic arch in children.
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Affiliation(s)
| | - Wen Li
- the University of Texas McGovern Medical School at Houston
| | | | | | - Santosh C Uppu
- The University of Texas Health Science Center at Houston
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Barros A, Udine M, Spurney C, Olivieri L, Loke YH. Discordance interpretation of left ventricular size between echocardiography and cardiac magnetic resonance in pediatric patients with aortic/mitral regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1049-1057. [PMID: 38519822 PMCID: PMC11147931 DOI: 10.1007/s10554-024-03073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This study investigated discordance between echocardiography (echo) and cardiac magnetic resonance (CMR) measurements of the left ventricle (LV) in pediatric patients with aortic and/or mitral regurgitation (AR/MR). METHODS Retrospective cohort study of pediatric patients. The cohorts were comprised of patients with AR/MR vs. non-AR/MR. Left ventricular end diastolic volume (LVEDV) by CMR and left ventricular internal diameter diastolic (LVIDd) by echo were obtained from clinical reports then echo images were reviewed to remeasure LVEDV by bullet method. Left ventricular internal diameter systolic (LVIDs) and left ventricular ejection fraction (LVEF) measurements by echo and LVEF by CMR were obtained from clinical reports. Fractional shortening (FS%) was recalculated. Z-scores were calculated using normative data. Correlation between echo and CMR LV measurements was assessed using correlation coefficients. Bland-Altman plots assessed bias between imaging modalities. Receiver operator characteristic (ROC) analysis was performed for detection of LV enlargement and LV dysfunction. RESULTS AR/MR patients had greater discrepancy in LV size interpretation by Z-score compared to non-AR/MR patients. This discrepancy persisted when the bullet method short axis measurements were incorporated. There was negative bias in echo-based measurements compared to CMR. The diagnostic performance of echo in identifying moderate LV enlargement was worse for AR/MR pediatrics patients. CONCLUSION The discordant interpretation of LV size by echo compared to CMR is worse in pediatric patients with AR/MR when compared to patients without AR/MR even when short axis measurements are incorporated. This finding suggests non-uniform geometrical changes in the LV as it enlarges due to AR/MR.
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Affiliation(s)
| | | | | | - Laura Olivieri
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Yue-Hin Loke
- Children's National Hospital, Washington, DC, USA
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Chinawa JM, Chukwu B, Chinawa A. Estimation of z-scores of cardiac structures in healthy children in Southeast Nigeria. Ir J Med Sci 2024; 193:689-698. [PMID: 37861940 DOI: 10.1007/s11845-023-03542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The z-scoring system shows the mean deviation of cardiac dimensions from age-specific population. The use of the European-based z-score studies has resulted in misdiagnosis and late treatment of Nigerian children with heart diseases leading to increased mortality and morbidity. OBJECTIVES This study aimed to determine the z‑scores for various cardiac structures and functions among healthy children in Southeast Nigeria. MATERIALS AND METHODS This is a cross-sectional observational study where z-scores of the cardiac structure and function of three hundred healthy children were estimated using echocardiography and compared with the standard Detroit values. RESULT There was a significant positive correlation between age and cardiac valve diameter. The aortic valve strongly correlated positively with age with the Pearson correlation coefficient (ρ) of 0.8 and probability value (P-value) of 0.00. None of the ventricular function variables deviated beyond the +2 or -2 z-score. There was a positive correlation between the z-scores of ventricular function parameters and participants' age, although the strength of the correlation varied. Comparing these values with that of Detroit values, there was a significant difference in the deviation of the mean of the mitral valve and left pulmonary artery diameters from the Detroit values between the males and the females. While the mean z-score mitral valve was 0.8 in males, it was 0.6 in females (P = 0.02). CONCLUSION Z-scores of cardiac structures and function are derived from children in this locale. These values were similar to that of Detroit values except for the mitral valve and left pulmonary artery.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Bartholomew Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Awoere Chinawa
- Department of Community Medicine, ESUCOM, Parklane, Enugu, Nigeria
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McGeoghegan PB, Lu M, Sleeper LA, Emani SM, Baird CW, Feins EN, Gellis LA, Friedman KG. Cleft closure and other predictors of contemporary outcomes after atrioventricular canal repair in patients with parachute left atrioventricular valve. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae048. [PMID: 38539038 PMCID: PMC11014788 DOI: 10.1093/icvts/ivae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Parachute left atrioventricular valve (LAVV) complicates atrioventricular septal defect (AVSD) repair. We evaluate outcomes of AVSD patients with parachute LAVV and identify risk factors for adverse outcomes. METHODS We evaluated all patients undergoing repair of AVSD with parachute LAVV from 2012 to 2021. The primary outcome was a composite of time-to-death, LAVV reintervention and development of greater than or equal to moderate LAVV dysfunction (greater than or equal to moderate LAVV stenosis and/or LAVV regurgitation). Event-free survival for the composite outcome was estimated using Kaplan-Meier methodology and competing risks analysis. Cox proportional hazards regression was used to identify predictors of the primary outcome. RESULTS A total of 36 patients were included with a median age at repair of 4 months (interquartile range 2.3-5.5 months). Over a median follow-up of 2.6 years (interquartile range 1.0-5.6 years), 6 (17%) patients underwent LAVV reintervention. All 6 patients who underwent LAVV reintervention had right-dominant AVSD. Sixteen patients (44%) met the composite outcome, and all did so within 2 years of initial repair. Transitional AVSD (versus complete), prior single-ventricle palliation, leaving the cleft completely open and greater than or equal to moderate preoperative LAVV regurgitation were associated with a higher risk of LAVV reintervention in univariate analysis. In multivariate analysis, leaving the cleft completely open was associated with the composite outcome. CONCLUSIONS Repair of AVSD with parachute LAVV remains a challenge with a significant burden of LAVV reintervention and dysfunction in medium-term follow-up. Unbalanced, right-dominant AVSDs are at higher risk for LAVV reintervention. Leaving the cleft completely open might independently predict poor overall outcomes and should be avoided when possible. CLINICAL TRIAL REGISTRATION NUMBER IRB-P00041642.
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Affiliation(s)
| | - Minmin Lu
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
| | - Lynn A Sleeper
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
| | - Sitaram M Emani
- Department of Cardiothoracic Surgery, Children’s Hospital Boston, Boston, MA, USA
| | - Christopher W Baird
- Department of Cardiothoracic Surgery, Children’s Hospital Boston, Boston, MA, USA
| | - Eric N Feins
- Department of Cardiothoracic Surgery, Children’s Hospital Boston, Boston, MA, USA
| | - Laura A Gellis
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
| | - Kevin G Friedman
- Department of Cardiology, Children’s Hospital Boston, Boston, MA, USA
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Donthula R, Li W, Kaur H, Adebo DA, Uppu SC. Normative computed tomography angiography values of the main and branch pulmonary arteries in children. Eur J Pediatr 2024; 183:1183-1193. [PMID: 38078969 DOI: 10.1007/s00431-023-05363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
Non-invasive cardiac imaging like echocardiogram, cardiac magnetic resonance imaging (CMR), and computed tomography angiography (CTA) play a key role in the diagnosis, aid in management and follow-up of congenital heart disease patients. Normative data for intracardiac and extracardiac vascular structures in children are currently available for echocardiogram, CMR, and non-gated CTA. We sought to establish systolic and diastolic normative data for main and branch pulmonary arteries in children using electrocardiogram (ECG)-gated CTA. Diameters and cross-sectional areas of the main and branch pulmonary arteries were measured in systole and diastole based on the aortic valve position (open versus closed) in 100 subjects who had ECG-gated cardiac CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area (BSAAE) was established using the previously described methods. A total of 100 children aged 0-18 years were analyzed; mean age was 5.3 years (SD, 6.1 years). Z-score curves were plotted in relation to the BSA for the mean, maximum, and minimum diameters and cross-sectional area of the main and branch pulmonary arteries for systole and diastole. Conclusion: We report systolic and diastolic mean, maximum, and minimum diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children derived using ECG-gated cardiac CTA. We believe our results can help identify abnormally sized main and branch pulmonary arteries. What is Known: • Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity. What is New: • Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the main and branch pulmonary arteries in children.
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Affiliation(s)
- Rakesh Donthula
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas McGovern Medical School at Houston, Houston, TX, 77030, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Harmanpreet Kaur
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Dilachew A Adebo
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Santosh C Uppu
- The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, 77030, USA.
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Cardoso MRR, Crestani AM, Souza AS, Braga FDCB, Brun MM, Murakami AN, Cajueiro FCM, Marchi CHD, Croti UA. Role of Computed Tomography Angiography in the Short-Term Follow-up of Aortic Coarctation Repair. Braz J Cardiovasc Surg 2024; 39:e20230220. [PMID: 38315562 PMCID: PMC10836914 DOI: 10.21470/1678-9741-2023-0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Coarctation of the aorta (CoA) is a narrowing of the thoracic aorta that often manifests as discrete stenosis but may be tortuous or in long segment. The study aimed to evaluate pre and post-surgical aspects of pediatric patients submitted to CoA surgical correction and to identify possible predisposing factors for aortic recoarctation. METHODS Twenty-five patients were divided into groups according to presence (N=8) or absence (N=17) of recoarctation after surgical correction of CoA and evaluated according to clinical-demographic profile, vascular characteristics via computed angiotomography (CAT), and other pathological conditions. RESULTS Majority of males (64%), ≥ 15 days old (76%), ≥ 2.5 kg (80%). There was similarity between groups with and without recoarctation regarding sex (male: 87% vs. 53%; P=0.277), age (≥ 15 days: 62.5 vs. 82%; P=0.505), and weight (≥ 2.5 kg: 87.5 vs. 76.5; P=0,492). Altered values of aortic root/Valsalva diameter, proximal transverse arch, and distal isthmus, and normal values for aorta prevailed in preoperative CAT. Normal values for the aortic root/Valsalva sinus diameter were observed with and without recoarctation, the same for both groups regarding ascending and descending aorta in postoperative CAT. No significant difference for altered values of proximal transverse arch and alteration in distal isthmus was observed. CONCLUSION No predictive risk for recoarctation was observed. CTA proved to be important in CoA diagnosis and management, since CoA is mainly related with altered diameter of aortic root/sinus of Valsalva and proximal and distal aortic arch/isthmus, however, it failed to show predictive risk for recoarctation.
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Affiliation(s)
- Mariana Ribeiro Rodero Cardoso
- Radiology Service, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio liPreto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Ariela Maltarolo Crestani
- Radiology Service, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio liPreto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Antônio Soares Souza
- Radiology Service, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio liPreto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Fernanda Del Campo Braojos Braga
- Radiology Service, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio liPreto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Marília Maroneze Brun
- CardioPedBrasil® - Centro do Coração da
Criança, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio Preto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Alexandre Noboru Murakami
- Cardiology Surgery Department, Serviço de Cirurgia
Cardíaca do Norte do Paraná, Universidade Estadual de Londrina (UEL),
Londrina, Paraná, Brazil
| | - Francisco Candido Monteiro Cajueiro
- CardioPedBrasil® - Centro do Coração da
Criança, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio Preto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Carlos Henrique De Marchi
- CardioPedBrasil® - Centro do Coração da
Criança, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio Preto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Ulisses Alexandre Croti
- CardioPedBrasil® - Centro do Coração da
Criança, Hospital da Criança e Maternidade (HCM),
Fundação Faculdade Regional de Medicina de São José do
Rio Preto (FUNFARME), Faculdade de Medicina de São José do Rio Preto
(FAMERP), São José do Rio Preto, São Paulo, Brazil
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Zamprakou A, Söderhult I, Ferm‐Widlund K, Ajne G, Johnson J, Herling L. Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion before and after intrauterine blood transfusion in pregnancies affected by red blood cell alloimmunization. Acta Obstet Gynecol Scand 2024; 103:313-321. [PMID: 37984405 PMCID: PMC10823390 DOI: 10.1111/aogs.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/15/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Maternal red blood cell alloimmunization during pregnancy can lead to hemolysis and various degrees of fetal anemia, which can be treated with intrauterine blood transfusion (IUT) to prevent adverse outcomes. Knowledge about fetal myocardial function and adaptation is limited. The aim of the present study was to measure fetal atrioventricular plane displacement before and after IUT and compare these measurements with previously established reference ranges. MATERIAL AND METHODS An observational study was conducted on pregnant women affected by red blood cell alloimmunization. Fetal echocardiography was performed before and after IUT. The atrioventricular plane displacement of the left and right ventricular walls and interventricular septum, described as mitral, septal, and tricuspid annular plane systolic excursion (MAPSE, SAPSE, and TAPSE, respectively), was assessed using color tissue Doppler imaging with automated analysis software. A Mann-Whitney U test was used to compare the z scores to the normal mean before and after IUT. RESULTS Twenty-seven fetuses were included. The mean z score for pre-IUT MAPSE was significantly increased compared with the reference ranges, +0.46 (95% confidence interval [CI] +0.17 to +0.75; p = 0.039), while the mean z scores for post-IUT SAPSE and TAPSE were significantly decreased, -0.65 (95% CI -1.11 to -0.19; p < 0.001) and -0.60 (95% CI -1.04 to -0.17; p = 0.003), respectively. The difference in atrioventricular plane displacement z scores before and after IUT was statistically significant in all three locations. The median difference between the pre-IUT and post-IUT z scores was -0.66 (95% CI -1.03 to -0.33, p < 0.001) for MAPSE, -1.05 (95% CI -1.43 to -0.61, p < 0.001) for SAPSE, and -0.60 (95% CI -1.19 to -0.01, p = 0.046) for TAPSE. CONCLUSIONS This study suggests that atrioventricular plane displacement, when determined using automated analysis software, may represent a quantitative parameter, describing fetal myocardial function and adaptation before and after IUT.
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Affiliation(s)
- Aikaterini Zamprakou
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Ingrid Söderhult
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
| | - Kjerstin Ferm‐Widlund
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
| | - Gunilla Ajne
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
| | - Jonas Johnson
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - Lotta Herling
- Center for Fetal Medicine, Pregnancy Care and DeliveryKarolinska University HospitalStockholmSweden
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
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de Jesus Cruz J, Bernardeco J, Rijo C, Cohen A, Serrano F. Hepatic arterial buffer response: activation in donor fetuses and the effect of laser ablation of intertwin anastomosis. J Perinat Med 2024; 52:71-75. [PMID: 37850825 DOI: 10.1515/jpm-2023-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Hepatic arterial buffer response (HABR) is an important defence mechanism for maintaining liver blood flow. It is suspected that HABR is active in monochorionic diamniotic twins (MCDA) with twin-to-twin transfusion syndrome (TTTS) where donor compensates a setting of volume depletion and the recipient an overload. The present study investigates whether in TTTS, HABR is active in donor and/or recipient individually and try to determine if the activation of HABR is a direct response to TTTS. METHODS Hepatic artery (HA) peak systolic velocity (PSV) was measured in normal MCDA fetuses and TTTS. Correlation with relevant fetal Dopplers and characteristics were determined. Z-scores for HA-PSV (HAV-Z) were calculated and its association with TTTS in donors and recipients were determined as well as changes in HAV-Z after laser treatment. RESULTS In this study 118 MCDA were included, 61.9 % normal and 38.1 % TTTS. Of the TTTS 22 required laser treatment. A total of 382 scans were performed in normal group and 155 in TTTS. Our data demonstrates that in donors HAV-Z was 2.4 Z-scores higher compared to normal fetuses (β=2.429 95 % CI 1.887, 2.971; p<0.001) and after laser treatment HAV-Z reduced (β=-1.829 95 % CI -2.593, -1.064; p<0.001). There was no significant difference between recipients and normal (β=-0.092 95 % CI -0.633, 0.449; p=0.738). CONCLUSIONS HABR is active in TTTS, promoting an increased hepatic blood flow in donors. The activation is direct response to TTTS as shown by the reduction in HAV-Z after laser. This finding provides important insights into the pathophysiology of TTTS.
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Affiliation(s)
- Jader de Jesus Cruz
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Joana Bernardeco
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Claudia Rijo
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Alvaro Cohen
- Department of Fetal Medicine, Central Lisbon University Hospitals, Lisbon, Portugal
| | - Fatima Serrano
- Department of Obstetrics, Central Lisbon University Hospitals, Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
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Cantinotti M, Marchese P, Franchi E, Santoro G, Assanta N, Giordano R. Four-Dimensional Flow Echocardiography: Blood Speckle Tracking in Congenital Heart Disease: How to Apply, How to Interpret, What Is Feasible, and What Is Missing Still. Healthcare (Basel) 2024; 12:263. [PMID: 38275542 PMCID: PMC10815034 DOI: 10.3390/healthcare12020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Blood speckle tracking echocardiography (BSTE) is a new, promising 4D flow ultrafast non-focal plane imaging technique. The aim of the present investigation is to provide a review and update on potentialities and application of BSTE in children with congenital heart disease (CHD) and acquired heart disease. A literature search was performed within the National Library of Medicine using the keywords "echocardiography", "BST", and "children". The search was refined by adding the keywords "ultrafast imaging", "CHD", and "4D flow". Fifteen studies were finally included. Our analysis outlined how BSTE is highly feasible, fast, and easy for visualization of normal/abnormal flow patterns in healthy children and in those with CHD. BSTE allows for visualization and basic 2D measures of normal/abnormal vortices forming the ventricles and in the main vessel. Left ventricular vortex characteristics and aortic flow patterns have been described both in healthy children and in those with CHD. Complex analysis (e.g., energy loss, vorticity, and vector complexity) are also highly feasible with BSTE, but software is currently available only for research. Furthermore, current technology allows for BSTE only in neonates and low-weight children (e.g., <40 kg). In summary, the feasibility and potentialities of BSTE as a complementary diagnostic tool in children have been proved; however, its systemic use is hampered by the lack of (i) accessible tools for complex quantification and for acquisition at all ages/weight, (ii) data on the diagnostic/prognostic significance of BSTE, and (iii) consensus/recommendation papers indicating when and how BSTE should be employed.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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12
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Ishigami S, Ye XT, Buratto E, Ivanov Y, Chowdhuri KR, Fulkoski N, Robertson T, Davies B, Brizard CP, Konstantinov IE. Long-term outcomes of tetralogy of Fallot repair: A 30-year experience with 960 patients. J Thorac Cardiovasc Surg 2024; 167:289-302.e11. [PMID: 37169063 DOI: 10.1016/j.jtcvs.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE This study evaluates the long-term results of tetralogy of Fallot repair and assesses the risk factors for adverse outcomes. METHODS This retrospective study included 960 patients who underwent transatrial transpulmonary tetralogy of Fallot repair between 1990 and 2020. RESULTS A transannular patch was placed in 722 patients, and pulmonary valve preservation was achieved in 233 patients. The median age at tetralogy of Fallot repair was 9.4 (interquartile range, 6.2-14.2) months. The median follow-up duration was 10.6 (interquartile range, 5.4-16.3) years. There were 8 early deaths (0.8%) and 20 late deaths (2.1%). Genetic syndrome and pulmonary valve annulus Z score less than -3 were risk factors for mortality. The survival was 97.7% (95% confidence interval, 96.4-98.5) and 94.5% (95% confidence interval, 90.9-96.7) at 10 and 30 years, respectively. Freedom from any reoperation was 86.4% (95% confidence interval, 83.6-88.7) and 65.4% (95% confidence interval, 59.8-70.4) at 10 and 20 years, respectively. Postoperative right ventricular outflow tract peak gradient of 25 mm Hg or greater correlated with reoperation. Propensity score-matched analysis demonstrated that freedom from pulmonary valve replacement at 15 years was higher in the pulmonary valve preservation group compared with the transannular patch group (98.2% vs 78.4%, P = .004). Freedom from reoperation for right ventricular outflow tract obstruction at 15 years was lower in the pulmonary valve preservation group compared with the transannular patch group (P = .006). CONCLUSIONS The long-term outcomes of tetralogy of Fallot repair are excellent. A postoperative right ventricular outflow tract peak gradient less than 25 mm Hg appears to be optimal to prevent reoperation. If the pulmonary valve size is suitable, pulmonary valve preservation reduces the risk of pulmonary valve replacement, yet increases the reoperation rate for right ventricular outflow tract obstruction.
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Affiliation(s)
- Shuta Ishigami
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Xin Tao Ye
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kuntal Roy Chowdhuri
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nick Fulkoski
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Ben Davies
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; The Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; The Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; The Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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13
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Stanciu (Neculau) C, Geamănu A, Purcărea RM, Sterian AG. The Relationship Between Anthropometric Z-Score Measurements and Ocular Structures in Turkish Children. Rom J Ophthalmol 2023; 67:374-380. [PMID: 38239419 PMCID: PMC10793364 DOI: 10.22336/rjo.2023.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Objective (Aim): This study explores the contact between anthropometric Z-score values and ocular parameters in children. Recent studies investigated the relationship, and contact between anthropometric measurements and ocular parameters in children, and height, weight, body mass index, and percentile curves are mostly used as anthropometric data. However, today, different scoring systems such as "Z-score" classify anthropometric values. Methods: Height and body mass index Z-scores were calculated for 725 children. Biometric and refractive measurements of all children were noted. For different reference values, those with a Z-score below the negative value of the reference were defined as a low Z-score, those between the negative and positive value of the reference were defined as a normal Z-score, those with a Z-score greater than the positive value of the reference were defined as a high Z-score. The mean ocular measurement results in the low, normal, and high Z-score groups were compared, and they were pointed to reach the reference value in both negative and positive sides which created the foremost critical contrast between the groups. Results: For a value of "-1" and "+1.5" in the height Z-score, from low to normal and from there to high Z-score group, axial length, and average corneal radius increased, and average corneal power decreased significantly. Anterior chamber depth increased from normal to high Z-score group, but no critical distinction was made between low and normal Z-score groups. Moreover, no critical distinction was observed in spherical equivalent refraction, central corneal thickness for height, and all values of body mass index. Conclusion: Considering a Z-score value of "-1" and "+1.5" as a reference value in children and anticipating the changes that may happen in the ocular structures of children at both ends of the Z-score, it may be useful to understand the effect of body development on ocular development more. Abbreviations: AL = Axial Length, ACD = Anterior Chamber Depth, BMI = Body Mass Index, NCHS = The United States National Center for Health Statistics, WHO = World Health Organization, NFHS 2 = National Family Health Survey 2, SER = Spherical Equivalent Refraction, CR = Average Corneal Radius, CP = Average Corneal Power, CCT = Central Corneal Thickness, HFAsZ = Height for Age Z-Score, BMIsZ = BMI for Age Z-Score, L = Low Z-score, N = Normal Z-score, H = High Z-score.
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Affiliation(s)
- Cristina Stanciu (Neculau)
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Aida Geamănu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alin Gabriel Sterian
- Department of Pediatric Surgery and Orthopedics, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; “Grigore Alexandrescu” Emergency Hospital for Children, Bucharest, Romania
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14
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Bulut E, Sakallioğlu AK, Dayi Ö, Alacamli G. "Partial Open Sky Method" - A novel technique to avoid the open sky condition during Triple procedure or Penetrating keratoplasty. Rom J Ophthalmol 2023; 67:381-388. [PMID: 38239416 PMCID: PMC10793373 DOI: 10.22336/rjo.2023.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/22/2024] Open
Abstract
Penetrating keratoplasty is referred to as an "open-sky" procedure because the intraocular contents are entirely exposed to atmospheric pressure after the diseased cornea has been trephined off and before the donor button is sutured. Suprachoroidal hemorrhage (SCH) is a major vision-threatening complication, associated with this open-sky procedure. While numerous factors may predispose an eye to SCH, like hypertension, myopia, trauma, glaucoma, etc., it is better to be prepared for the worst eventuality. We described a novel technical modification, denoted as the "partial open sky technique", that we used during the surgical steps of trephining and excision of host corneal tissue in seven cases of triple procedure and penetrating keratoplasty in our center over two months. We propose that the technique would be additionally helpful in managing the inadvertent suprachoroidal hemorrhage associated with keratoplasty over the available existing methods. Abbreviations: SCH = Suprachoroidal hemorrhage, ICCE = Intracapsular cataract surgery, ECCE = Extracapsular cataract surgery, WTW = White to White.
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Affiliation(s)
- Erkan Bulut
- Department of Opticianry, Gelişim University, Vocational School of Health Services, Istanbul, Turkey
| | | | - Özlem Dayi
- Department of Ophthalmology, Beylikdüzü Public Hospital, Istanbul, Turkey
| | - Goksu Alacamli
- Department of Ophthalmology, Trakya University, School of Medicine, Edirne, Turkey
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15
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 300] [Impact Index Per Article: 300.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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16
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Pinto S, Caribé P, Sebastião Matushita C, Bromfman Pianta D, Narciso L, da Silva AMM. Aiming for [ 18F]FDG-PET acquisition time reduction in clinical practice for neurological patients. Phys Med 2023; 112:102604. [PMID: 37429182 DOI: 10.1016/j.ejmp.2023.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/02/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Positron emission tomography (PET) imaging with [18F]FDG provides valuable information regarding the underlying pathological processes in neurodegenerative disorders. PET imaging for these populations should be as short as possible to limit head movements and improve comfort. This study aimed to validate an optimized [18F]FDG-PET image reconstruction protocol aiming to reduce acquisition time while maintaining adequate quantification accuracy and image quality. METHODS A time-reduced reconstruction protocol (5 min) was evaluated in [18F]FDG-PET retrospective data from healthy individuals and Alzheimer's disease (AD) patients. Standard (8 min) and time-reduced protocols were compared by means of image quality and quantification accuracy metrics, as well as standardized uptake value ratio (SUVR) and Z-scores (pons was used as reference). Images were randomly and blindly presented to experienced physicians and scored in terms of image quality. RESULTS No differences between protocols were identified during the visual assessment. Small differences (p < 0.01) in the pons SUVR were observed between the standard and time-reduced protocols for healthy individuals (-0.002 ± 0.011) and AD patients (-0.007 ± 0.013). Likewise, incorporating the PSF correction in the reconstruction algorithm resulted in small differences (p < 0.01) in SUVR between protocols (healthy individuals: -0.003 ± 0.011; AD patients: -0.007 ± 0.014). CONCLUSION Quality metrics were similar between time-reduced and standard protocols. In the visual assessment of the images, the physicians did not consider the use of PSF adequate, as it degraded the quality image. Shortening the acquisition time is possible by optimizing the image reconstruction parameters while maintaining adequate quantification accuracy and image quality.
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Affiliation(s)
- Samara Pinto
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil.
| | - Paulo Caribé
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil; Medical Imaging and Signal Processing (MEDISIP), Ghent University, Ghent, Belgium
| | | | | | - Lucas Narciso
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil; Lawson Health Research Institute, London, Ontario, Canada
| | - Ana Maria Marques da Silva
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil; School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
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17
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Dani C, Luzzati M, Corsini I, Poggi C, Vangi V, Coviello C, Pratesi S. Cardiac Hypertrophy Associated with Insulin Therapy in Extremely Preterm Infants. Paediatr Drugs 2023:10.1007/s40272-023-00571-0. [PMID: 37204612 DOI: 10.1007/s40272-023-00571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND In the neonatal period, cardiac hypertrophy (CH) has been commonly associated with hyperinsulinemic pathologies, and the first case of CH in an extremely preterm infant treated with insulin infusion has recently been reported. To confirm this association, we report a case series of patients who developed CH after insulin therapy. METHODS Infants with gestational age < 30 weeks and birth weight < 1500 g, born from November 2017 to June 2022, were studied if they developed hyperglycemia requiring treatment with insulin and had echocardiographic diagnosis of CH. RESULTS We studied 10 extremely preterm infants (24.3 ± 1.4 weeks) who developed CH at a mean age of 124 ± 37 h of life, 98 ± 24 h after the initiation of insulin therapy. All surviving patients had resolution of CH at discharge, while three of four (75%) of the deceased patients had persistent CH. CONCLUSIONS Our case series supports the association between the development of CH and insulin therapy in extremely preterm infants and suggests further caution and the need for echocardiographic monitoring when treating these fragile patients with insulin.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Michele Luzzati
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Chiara Poggi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Venturella Vangi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Caterina Coviello
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50141, Florence, Italy
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Pridham K, Nemykina Y, Connor A, Melby J, Brown R. Caregiving and Support Issues Identified by Parents of an Infant With Congenital Heart Disease for Interactive Problem-Solving. Res Theory Nurs Pract 2023; 37:RTNP-2022-0062.R1. [PMID: 37130796 PMCID: PMC10620106 DOI: 10.1891/rtnp-2022-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background and Purpose: Parents of an infant with complex congenital heart disease report caregiving challenges in the infant's first half year. We studied the issues parent dyads (mothers and fathers) were dealing with and their effect on their coparenting competencies in interactive problem-solving. Methods: The issues 31 parent dyads identified for interactive problem-solving at either or both infants aged 2 and 6 months were typed as caregiving or relational/support. The parent dyad's interactive competencies were assessed from video recording for two types of tasks (i.e., caregiving and the parent dyad's relationship as caregivers). Constructs of Iowa Family Interaction Rating Scales were applied to assess the competencies of mothers, fathers, and the parent dyad for a group that received guided participation (n = 17) and a group that received usual care (n = 8). Results: Pie charts showed feeding, most frequently identified for interactive problem-solving at 2 months, was surpassed at 6 months by growth and development. The time parents spent together was the most mentioned relationship issue at 2 and 6 months. Forest plots showed caregiving issues were associated with at least medium effect sizes for dyadic problem-solving for both parents at 2 and 6 months and for problem-solving for fathers at 2 and 6 months. Relational/support issues were associated with higher hostility and communication hindering than caregiving issues. Implications for Practice: Intervention to aid parents in interactive problem-solving for both caregiving and relationship/support issues merits development and testing.
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Affiliation(s)
- Karen Pridham
- School of Nursing, University of Wisconsin-Madison, Madison WI, USA
| | - Yuliya Nemykina
- School of Nursing, University of Wisconsin-Madison, Madison WI, USA
| | | | - Janet Melby
- Department of Human Development and Family Studies, Iowa State University, Ames IA, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison WI, USA
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19
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Pruter WW, Klassen SA, Dominelli PB, Wiggins CC, Senefeld JW, Roy TK, Joyner MJ, Baker SE. Attenuated cardiac autonomic function in humans with high-affinity hemoglobin and compensatory polycythemia. Am J Physiol Regul Integr Comp Physiol 2023; 324:R625-R634. [PMID: 36878486 PMCID: PMC10085552 DOI: 10.1152/ajpregu.00113.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
During hypoxic exposure, humans with high-affinity hemoglobin (and compensatory polycythemia) have blunted increases in heart rate compared with healthy humans with typical oxyhemoglobin dissociation curves. This response may be associated with altered autonomic control of heart rate. Our hypothesis-generating study aimed to investigate cardiac baroreflex sensitivity and heart rate variability among nine humans with high-affinity hemoglobin [6 females, O2 partial pressure at 50% [Formula: see text] (P50) = 16 ± 1 mmHg] compared with 12 humans with typical affinity hemoglobin (6 F, P50 = 26 ± 1 mmHg). Participants breathed normal room air for a 10-min baseline, followed by 20 min of isocapnic hypoxic exposure, designed to lower the arterial partial pressure O2 ([Formula: see text]) to ∼50 mmHg. Beat-by-beat heart rate and arterial blood pressure were recorded. Data were averaged in 5-min periods throughout the hypoxia exposure, beginning with the last 5 min of baseline in normoxia. Spontaneous cardiac baroreflex sensitivity and heart rate variability were determined using the sequence method and the time and frequency domain analyses, respectively. Cardiac baroreflex sensitivity was lower in humans with high-affinity hemoglobin than controls at baseline and during isocapnic hypoxic exposure (normoxia: 7 ± 4 vs. 16 ± 10 ms/mmHg, hypoxia minutes 15-20: 4 ± 3 vs. 14 ± 11 ms/mmHg; group effect: P = 0.02, high-affinity hemoglobin vs. control, respectively). Heart rate variability calculated in both the time (standard deviation of the N-N interval) and frequency (low frequency) domains was lower in humans with high-affinity hemoglobin than in controls (all P < 0.05). Our data suggest that humans with high-affinity hemoglobin may have attenuated cardiac autonomic function.
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Affiliation(s)
- Wyatt W Pruter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Stephen A Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Tuhin K Roy
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Bendas ER, Rezk MR, Badr KA. Does the Ethnic Difference Affect the Pharmacokinetics of Favipiravir? A Pharmacokinetic Study in Healthy Egyptian Volunteers and Development of Level C In-vitro In-vivo Correlation. Drug Res (Stuttg) 2023. [PMID: 37094796 DOI: 10.1055/a-2061-7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Favipiravir is an antiviral drug used to treat influenza and is also being investigated for the treatment of SARS-CoV-2. Its pharmacokinetic profile varies depending on ethnic group. The present research examines the pharmacokinetic features of favipiravir in healthy male Egyptian volunteers. Another goal of this research is to determine the optimum dissolution testing conditions for immediate release tablets. In vitro dissolution testing was investigated for favipiravir tablets in three different pH media. The pharmacokinetic features of favipiravir were examined in 27 healthy male Egyptian volunteers. The parameter "AUC0-t" vs. percent dissolved was used to develop level C in vitro in vivo correlation (IVIVC) to set the optimum dissolution medium to achieve accurate dissolution profile for favipiravir (IR) tablets. The in vitro release results revealed significant difference among the three different dissolution media. The Pk parameters of twenty-seven human subjects showed mean value of Cpmax of 5966.45 ng/mL at median tmax of 0.75 h with AUC0-∞ equals 13325.54 ng.h/mL, showing half-life of 1.25 h. Level C IVIVC was developed successfully. It was concluded that Egyptian volunteers had comparable Pk values to American and Caucasian volunteers, however they were considerably different from Japanese subjects. AUC0-t vs. % dissolved was used to develop level C IVIVC to set the optimum dissolution medium. Phosphate buffer medium (pH 6.8) was found to be the optimum dissolution medium for in vitro dissolution testing for Favipiravir IR tablets.
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Affiliation(s)
- Ehab R Bendas
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Mamdouh R Rezk
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Kamal A Badr
- Pharmaceutics Department, Faculty of Pharmacy, Deraya University, New Minya, Egypt
- Advanced Research Center, Nasr City, Cairo, Egypt
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Rajbhoj AA, Matthews H, Doucet K, Claes P, Begnoni G, Willems G, de Llano-Pérula MC. Influence of age and diet consistency on the oral muscle pressure of orthodontically treated and untreated subjects with normal occlusion and comparison of their 3D facial shape. Clin Oral Investig 2023:10.1007/s00784-023-04977-5. [PMID: 36976359 DOI: 10.1007/s00784-023-04977-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES (1) To investigate the effect of age and diet consistency on maximum lips, tongue and cheek pressure of orthodontically treated and untreated subjects with normal, Class I dental occlusion, (2) to find out whether there is a muscle imbalance between anterior tongue and lip pressure in the same subjects at different ages and (3) to compare the 3D facial shape of treated and untreated individuals. MATERIAL AND METHODS Subjects with normal occlusion were prospectively grouped into orthodontically treated/untreated and in children/adolescents/adults. Iowa Oral Performance Instrument was used to record the maximum muscle pressure. Two-way ANOVA and Tukey post hoc test analysed age-specific differences in muscle pressure. Two-way ANCOVA analysed the effect of diet consistency on muscle pressure. Lips and tongue imbalance was analysed using z-scores and 3D faces using a generalized Procrustes analysis. RESULTS One hundred thirty-five orthodontically untreated and 114 treated participants were included. Muscle pressure was found to increase with age in both groups, except for the tongue in treated subjects. No differences in the balance between lips and tongue muscle pressure were found, but a higher cheek pressure in untreated adults (p<0.05) was observed. 3D facial shapes showed subtle differences. Untreated subjects with soft diet consistency showed lower lip pressure (p<0.05). CONCLUSION Oral muscle pressure of orthodontically treated patients without relapse does not differ from that of untreated patients with Class-I occlusion. CLINICAL RELEVANCE This study provides normative lip, tongue and cheek muscle pressure in subjects with normal occlusion, which can be used for diagnosis, treatment planning and stability.
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Affiliation(s)
- Amit Arvind Rajbhoj
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
| | - Harold Matthews
- Medical Imaging Research Center, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Kaat Doucet
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Peter Claes
- Medical Imaging Research Center, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Giacomo Begnoni
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - María Cadenas de Llano-Pérula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
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Jungwirth A, Zöttl M, Bonfils D, Josi D, Frommen JG, Taborsky M. Philopatry yields higher fitness than dispersal in a cooperative breeder with sex-specific life history trajectories. SCIENCE ADVANCES 2023; 9:eadd2146. [PMID: 36867697 PMCID: PMC9984175 DOI: 10.1126/sciadv.add2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Social evolution is tightly linked to dispersal decisions, but the ecological and social factors selecting for philopatry or dispersal often remain obscure. Elucidating selection mechanisms underlying alternative life histories requires measurement of fitness effects in the wild. We report on a long-term field study of 496 individually marked cooperatively breeding fish, showing that philopatry is beneficial as it increases breeding tenure and lifetime reproductive success in both sexes. Dispersers predominantly join established groups and end up in smaller groups when they ascend to dominance. Life history trajectories are sex specific, with males growing faster, dying earlier, and dispersing more, whereas females more likely inherit a breeding position. Increased male dispersal does not seem to reflect an adaptive preference but rather sex-specific differences in intrasexual competition. Cooperative groups may thus be maintained because of inherent benefits of philopatry, of which females seem to get the greater share in social cichlids.
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Affiliation(s)
- Arne Jungwirth
- Division of Behavioural Ecology, Institute of Ecology and Evolution, University of Bern, Wohlenstrasse 50a, CH-3032 Hinterkappelen, Switzerland
- Konrad Lorenz Institute of Ethology, University of Veterinary Medicine Vienna, Savoyenstraße 1a, A-1160 Vienna, Austria
| | - Markus Zöttl
- Division of Behavioural Ecology, Institute of Ecology and Evolution, University of Bern, Wohlenstrasse 50a, CH-3032 Hinterkappelen, Switzerland
- Ecology and Evolution in Microbial Model Systems, EEMiS, Department of Biology and Environmental Science, Linnaeus University, SE-391 82 Kalmar, Sweden
| | - Danielle Bonfils
- Division of Behavioural Ecology, Institute of Ecology and Evolution, University of Bern, Wohlenstrasse 50a, CH-3032 Hinterkappelen, Switzerland
| | - Dario Josi
- Division of Behavioural Ecology, Institute of Ecology and Evolution, University of Bern, Wohlenstrasse 50a, CH-3032 Hinterkappelen, Switzerland
- Eawag Swiss Federal Institute of Aquatic Science and Technology, CH-6047 Kastanienbaum, Switzerland
| | - Joachim G. Frommen
- Division of Behavioural Ecology, Institute of Ecology and Evolution, University of Bern, Wohlenstrasse 50a, CH-3032 Hinterkappelen, Switzerland
- Ecology and Environment Research Centre, Department of Natural Sciences, Manchester Metropolitan University, Chester Street, M1 5GD Manchester, United Kingdom
| | - Michael Taborsky
- Division of Behavioural Ecology, Institute of Ecology and Evolution, University of Bern, Wohlenstrasse 50a, CH-3032 Hinterkappelen, Switzerland
- Max Planck Institute of Animal Behavior, D-78467 Konstanz, Germany
- Institute for Advanced Study (Wissenschaftskolleg) Berlin, D-14193 Berlin, Germany
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23
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Yang Y, Wang L, Yang Y, Wu X, Xu L, Bi C. Z-score regression model for coronary artery diameter in healthy Chinese Han children. Acta Radiol 2023; 64:798-805. [PMID: 35306860 DOI: 10.1177/02841851221085685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery distension and aneurysm are complications of Kawasaki disease in children. PURPOSE To develop a Z-score regression model for coronary artery diameter in children that could be used as reference. MATERIAL AND METHODS This retrospective analysis included children with normal heart structure between March 2013 and April 2017. Body surface area (BSA) was calculated. The diameters of the right coronary, left main coronary, left anterior descending, and circumflex arteries were measured by echocardiography. Pearson correlation analysis was used to establish linear, exponential, logarithmic, power, and square root regression models. RESULTS The analysis included 509 children (280 boys) aged 1 day to 15.2 years. Coronary artery diameters were significantly correlated with age, height, body mass, BSA, and BSA (r = 0.663-0.826; P < 0.05), with a stronger correlation for BSA than BSA (P < 0.05). The adjusted determination coefficients (Ra2) were higher for the exponential and square root models than for the other models (P < 0.05). The random error term variance was constant for the exponential model (P > 0.05), and processing with the weighted least-square methods eliminated heteroscedasticity in the other models. The Z-scores were normally distributed for the exponential and square root models (P > 0.05). CONCLUSION Overall, the square root model was the optimal equation for the calculation of coronary artery Z-score in Chinese Han children. This model could be used to facilitate the diagnosis of coronary artery distension in children with suspected Kawasaki disease.
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Affiliation(s)
- Yanzhang Yang
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Li Wang
- Department of Pediatrics, Shijiazhuang Fifth Hospital, Shijiazhuang, Hebei, PR China
| | - Yanfang Yang
- Department of Medical Imaging, Gaocheng Integrated Traditional Chinese and Western Medicine Hospital, Shijiazhuang, Hebei, PR China
| | - Xiaojing Wu
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Lijin Xu
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Changbo Bi
- Department of Pediatrics, 117872Hebei General Hospital, Shijiazhuang, Hebei, PR China
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24
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Zhao DT, Yan HP, Liao HY, Liu YM, Han Y, Zhang HP, Zhang WM, Huang CY, Liu XH, Lou JL, Zhao Y. Using two-step cluster analysis to classify inpatients with primary biliary cholangitis based on autoantibodies: A real-world retrospective study of 537 patients in China. Front Immunol 2023; 13:1098076. [PMID: 36685575 PMCID: PMC9845730 DOI: 10.3389/fimmu.2022.1098076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
Background A variety of autoantibodies have been detected in primary biliary cholangitis (PBC), while the presence of autoantibody clusters and their clinical significance have not been fully understood. We aimed at defining autoantibody clusters and to better understand the clinical features and prognosis of PBC patients based on autoantibody clusters under real-world conditions. Methods We retrospectively analyzed 788 inpatients with PBC evaluated between October 2008 and July 2019, and included 537 patients. Nineteen autoantibodies which were measured routinely were investigated for cluster analysis. Two-step clustering, Kaplan-Meier survival, and Cox regression analyses were used. Results Five clusters were defined. A cluster of antinuclear antibodies (ANA) and anti-gp210 positive patients were identified with a high rate of cirrhosis at baseline and low survival rate; a cluster of ANA, anti-centromere antibodies (ACA) and/or anti-CENP-B female dominant patients with older disease onset, low level of platelet count at baseline, high rate of hepatic decompensation, and low survival rate was also characterized; and another cluster of anti-mitochondrial antibodies (AMA) and/or AMA-M2, anti-Ro52 and a high rate of anti-gp210 positive patients were identified with a high proportion of male patients and low survival rate. A subgroup of patients with anti-SSA and/or anti-SSB coexists with SjS was also identified; patients with only AMA and/or AMA-M2-positive with a benign clinical outcome and relatively high complication of non-alcoholic fatty liver disease (NAFLD) were also identified. Only anti-gp210 was considered as a significant predictor for poor outcomes especially in patients with cirrhosis. Conclusion Clustering methods allow the identification of distinct autoantibody profiles of PBC that form clinical subsets and can be useful for personalized approaches to diagnosis, clinical management, and the prediction of clinical outcomes. Anti-gp210 was the strongest predictive factor for poor outcomes especially in PBC patients with cirrhosis under real-world conditions.
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Affiliation(s)
- Dan-Tong Zhao
- Clinical Laboratory Center and Clinical Research Center for Autoimmune Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing, China,*Correspondence: Dan-Tong Zhao, ; ; Yan Zhao,
| | - Hui-Ping Yan
- Clinical Laboratory Center and Clinical Research Center for Autoimmune Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing, China,Second Department of Liver Disease Center, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Hui-Yu Liao
- Second Department of Liver Disease Center, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Yan-Min Liu
- Second Department of Liver Disease Center, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Ying Han
- Second Department of Liver Disease Center, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Hai-Ping Zhang
- Clinical Laboratory Center and Clinical Research Center for Autoimmune Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Wei-Ming Zhang
- Department of Clinical Laboratory Diagnosis, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Chun-Yang Huang
- Second Department of Liver Disease Center, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Xiu-Hong Liu
- Clinical Laboratory Center and Clinical Research Center for Autoimmune Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Jin-Li Lou
- Clinical Laboratory Center and Clinical Research Center for Autoimmune Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Yan Zhao
- Clinical Laboratory Center and Clinical Research Center for Autoimmune Liver Disease, Beijing You’An Hospital, Capital Medical University, Beijing, China,Clinical Laboratory Center, Beijing Chest Hospital, Capital Medical University, Beijing, China,*Correspondence: Dan-Tong Zhao, ; ; Yan Zhao,
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Genetic Profile of Left Ventricular Noncompaction Cardiomyopathy in Children-A Single Reference Center Experience. Genes (Basel) 2022; 13:genes13081334. [PMID: 35893073 PMCID: PMC9332142 DOI: 10.3390/genes13081334] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/14/2022] [Accepted: 07/24/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Left ventricular noncompaction cardiomyopathy (LVNC) is a rare cardiac disorder characterised by the presence of a two-layer myocardium with prominent ventricular trabeculation, intertrabecular deep depressions and an increased risk of heart failure, atrial and ventricular arrhythmias and systemic thromboembolic events in affected patients. The heterogeneous molecular aetiology solved in 10%–50% of patients more frequently involves sarcomeric, cytoskeletal or ion channel protein dysfunction—mainly related to causative MYH7, TTN or MYBPC3 variants. The aim of the study was to determine the molecular spectrum of isolated LVNC in a group of children examined in a single paediatric reference centre. Methods: Thirty-one paediatric patients prospectively diagnosed with LVNC by echocardiography and cardiovascular magnetic resonance examination were recruited into the study group. The molecular analysis included next-generation sequencing (gene panel or whole exome) and classic Sanger sequencing. All selected variants with high priority were co-segregated in the available parents. Results: We identified 16 distinct variants in 11 genes in 16 patients (52%), including 10 novel alterations. The most frequent defects in our cohort were found in the genes HCN4 (n = 4), MYH7 (n = 2) and PRDM16 (n = 2). Other likely disease-causing variants were detected in ACTC1, ACTN2, HCCS, LAMA4, MYH6, RBM20, TAFFAZIN and TTN. Patients with established molecular defects more often presented with arrhythmia, thromboembolic events and death, whereas the predominant symptoms in patients with no identified molecular defects were heart failure and the presence of late gadolinium enhancement. Conclusion: This study expands the genetic and clinical spectrum of childhood LVNC. Although the molecular aetiology of LVNC varies widely, the comprehensive testing of a wide panel of cardiomyopathy-related genes helped to identify underlying molecular defects in more than half of the children in the study group. The molecular spectrum in our cohort correlated with the occurrence of arrhythmia, death and a family history of cardiomyopathy. We confirmed that genetic testing is an integral part of the work-up and management LVNC in children.
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New England Congenital Cardiology Association Bicuspid Aortopathy Registry (NECCA BAR): A regional preventive cardiovascular care collaboration. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Clinical Presentation of Left Ventricular Noncompaction Cardiomyopathy and Bradycardia in Three Families Carrying HCN4 Pathogenic Variants. Genes (Basel) 2022; 13:genes13030477. [PMID: 35328031 PMCID: PMC8949387 DOI: 10.3390/genes13030477] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Left ventricular noncompaction (LVNC) is a genetically and phenotypically heterogeneous cardiomyopathy in which myocardium consists of two, distinct compacted and noncompacted layers, and prominent ventricular trabeculations and deep intertrabecular recesses are present. LVNC is associated with an increased risk of heart failure, atrial and ventricular arrhythmias and thromboembolic events. Familial forms of primary sinus bradycardia have been attributed to alterations in HCN4. There are very few reports about the association between HCN4 and LVNC. The aim of our study was to characterize the clinical phenotype of families with LVNC and sinus bradycardia caused by pathogenic variants of the HCN4 gene. Methods: From March 2008 to July 2021, we enrolled six patients from four families with diagnosed isolated LVNC based on the clinical presentation, family history and echocardiographic and cardiovascular magnetic resonance (CMR) evidence of LVNC. Next generation sequencing (NGS) analysis was undertaken for the evaluation of the molecular basis of the disease in each family. Results: A total of six children (median age 11 years) were recruited and followed prospectively for the median of 12 years. All six patients were diagnosed with LVNC by echocardiography, and five participants additionally by CMR. The presence of late gadolinium enhancement (LGE) was found in three children. Sinus bradycardia and dilation of the ascending aorta occurred in five studied patients. In four patients from three families, the molecular studies demonstrated the presence of rare heterozygous HCN4 variants. Conclusion: (1) The HCN4 molecular variants influence the presence of a complex LVNC phenotype, sinus bradycardia and dilation of the ascending aorta. (2) The HCN4 alteration may be associated with the early presentation of clinical symptoms and the severe course of the disease. (3) It is particularly important to assess myocardial fibrosis not only within the ventricles, but also in the atria in patients with LVNC and sinus bradycardia.
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Imaging Features of Pediatric Left Ventricular Noncompaction Cardiomyopathy in Echocardiography and Cardiovascular Magnetic Resonance. J Cardiovasc Dev Dis 2022; 9:jcdd9030077. [PMID: 35323625 PMCID: PMC8956040 DOI: 10.3390/jcdd9030077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Left ventricular noncompaction (LVNC) is a distinct cardiomyopathy characterized by the presence of a two-layer myocardium with prominent trabeculation and deep intertrabecular recesses. The diagnosis of LVNC can be challenging because the diagnostic criteria are not uniform. The aim of our study was to evaluate echocardiographic and CMR findings in a group of children with isolated LVNC. Methods: From February 2008 to July 2021, pediatric patients under 18 years of age at the time of diagnosis with echocardiographic evidence of isolated LVNC were prospectively enrolled. The patients underwent echocardiography and contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement to assess myocardial noncompaction, ventricular size, and function. Results: A total of 34 patients, with a median age of 11.9 years, were recruited. The patients were followed prospectively for a median of 5.1 years. Of the 31 patients who met Jenni’s criteria in echocardiography, CMR was performed on 27 (79%). Further comprehensive analysis was performed in the group of 25 patients who met the echocardiographic and CMR criteria for LVNC. In echocardiography, the median NC/C ratio in systole was 2.60 and in diastole 3.40. In 25 out of 27 children (93%), LVNC was confirmed by CMR, according to Petersen’s criteria, with a median NC/C ratio of 3.27. Conclusions: (1) Echocardiography precisely identifies patients with LVNC. (2) Echocardiography is a good method for monitoring LV systolic function, but CMR is indicated for the precise assessment of LV remodeling and RV size and function, as well as for the detection of myocardial fibrosis.
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Salvatori G, Brindisi G, Colantonio M, Zicari AM. Cardiac hypertrophy and insulin therapy in a pre-term newborn: is there a relationship? Ital J Pediatr 2022; 48:24. [PMID: 35135591 PMCID: PMC8822805 DOI: 10.1186/s13052-022-01216-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) in newborns is a rare condition with heterogeneous etiologies. While the relationship between hyperinsulinism and cardiac hypertrophy (CH) is known, hyperinsulinism has not been reported as cause of HCM. Case presentation We report the case of cardiac hypertrophy (CH) in an Extremely Low Birth Weight (ELBW) infant; this patient underwent insulin therapy after the onset of persistent hyperglycemia due to parenteral nutrition (PN), supporting the hypothesis of a role of iatrogenic hyperinsulinemia in the development of HCM. Conclusions The present case underlines the importance of a close cardiological follow-up in infants undergoing insulin infusion for an alteration in the glucose metabolism.
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Affiliation(s)
- Guglielmo Salvatori
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Giulia Brindisi
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, Italy. .,Department of Maternal Infantile and Urological Sciences, Division of Pediatric Allergology and Immunology, Sapienza University of Rome, Rome, Italy.
| | - Mario Colantonio
- Department of Neonatology, S. Camillo Forlanini Hospital, Rome, Italy
| | - Anna Maria Zicari
- Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, Italy
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Rodriguez-López AM, Javier G, Carmen P, Esteban P, Luisa GC, Tomas F, Josefa HM, Luis F. Athlete Heart in Children and Young Athletes. Echocardiographic Findings in 331 Cases. Pediatr Cardiol 2022; 43:407-412. [PMID: 34586455 DOI: 10.1007/s00246-021-02736-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
The changes of the athlete's heart are not well defined and characterized in children. We aimed to describe the morphological changes of the heart related to sport in young athletes. We evaluated a group of 331 young athletes under 18 years (mean 11.9 ± 3.2) who practice tennis: 58 (16.52%), football: 118 (33.62%), basketball: 16 (4.56%), athletics: 40 (11.4%), and swimming: 99 (28.21%). Type of sport, years of practice, and duration of the training were collected. All children underwent echocardiography with the following M-mode parameters: left atrium diameter (LAD), interventricular septum (IVS), and left ventricle posterior Wall (LVPW), diastolic diameter of the left ventricle (LVDD), and right ventricle outflow tract (RVOT). The major finding of our study was that 20% of the children had a Z score > 2 for the IVS and that increased to 30% for the children playing tennis or swimming. Also, other changes like LA and RVOT dilatation were observed in about 10 and 14% of the cases, respectively. Taken together, these figures indicate that cardiac remodeling is frequent in children. Further studies are needed to establish consensus-based criteria of athlete's heart in young children.
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Affiliation(s)
- Ana M Rodriguez-López
- Department of Cardiology, Hospiten Sur, Tenerife, Spain.
- Department of Cardiology, Hospiten Bellevue, Tenerife, Spain.
| | - González Javier
- Service of Sport Medicine Ayuntamiento del Puerto de la Cruz, Hospital Universitario de Canarias, Tenerife, Spain
| | - Padrón Carmen
- Department of Paediatric, Hospiten Sur, Tenerife, Spain
| | | | | | - Febles Tomas
- Department of Cardiology, Hospiten Sur, Tenerife, Spain
| | | | - Febles Luis
- Department of Cardiology, Hospiten Bellevue, Tenerife, Spain
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31
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Chen H, Gong Y, Sun F, Han B, Zhou B, Fan J, Gu X. Myocardial Function in Offspring Aged 5 to 8 Years of Pregnancy Complicated by Severe Preeclampsia Measured by Two-Dimensional Speckle-Tracking Echocardiography. Front Physiol 2022; 12:643926. [PMID: 35069228 PMCID: PMC8774218 DOI: 10.3389/fphys.2021.643926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: This study aimed to quantitatively assess myocardial strain in preterm children aged 5 to 8 years of pregnancy complicated by severe preeclampsia (PE) by two-dimensional (2D) speckle tracking echocardiography. Method: A cohort study of 23 preterm children delivered by severe PE pregnant women from 2010 to 2012 in the First Affiliated Hospital of Soochow University was carried out. 23 preterm children from uneventful pregnancies in the same period served as controls. Myocardial functions including left ventricular longitudinal strain, radial strain, circumferential strain, and right ventricular longitudinal strain were evaluated by conventional Doppler, tissue Doppler imaging, and 2D speckle-tracking echocardiography (2D STE). All examinations were performed by an experienced ultrasonographer using the VIVID E9 (GE Healthcare) machine, according to standard techniques. Results: Children aged 5–8 years delivered from severe PE presented less weight (24.41 vs. 20.89 kg, P < 0.05), shorter height (124.1 vs 115.6 cm, P < 0.05) and faster heart rates (84 vs. 93 bpm, P < 0.05) compared to offspring of normotensive women. There were no significant differences in global left ventricular longitudinal strain, radial strain, circumferential strain, and right ventricular longitudinal strain between the children in the experimental group and the control group (P > 0.05). Conclusion: Exposure to the intrauterine environment of severe PE during the fetal period did not have a significant impact on cardiac structure in premature children at 5–8 years old, but they had a higher resting heart rate which may be associated with cardiovascular disease in the long run.
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Affiliation(s)
- Huiyun Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Gong
- Suining Central Hospital, Suining, China
| | - Fangcan Sun
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bing Han
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bingyuan Zhou
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiali Fan
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinxian Gu
- Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
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32
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Wong C, Aurigemma GP, Parker MW. Normal Aortic Dimensions: From A-to-Z-score. J Am Soc Echocardiogr 2021; 35:275-277. [PMID: 34915135 DOI: 10.1016/j.echo.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Cecillia Wong
- UMass Memorial Medical Center and the University of Massachusetts T. H. Chan School of Medicine
| | - Gerard P Aurigemma
- UMass Memorial Medical Center and the University of Massachusetts T. H. Chan School of Medicine
| | - Matthew W Parker
- UMass Memorial Medical Center and the University of Massachusetts T. H. Chan School of Medicine.
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33
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Chinawa JM, Chinawa AT, Ossai EN, Chukwu BF, Ndu IK, Asinobi IN. Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria. Malawi Med J 2021; 33:127-134. [PMID: 34777708 PMCID: PMC8560357 DOI: 10.4314/mmj.v33i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations. Objectives The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography. Methods A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls. Results A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005). Conclusion This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Awore T Chinawa
- Consultant Community Physician and Lecturer Enugu state University Teaching hospital, Enugu State
| | - Edmund N Ossai
- Department of community Medicine College of Health Sciences Ebonyi State University Abakaliki, Nigeria
| | - Bartholomew F Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, Enugu state University Teaching hospital, Enugu State
| | - Isaac N Asinobi
- Department of Paediatrics, Enugu state University Teaching hospital, Enugu State
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Azim R, Wang S. Cell-specific gene association network construction from single-cell RNA sequence. Cell Cycle 2021; 20:2248-2263. [PMID: 34530677 DOI: 10.1080/15384101.2021.1978265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The recent development of a high throughput single-cell RNA sequence devises the opportunity to study entire transcriptomes in the smallest detail. It also leads to the characterization of molecules and subtypes of a cell. Cancer epigenetics induced not only from individual molecules but also from the dysfunction of the system and the coupling effect of genes. While rapid advances are being made in the development of tools for single-cell RNA-seq data analysis, few slants are noticed in the potential advantages of single-cell network construction.Here, we used network perturbation theory with significant analysis to develop a cell-specific network that provides an insight into gene-gene association based on molecular expressions in a single-cell resolution. Besides, using this method, we can characterize each cell by inspecting how genes are connected and can identify the hub genes using network degree theory. Pathway & Gene enrichment analysis of the identified cell-specific high network degree genes supported the effectiveness of this method. This method could be beneficial for personalized drug design and even therapeutics.
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Affiliation(s)
- Riasat Azim
- College of Computer Science and Electronic Engineering, Hunan University, Changsha, Hunan, P.R. China
| | - Shulin Wang
- College of Computer Science and Electronic Engineering, Hunan University, Changsha, Hunan, P.R. China
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35
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Bonagura JD, Visser LC. Echocardiographic assessment of dilated cardiomyopathy in dogs. J Vet Cardiol 2021; 40:15-50. [PMID: 34750089 DOI: 10.1016/j.jvc.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
Dilated cardiomyopathy (DCM) is a frequent cause of cardiac disability, congestive heart failure (CHF), and arrhythmic death in dogs. The etiology of DCM is usually idiopathic/genetic, but some causes of a DCM phenotype are reversible. The disease is classified into preclinical (occult) and clinical (overt) stages; the latter stems from heart failure with reduced ejection fraction. DCM is further characterized by clinical, electrocardiographic, circulating biomarker, and imaging abnormalities. The diagnosis of clinical DCM with CHF is straightforward; however, identification of the preclinical stage can be challenging. Echocardiography is central to the diagnosis of both stages and characterized by left ventricular (LV) systolic dysfunction with progressive chamber dilation and variable enlargements of the left atrium and right-sided chambers. Left ventricular dilation is defined by increased LV end-diastolic volumes, areas, and internal dimensions normalized to body size or indexed to the aorta. Systolic dysfunction is characterized by decreased LV ejection fraction, increased end-systolic volume, and reduced shortening across minor and longitudinal LV axes. Dyssynchrony can confound the interpretation of linear indices of systolic function. A comprehensive echocardiogram in DCM includes two-dimensional and M-mode studies, spectral and tissue Doppler imaging, and potentially three-dimensional echocardiography and myocardial strain imaging. Echocardiographic findings should be interpreted within the context of identifiable risks and comorbidities, physical diagnosis, complementary diagnostic testing, and limitations of current reference intervals. Ambiguous examinations should be repeated. Specific echocardiographic criteria for the diagnosis of DCM are proposed to encourage discussion and additional outcome and breed-specific echocardiographic studies of canine DCM.
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Affiliation(s)
- John D Bonagura
- Departments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr, Raleigh, NC, 27606, USA; Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA.
| | - Lance C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
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Nelson JA, Mortensen MJ, Horslen S, Bhat AH. Impact of nutritional status on prevalence of left ventricular hypertrophy in children undergoing liver transplant. Pediatr Transplant 2021; 25:e14011. [PMID: 34004058 DOI: 10.1111/petr.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to (1) determine the prevalence of cardiac changes in patients with ESLD awaiting OLT (2) determine relationship between nutritional indices and cardiac changes. METHODS Retrospective review of transthoracic ECHO, clinical and nutritional information of pediatric patients evaluated for OLT. ECHO was analyzed for LVH, defined as LVMI > 95 g/m2.7 and/or RWT > 0.42. These findings were correlated with age, ESLD etiology, growth and nutritional parameters as well as pre- and post-OLT. RESULTS Sixty-five patients were included, all had normal left ventricular systolic function. Nine patients (14%) had LVMI > 95 g/m2.7 , five patients (8%) had RWT > 0.42, none met both criteria. None had thickened interventricular septal wall. Fourteen patients (20%) had significant left ventricular dilation. Nutritional deprivation was modestly present-weight under third percentile in 22%, length under third percentile in 24%, and both weight and length under third percentile in 17%. There were 12 patients (17%) with MUAC below two standard deviations for age; of these one had an elevated LVMI and another had an RWT > 0.42. CONCLUSIONS In this contemporary cross-sectional evaluation, a smaller proportion of patients with ESLD had LVH in contrast to prior studies. Despite a comparable disease burden, our cohort had better nutritional status. Though there was a trend between nutritional and LVH indices, this correlation may be better assessed prospectively in a larger cohort.
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Affiliation(s)
- James A Nelson
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Simon Horslen
- Division of Pediatric Gastroenterology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Aarti H Bhat
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Giri P, Mukhopadhyay A, Gupta M, Mohapatra B. Dilated cardiomyopathy: a new insight into the rare but common cause of heart failure. Heart Fail Rev 2021; 27:431-454. [PMID: 34245424 DOI: 10.1007/s10741-021-10125-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/26/2022]
Abstract
Heart failure is a global health burden responsible for high morbidity and mortality with a prevalence of greater than 60 million individuals worldwide. One of the major causes of heart failure is dilated cardiomyopathy (DCM), characterized by associated systolic dysfunction. During the last few decades, there have been remarkable advances in our understanding about the genetics of dilated cardiomyopathy. The genetic causes were initially thought to be associated with mutations in genes encoding proteins that are localized to cytoskeleton and sarcomere only; however, with the advancement in mechanistic understanding, the roles of ion channels, Z-disc, mitochondria, nuclear proteins, cardiac transcription factors (e.g., NKX-2.5, TBX20, GATA4), and the factors involved in calcium homeostasis have also been identified and found to be implicated in both familial and sporadic DCM cases. During past few years, next-generation sequencing (NGS) has been established as a diagnostic tool for genetic analysis and it has added significantly to the existing candidate gene list for DCM. The animal models have also provided novel insights to develop a better treatment strategy based on phenotype-genotype correlation, epigenetic and phenomic profiling. Most of the DCM biomarkers that are used in routine genetic and clinical testing are structural proteins, but during the last few years, the role of mi-RNA has also emerged as a biomarker due to their accessibility through noninvasive methods. Our increasing genetic knowledge can improve the clinical management of DCM by bringing clinicians and geneticists on one platform, thereby influencing the individualized clinical decision making and leading to precision medicine.
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Affiliation(s)
- Prerna Giri
- Cytogenetics Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Uttar Pradesh, Varanasi-5, India
| | - Amrita Mukhopadhyay
- Cytogenetics Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Uttar Pradesh, Varanasi-5, India
| | - Mohini Gupta
- Cytogenetics Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Uttar Pradesh, Varanasi-5, India
| | - Bhagyalaxmi Mohapatra
- Cytogenetics Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Uttar Pradesh, Varanasi-5, India.
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Dumitrascu-Biris I, Zidere V, Vigneswaran T, Charakida M, Mathur S, Kametas N, Simpson J. Dilated ascending aorta in the fetus. Prenat Diagn 2021; 41:1127-1133. [PMID: 34212413 DOI: 10.1002/pd.6007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/21/2021] [Accepted: 05/30/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Prenatal recognition of dilated aortic root is extremely rare and there are significant challenges in counselling these patients. The primary aim of this case series is to describe the prevalence, associations and outcome of dilated ascending aorta diagnosed during fetal life. METHODS This is a retrospective cohort study from two tertiary fetal cardiology centres. Dilated ascending aorta was defined as gestation-specific standard deviation > 1.96 at some point during gestation. RESULTS Sixteen infants were live born and underwent postnatal echocardiography. Prenatally suspected bicuspid aortic valve (BAV) (n = 6) was confirmed in 5 cases (83%) postnatally. Thirteen children have been followed up for a period of minimum one year. No connective tissue disease was found. CONCLUSIONS Prenatal dilated ascending aorta is a rare finding (0.06%). It is associated with BAV in 37% of cases and extracardiac abnormalities in 15.7%. Nuchal translucency measurement was >3.5 in 13% of cases. Connective tissue disease was not diagnosed postnatally. This is the largest prenatal cohort with dilated ascending aorta and postnatal outcomes to date. We showed a postnatal persistence of ascending aortic dilatation in 43% of babies. In the absence of extra-cardiac abnormalities, medium term outcome appears good but postnatal surveillance of aortic dilation is required.
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Affiliation(s)
- Ioana Dumitrascu-Biris
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, NHS Foundation Trust, London, UK
| | - Vita Zidere
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, NHS Foundation Trust, London, UK
| | - Trisha Vigneswaran
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, NHS Foundation Trust, London, UK
| | - Marietta Charakida
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, NHS Foundation Trust, London, UK.,School of Biomedical Engineering, Division of Imaging Sciences, King's College London, London, UK
| | - Sujeev Mathur
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nick Kametas
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, NHS Foundation Trust, London, UK
| | - John Simpson
- Fetal Cardiology Unit, Department of Congenital Heart Disease, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, NHS Foundation Trust, London, UK.,School of Biomedical Engineering, Division of Imaging Sciences, King's College London, London, UK
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Abstract
This study aimed to describe the variety of etiologies currently identified in infants with cardiac hypertrophy (CH) and investigate whether there is a relation with hyperinsulinism, echocardiographic characteristics and prognosis. This retrospective cohort study included infants born between 2005 and 2018 with CH measured by echocardiography [interventricular septum (IVS) and/or left ventricular posterior wall (LVPW) thickness with Z-score ≥ 2.0]. Children with congenital heart disease or hypertension were excluded. Underlying diagnosis, echocardiographic and follow-up data were extracted from patient files. Seventy-one infants with CH were included. An underlying cause of CH was identified in two-thirds (n = 47). Most common etiologies of CH were malformation syndromes (n = 23, including Noonan n = 12) and maternal diabetes mellitus (n = 13). Less common causes were congenital hyperinsulinism (n = 3), metabolic- (n = 5), sarcomeric- (n = 2) and neuromuscular disease (n = 1). In half of the identified causes (n = 22) an association with hyperinsulinism was described, including maternal diabetes mellitus (n = 13), malformation syndromes with insulin resistance (n = 6) and congenital hyperinsulinism (n = 3). CH associated with hyperinsulinism was echocardiographically characterized by lower LVPW thickness, higher IVS:LVPW ratio and more frequent sole involvement of the IVS (all, p ≤ 0.02). CH associated with hyperinsulinism normalized more often (41 vs. 0%) with lower mortality rates (14 vs. 44%) compared to CH not associated with hyperinsulinism (all, p ≤ 0.03). Nowadays, an etiology of CH can be identified in the majority of infants. The development of CH is often associated with hyperinsulinism which is mainly characterized by focal hypertrophy of the IVS on echocardiography. Prognosis depends on the underlying cause and is more favorable in CH associated with hyperinsulinism.
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40
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Zidere V, Vigneswaran TV, Syngelaki A, Charakida M, Allan LD, Nicolaides KH, Simpson JM, Akolekar R. Reference Ranges for Pulsed-Wave Doppler of the Fetal Cardiac Inflow and Outflow Tracts from 13 to 36 Weeks' Gestation. J Am Soc Echocardiogr 2021; 34:1007-1016.e10. [PMID: 33957251 DOI: 10.1016/j.echo.2021.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/02/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Doppler assessment of ventricular filling and outflow tract velocities is an integral part of fetal echocardiography, to assess diastolic function, systolic function, and outflow tract obstruction. There is a paucity of prospective data from a large sample of normal fetuses in the published literature. The authors report reference ranges for pulsed-wave Doppler flow of the mitral valve, tricuspid valve, aortic valve, and pulmonary valve, as well as heart rate, in a large number of fetuses prospectively examined at a single tertiary fetal cardiology center. METHODS The study population comprised 7,885 fetuses at 13 to 36 weeks' gestation with no detectable abnormalities from pregnancies resulting in normal live births. Prospective pulsed-wave Doppler blood flow measurements were taken of the mitral, tricuspid, aortic, and pulmonary valves. The fetal heart rate was recorded at the time of each assessment. Regression analysis, with polynomial terms to assess for linear and nonlinear contributors, was used to establish the relationship between each measurement and gestational age. RESULTS The measurement for each cardiac Doppler measurement was expressed as a Z score (difference between observed and expected values divided by the fitted SD corrected for gestational age) and percentile. Analysis included calculation of gestation-specific SDs. Regression equations are provided for the cardiac inflow and outflow tracts. CONCLUSIONS This study establishes reference ranges for fetal cardiac Doppler measurements and heart rate between 13 to 36 weeks' gestation that may be useful in clinical practice.
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Affiliation(s)
- Vita Zidere
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom.
| | - Trisha V Vigneswaran
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Argyro Syngelaki
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Marietta Charakida
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Lindsey D Allan
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Kypros H Nicolaides
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - John M Simpson
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, United Kingdom
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway Maritime Hospital, Gillingham, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, United Kingdom
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Gallo G, Mastromarino V, Limongelli G, Calcagni G, Maruotti A, Ragni L, Valente F, Musumeci MB, Adorisio R, Rubino M, Autore C, Magrì D. Insights from Cardiopulmonary Exercise Testing in Pediatric Patients with Hypertrophic Cardiomyopathy. Biomolecules 2021; 11:biom11030376. [PMID: 33801562 PMCID: PMC7999553 DOI: 10.3390/biom11030376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
The usefulness of cardiopulmonary exercise test (CPET) in adult hypertrophic cardiomyopathy (HCM) patients is well-known, whereas its role in pediatric HCM patients has not yet been explored. The present study investigates possible insights from a CPET assessment in a cohort of pediatric HCM outpatients in terms of functional and prognostic assessment. Sixty consecutive pediatric HCM outpatients aged <18 years old were enrolled, each of them undergoing a full clinical assessment including a CPET; a group of 60 healthy subjects served as controls. A unique composite end-point of heart failure (HF) related and sudden cardiac death (SCD) or SCD-equivalent events was also explored. During a median follow-up of 53 months (25th–75th: 13–84 months), a total of 13 HF- and 7 SCD-related first events were collected. Compared to controls, HCM patients showed an impaired functional capacity with most of them showing peak oxygen uptake (pVO2) values of <80% of the predicted, clearly discrepant with functional New York Heart Association class assessment. The composite end-point occurred more frequently in patients with the worst CPETs’ profiles. At the univariate analysis, pVO2% was the variable with the strongest association with adverse events at follow-up (C-index = 0.72, p = 0.025) and a cut-off value equal to 60% was the most accurate in identifying those patients at the highest risk. In a pediatric HCM subset, the CPET assessment allows a true functional capacity estimation and it might be helpful in identifying early those patients at high risk of events.
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Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Vittoria Mastromarino
- Paediatric Cardiology and ACHD Unit, S. Orsola, Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (L.R.)
| | - Giuseppe Limongelli
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy; (G.C.); (R.A.)
| | - Antonello Maruotti
- Department of Scienze Economiche, Politiche e delle Lingue Moderne, Libera Università SS Maria Assunta, 00193 Rome, Italy;
- Department of Mathematics, University of Bergen, 5052 Bergen, Norway
- School of Computing, University of Portsmouth, Portsmouth PO2 8QD, UK
| | - Luca Ragni
- Paediatric Cardiology and ACHD Unit, S. Orsola, Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (L.R.)
| | - Fabio Valente
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Maria Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00050 Rome, Italy; (G.C.); (R.A.)
| | - Marta Rubino
- Cardiologia SUN, Monaldi Hospital, II University of Naples, 80100 Naples, Italy; (G.L.); (F.V.); (M.R.)
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy; (G.G.); (M.B.M.); (C.A.)
- Correspondence: ; Tel.: +39-(0)6-3377-5563; Fax: +39-(0)6-3377-5061
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Lopez L, Frommelt PC, Colan SD, Trachtenberg FL, Gongwer R, Stylianou M, Bhat A, Burns KM, Cohen MS, Dragulescu A, Freud LR, Frommelt MA, Lytrivi ID, Mahgerefteh J, McCrindle BW, Pignatelli R, Prakash A, Sachdeva R, Soslow JH, Spurney C, Taylor CL, Thankavel PP, Thorsson T, Tretter JT, Young LT, LuAnn Minich L. Pediatric Heart Network Echocardiographic Z Scores: Comparison with Other Published Models. J Am Soc Echocardiogr 2021; 34:185-192. [PMID: 33189460 PMCID: PMC7870534 DOI: 10.1016/j.echo.2020.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Different methods have resulted in variable Z scores for echocardiographic measurements. Using the measurements from 3,215 healthy North American children in the Pediatric Heart Network (PHN) echocardiographic Z score database, the authors compared the PHN model with previously published Z score models. METHODS Z scores were derived for cardiovascular measurements using four models (PHN, Boston, Italy, and Detroit). Model comparisons were performed by evaluating (1) overlaid graphs of measurement versus body surface area with curves at Z = -2, 0, and +2; (2) scatterplots of PHN versus other Z scores with correlation coefficients; (3) Bland-Altman plots of PHN versus other Z scores; and (4) comparison of median Z scores for each model. RESULTS For most measurements, PHN Z score curves were similar to Boston and Italian curves but diverged from Detroit curves at high body surface areas. Correlation coefficients were high when comparing the PHN model with the others, highest with Boston (mean, 0.99) and lowest with Detroit (mean, 0.90). Scatterplots suggested systematic differences despite high correlations. Bland-Altman plots also revealed poor agreement at both extremes of size and a systematic bias for most when comparing PHN against Italian and Detroit Z scores. There were statistically significant differences when comparing median Z scores between the PHN and other models. CONCLUSIONS Z scores from the multicenter PHN model correlated well with previous single-center models, especially the Boston model, which also had a large sample size and similar methodology. The Detroit Z scores diverged from the PHN Z scores at high body surface area, possibly because there were more subjects in this category in the PHN database. Despite excellent correlation, significant differences in Z scores between the PHN model and others were seen for many measurements. This is important when comparing publications using different models and for clinical care, particularly when Z score thresholds are used to guide diagnosis and management.
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Affiliation(s)
- Leo Lopez
- Stanford University School of Medicine, Palo Alto, California.
| | | | | | | | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Aarti Bhat
- Seattle Children's Hospital, Seattle, Washington
| | - Kristin M Burns
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | - Carolyn L Taylor
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | - Luciana T Young
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Amr NH, Mahmoud RAA, Youssef O, Toaima NN, Elsedfy H. Effect of long-term glucocorticoid therapy on cardiac functions in children with congenital adrenal hyperplasia. Clin Endocrinol (Oxf) 2021; 94:210-218. [PMID: 32946608 DOI: 10.1111/cen.14333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Glucocorticoids play an important role in cardiac physiology. Chronic exposure and higher doses may cause adverse effects on the myocardium, especially in young patients receiving long-term therapy. OBJECTIVE To assess cardiac function in children with congenital adrenal hyperplasia (CAH) and its relation to glucocorticoid dose and therapy duration. METHODS Forty-seven patients with CAH due to 21-hydroxylase deficiency were compared to 47 controls. Patients were subdivided according to treatment duration (Group A: less than 6 years, Group B: more than 6 years). Mean daily glucocorticoid and cumulative glucocorticoid doses were calculated. Echocardiography was performed for patients and controls to evaluate cardiac functions, chamber dimensions and tissue Doppler valvular status. RESULTS Compared to controls, patients had cardiac chamber hypertrophy reflected by higher M-mode dimensions. Patients had lower fractional shortening, defective ventricular relaxation, lower average mitral and tricuspid e´/a´ ratios (e´ early diastolic, a´ late diastolic) as well as s´ (systolic) velocities, higher average mitral E/e ratio and higher left ventricle TDI Tei index (P < .05). Group B had lower average mitral e´/a´ and tricuspid s´ velocities, and higher average mitral E/e ratio (P < .05). Cumulative glucocorticoid dose significantly correlated with different echocardiographic parameters. CONCLUSION Long-term glucocorticoid therapy even within the recommended therapeutic range adversely affects cardiac functions in children with 21-hydroxylase deficiency.
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Affiliation(s)
| | | | - Omneyia Youssef
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | | | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
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Lenoir M, Desnous B, Rahmani B, El Gueddari N, Aries É, El Louali F, Aldebert P, Ovaert C, Metras D, Macé L, Fouilloux V. Anterograde blood flow associated with modified Blalock-Taussig shunt does not modify pulmonary artery growth compared with modified Blalock-Taussig shunt alone. Arch Cardiovasc Dis 2021; 114:268-276. [PMID: 33509744 DOI: 10.1016/j.acvd.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The main difference between extreme tetralogy of Fallot (TOF) and pulmonary atresia with ventricle septal defect (PA/VSD) is anterograde pulmonary blood flow (APBF). It is speculated that the association of modified Blalock-Taussig shunt (mBTS) with APBF favours shunt thrombosis, but promotes better pulmonary artery growth. AIM To compare pulmonary artery growth after mBTS between TOF and PA/VSD. METHODS From 1995 to 2018, 77 mBTS procedures were performed in infants (aged<1 year): 45 for TOF; 32 for PA/VSD. Using a 1/1 propensity score-matched analysis, 38 patients were included (19 per group). Delta Nakata was defined as the difference in the Nakata index before biventricular repair and before mBTS. RESULTS After matching, the preoperative Nakata index was similar in the two groups (TOF 101±34 vs. PA/VSD 106±35 mm2/m2; P=0.75). Age and weight were similar (TOF 24±20 days, 3.3±0.6kg vs. PA/VSD 24±33 days, 3.3±0.9kg; P=0.84 and P=0.77, respectively). There was no difference in rates of in-hospital mortality (TOF 0% vs. PA/VSD 10%; P=0.13) or mBTS thrombosis (TOF 15% vs. PA/VSD 10%; P=0.63). The left and right pulmonary artery diameters at time of biventricular repair were similar (TOF 7.5±2.2 and 6.7±2.1 vs. PA/VSD 8±2.7 and 7.1±2.5mm; P=0.43 and P=0.78, respectively), as were delta Nakata (TOF 112±102 vs. PA/VSD 107±66 mm2/m2; P=0.89), median age for biventricular repair (P=0.83) and reintervention rates (TOF 10% vs. PA/VSD 15%; P=0.67). CONCLUSIONS We found no difference in pulmonary artery growth between APBF with mBTS versus mBTS alone. Thus, we could not show an increase in mBTS thrombosis with APBF.
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Affiliation(s)
- Marien Lenoir
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - Beatrice Desnous
- Department of paediatric neurology, Timone hospital, AP-HM, 13005 Marseille, France
| | - Bilal Rahmani
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Nabila El Gueddari
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Édouard Aries
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Fedoua El Louali
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Philippe Aldebert
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Caroline Ovaert
- Department of paediatric cardiology, Timone hospital, AP-HM, 13385 Marseille, France
| | - Dominique Metras
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Loic Macé
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Virginie Fouilloux
- Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
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Ziolkowska L, Boruc A, Sobielarska-Lysiak D, Grzyb A, Petryka-Mazurkiewicz J, Mazurkiewicz Ł, Brzezinska-Rajszys G. Prognostic Significance of Myocardial Ischemia Detected by Single-Photon Emission Computed Tomography in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2021; 42:960-968. [PMID: 33687492 PMCID: PMC8110494 DOI: 10.1007/s00246-021-02570-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/25/2021] [Indexed: 11/01/2022]
Abstract
Myocardial ischemia caused by microvascular dysfunction is an important pathophysiologic component of hypertrophic cardiomyopathy (HCM), promoting myocardial fibrosis, adverse left ventricular remodeling, and impacting on clinical course and outcome in HCM patients. The aim of study was to assess the prevalence and clinical significance of myocardial ischemia in children with HCM using 99mTc-MIBI single-photon emission computed tomography (SPECT). Ninety-one children with HCM, median age 13.6 years, underwent SPECT evaluation from 2006 to 2017. Imaging was performed at rest and after maximal exercise. Myocardial perfusion defects were identified in 70 children (76.9%; group I), median age 13.8 years. Fixed perfusion defects were evident in 22 of them, while reversible at rest in 48. In 21 children (23.1%; group II), median age 11 years, myocardial perfusion defects were not detected. Patient demographics, echocardiography, resting electrocardiogram (ECG), 24-h Holter ECG, myocardial fibrosis in cardiovascular magnetic resonance imaging, and cardiovascular events were analyzed and compared between the groups. During follow-up at a median of 8.3 years in children with myocardial ischemia, clinical endpoints occurred more often (47 vs. 5; p = 0.02) and more patients reached a clinical endpoint (28 [40%] vs. 3 [14.3%]; p = 0.036). In children with myocardial ischemia, myocardial fibrosis was observed with greater frequency. Myocardial perfusion defects may reflect an ischemic process which (1) affects the clinical manifestations and (2) is an important predictor of adverse clinical events and risk of death in children with HCM. Myocardial ischemia in HCM patients frequently correlates with myocardial fibrosis.
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Affiliation(s)
- Lidia Ziolkowska
- Department of Cardiology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730, Warszawa, Poland.
| | - Agnieszka Boruc
- grid.413923.e0000 0001 2232 2498Department of Cardiology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Dorota Sobielarska-Lysiak
- grid.413923.e0000 0001 2232 2498Department of Nuclear Medicine, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Agnieszka Grzyb
- grid.413923.e0000 0001 2232 2498Department of Cardiology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Joanna Petryka-Mazurkiewicz
- grid.418887.aMagnetic Resonance Unit, Department of Cardiomyopathies, National Institute of Cardiology, 04-628 Warsaw, Poland ,grid.418887.aDepartment of Coronary and Structural Heart Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Łukasz Mazurkiewicz
- grid.418887.aMagnetic Resonance Unit, Department of Cardiomyopathies, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Grazyna Brzezinska-Rajszys
- grid.413923.e0000 0001 2232 2498Department of Cardiology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
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Schöffl I, Wüstenfeld J, Jones G, Dittrich S, Lutter C, Schöffl V. Athlete's Heart in Elite Sport Climbers: Cardiac Adaptations Determined Using ECG and Echocardiography Data. Wilderness Environ Med 2020; 31:418-425. [PMID: 33189521 DOI: 10.1016/j.wem.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Sudden cardiac death in a young athlete is the leading cause of mortality in athletes during sport. Specific knowledge about cardiac adaptations are necessary for a better understanding of the underlying causes of such events. METHODS A retrospective analysis of the electrocardiogram and echocardiographic data obtained during the yearly medical examination of the entire German junior national climbing team was undertaken. First, data from 1 examination were used. In a second step, data from 2 examinations spaced 2 y apart were analyzed for a selected subgroup to gain more knowledge about adaptations to climbing. The data from the subgroup were compared to an age- and sex-matched control group of Nordic skiers from the German junior national Nordic skiing team. RESULTS Forty-seven young climbers (20 girls, 27 boys) were examined once. There were no pathological findings in the electrocardiogram or echocardiography. The left ventricular (LV) measurements fell between those for athletes and nonathletes. Eight boys and 6 girls from this group were tested twice over a timeframe of 27.5 mo. All LV measurements increased over time. After 2 y, the measurements from the climbers were comparable to those of the Nordic skiers. CONCLUSIONS Hypertrophic cardiomyopathy (hypertrophy of the LV) is the leading cause of sudden cardiac death in athletes. An increase in LV dimensions was observed in the young climbers in this study. LV dimensions being comparable to high-level Nordic skiers after 2 y in the national team imply structural changes over time in this cohort.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany; Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
| | - Jan Wüstenfeld
- Insitute for Applied Exercise Science, University Leipzig, Leipzig, Germany
| | - Gareth Jones
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Chris Lutter
- Department of Orthopaedics, University Hospital Rostock, Rostock, Germany
| | - Volker Schöffl
- Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom; Department of Emergency Medicine, Section Wilderness Medicine, University of Colorado School of Medicine, Denver, CO
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47
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Zinter MS, Dvorak CC, Mayday MY, Iwanaga K, Ly NP, McGarry ME, Church GD, Faricy LE, Rowan CM, Hume JR, Steiner ME, Crawford ED, Langelier C, Kalantar K, Chow ED, Miller S, Shimano K, Melton A, Yanik GA, Sapru A, DeRisi JL. Pulmonary Metagenomic Sequencing Suggests Missed Infections in Immunocompromised Children. Clin Infect Dis 2020; 68:1847-1855. [PMID: 30239621 PMCID: PMC6784263 DOI: 10.1093/cid/ciy802] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite improved diagnostics, pulmonary pathogens in immunocompromised children frequently evade detection, leading to significant mortality. Therefore, we aimed to develop a highly sensitive metagenomic next-generation sequencing (mNGS) assay capable of evaluating the pulmonary microbiome and identifying diverse pathogens in the lungs of immunocompromised children. METHODS We collected 41 lower respiratory specimens from 34 immunocompromised children undergoing evaluation for pulmonary disease at 3 children's hospitals from 2014-2016. Samples underwent mechanical homogenization, parallel RNA/DNA extraction, and metagenomic sequencing. Sequencing reads were aligned to the National Center for Biotechnology Information nucleotide reference database to determine taxonomic identities. Statistical outliers were determined based on abundance within each sample and relative to other samples in the cohort. RESULTS We identified a rich cross-domain pulmonary microbiome that contained bacteria, fungi, RNA viruses, and DNA viruses in each patient. Potentially pathogenic bacteria were ubiquitous among samples but could be distinguished as possible causes of disease by parsing for outlier organisms. Samples with bacterial outliers had significantly depressed alpha-diversity (median, 0.61; interquartile range [IQR], 0.33-0.72 vs median, 0.96; IQR, 0.94-0.96; P < .001). Potential pathogens were detected in half of samples previously negative by clinical diagnostics, demonstrating increased sensitivity for missed pulmonary pathogens (P < .001). CONCLUSIONS An optimized mNGS assay for pulmonary microbes demonstrates significant inoculation of the lower airways of immunocompromised children with diverse bacteria, fungi, and viruses. Potential pathogens can be identified based on absolute and relative abundance. Ongoing investigation is needed to determine the pathogenic significance of outlier microbes in the lungs of immunocompromised children with pulmonary disease.
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Affiliation(s)
- Matt S Zinter
- Division of Critical Care, University of California, San Francisco School of Medicine
| | - Christopher C Dvorak
- Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California, San Francisco School of Medicine
| | - Madeline Y Mayday
- Division of Critical Care, University of California, San Francisco School of Medicine
| | - Kensho Iwanaga
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Ngoc P Ly
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Meghan E McGarry
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Gwynne D Church
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Lauren E Faricy
- Division of Pulmonology, Department of Pediatrics, University of Vermont School of Medicine, Burlington
| | - Courtney M Rowan
- Division of Critical Care, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis
| | - Janet R Hume
- Division of Critical Care, University of Minnesota School of Medicine, Minneapolis
| | - Marie E Steiner
- Division of Critical Care, University of Minnesota School of Medicine, Minneapolis.,Hematology/Oncology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota School of Medicine, Minneapolis
| | - Emily D Crawford
- Chan Zuckerberg Biohub, University of California-San Francisco School of Medicine.,Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
| | - Charles Langelier
- Division of Infectious Diseases, Department of Internal Medicine, University of California-San Francisco School of Medicine
| | - Katrina Kalantar
- Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
| | - Eric D Chow
- Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
| | - Steve Miller
- Department of Laboratory Medicine, University of California-San Francisco School of Medicine
| | - Kristen Shimano
- Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California, San Francisco School of Medicine
| | - Alexis Melton
- Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California, San Francisco School of Medicine
| | - Gregory A Yanik
- Division of Oncology, Department of Pediatrics, Motts Children's Hospital, University of Michigan School of Medicine, Ann Arbor
| | - Anil Sapru
- Division of Critical Care, University of California, San Francisco School of Medicine.,Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital, University of California-Los Angeles, Geffen School of Medicine
| | - Joseph L DeRisi
- Chan Zuckerberg Biohub, University of California-San Francisco School of Medicine.,Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
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48
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How to interpret a paediatric echocardiography report. BJA Educ 2020; 20:278-286. [DOI: 10.1016/j.bjae.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 11/19/2022] Open
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Rajput JS, Sharma M, Tan RS, Acharya UR. Automated detection of severity of hypertension ECG signals using an optimal bi-orthogonal wavelet filter bank. Comput Biol Med 2020; 123:103924. [DOI: 10.1016/j.compbiomed.2020.103924] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022]
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50
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Li X, Wu M, Sun C, Zhao Z, Wang F, Zheng X, Ge W, Zhou J, Zou J. Using machine learning to predict stroke‐associated pneumonia in Chinese acute ischaemic stroke patients. Eur J Neurol 2020; 27:1656-1663. [PMID: 32374076 DOI: 10.1111/ene.14295] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- X. Li
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - M. Wu
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Pharmacy Nanjing Drum Tower Hospital Medical College of Nanjing University Nanjing China
| | - C. Sun
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Z. Zhao
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - F. Wang
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - X. Zheng
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - W. Ge
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Pharmacy Nanjing Drum Tower Hospital Medical College of Nanjing University Nanjing China
| | - J. Zhou
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - J. Zou
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
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