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Xiang J, Lamy J, Qiu M, Galiana G, Peters DC. K-t PCA accelerated in-plane balanced steady-state free precession phase-contrast (PC-SSFP) for all-in-one diastolic function evaluation. Magn Reson Med 2024; 91:911-925. [PMID: 37927206 PMCID: PMC10803002 DOI: 10.1002/mrm.29897] [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: 05/31/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Diastolic function evaluation requires estimates of early and late diastolic mitral filling velocities (E and A) and of mitral annulus tissue velocity (e'). We aimed to develop an MRI method for simultaneous all-in-one diastolic function evaluation in a single scan by generating a 2D phase-contrast (PC) sequence with balanced steady-state free precession (bSSFP) contrast (PC-SSFP). E and A could then be measured with PC, and e' estimated by valve tracking on the magnitude images, using an established deep learning framework. METHODS Our PC-SSFP used in-plane flow-encoding, with zeroth and first moment nulling over each TR. For further acceleration, different k-t principal component analysis (PCA) methods were investigated with both retrospective and prospective undersampling. PC-SSFP was compared to separate balanced SSFP cine and PC-gradient echo acquisitions in phantoms and in 10 healthy subjects. RESULTS Phantom experiments showed that PC-SSFP measured accurate velocities compared to PC-gradient echo (r = 0.98 for a range of pixel-wise velocities -80 cm/s to 80 cm/s). In subjects, PC-SSFP generated high SNR and myocardium-blood contrast, and excellent agreement for E (limits of agreement [LOA] 0.8 ± 2.4 cm/s, r = 0.98), A (LOA 2.5 ± 4.1 cm/s, r = 0.97), and e' (LOA 0.3 ± 2.6 cm/s, r = 1.00), versus the standard methods. The best k-t PCA approach processed the complex difference data and substituted in raw k-space data. With prospective k-t PCA acceleration, higher frame rates were achieved (50 vs. 25 frames per second without k-t PCA), yielding a 13% higher e'. CONCLUSION The proposed PC-SSFP method achieved all-in-one diastolic function evaluation.
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Affiliation(s)
- Jie Xiang
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
| | - Jerome Lamy
- Université de Paris, Cardiovascular Research Center, INSERM, 75015 Paris, France
| | - Maolin Qiu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
| | - Gigi Galiana
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
| | - Dana C. Peters
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
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Rahbar Z, Tavoosi A, Bakhshandeh A, Mehrpooya M, Sardari A, Larti F, Sattarzadeh Badkoubeh R. Echocardiographic estimation of left ventricular filling pressures in heart transplant recipients. Egypt Heart J 2024; 76:12. [PMID: 38289542 PMCID: PMC10828230 DOI: 10.1186/s43044-024-00443-z] [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: 08/17/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Echocardiographic estimation of left ventricular filling pressure in heart transplant (HTx) recipients is challenging. The ability of echocardiography to detect elevated left ventricular end-diastolic pressure (LVEDP) in HTx patients was assessed in this study. RESULTS This descriptive cross-sectional study included 39 HTx recipients who were candidates for endomyocardial biopsy as a part of their routine post-transplantation surveillance. Doppler transthoracic echocardiography was done before the procedure, and left heart catheterization was done during the endomyocardial biopsy. Thirty-nine patients (15 female, 24 male), with a mean age of 39.6 years (range 13-70), were enrolled. A strong relation was observed between lateral E/e' and LVEDP (R = 0.64, P value < 0.001) and average E/e' and LVEDP (R = 0.6, P value < 0.001). The best cutoff value for LVEDP prediction was the average E/e' ≥ 6.8 with a sensitivity of 96.15% and specificity of 68.5% for the prediction of LVEDP more than or equal to 20 mmHg. Two predictive models comprising age, gender, and lateral E/e' or average E/e' were also proposed. A significant relationship was also found between LVEDP and left ventricular global longitudinal strain (R = - 0.31, P value < 0.01). CONCLUSIONS Lateral E/e' was the best predictor of LVEDP. The cutoff of average E/e' had the best validity for the estimation of LVEDP. Despite the strong observed association, echocardiographic parameters cannot be considered a surrogate for invasive LVEDP measurements when seeking information about left ventricle filling pressure on heart transplant recipients.
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Affiliation(s)
- Zohreh Rahbar
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Anahita Tavoosi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Alireza Bakhshandeh
- Department of Cardiothoracic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mehrpooya
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Akram Sardari
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Farnoosh Larti
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran.
| | - Roya Sattarzadeh Badkoubeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran
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3
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Ravnkilde K, Skaarup KG, Grove GL, Modin D, Nielsen AB, Falsing MM, Iversen AZ, Pedersen S, Fritz-Hansen T, Galatius S, Shah A, Biering-Sørensen T. Longitudinal change in cardiac structure and function following acute coronary syndrome according to culprit coronary artery lesion. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1029-1036. [PMID: 34855043 DOI: 10.1007/s10554-021-02478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
Acute coronary syndrome (ACS) may lead to adverse remodelling and impaired cardiac function. Limited data exists on the effect of culprit coronary artery lesion site and impact on longitudinal cardiac remodelling. The present study included a total of 299 patients suffering from ACS treated with percutaneous coronary intervention (PCI). All patients had two echocardiographic examinations. The first echocardiography was median 2(IQR: 1;3) days following PCI, while the follow-up echocardiography (FUE) was median 257(IQR: 96;942) days following the first. Patients were grouped based on coronary artery PCI location; left anterior descending artery (LAD), right coronary artery (RCA) or circumflex artery (Cx). Patients with multiple lesions were excluded. Mean age was 63 ± 11 years and 77% were male. At FUE, mean left ventricular ejection fraction was 42 ± 9% and global longitudinal strain (GLS) was - 13 ± 4%. PCI treatment was allocated as 168 LAD lesions, 95 RCA lesions, and 36 Cx lesions. Linear regression analysis showed that patients with a LAD lesion displayed worsening in E/A (mean ∆ = 0.05, β = - 0.196, p = 0.001) and a larger increase in LVEDV (mean ∆ = 33.18 mL, β = 0.135, p = 0.012). Meanwhile patients with Cx lesion were significantly associated with a larger decrease in E/e' (mean ∆ = 2.6, β = - 0.120, p = 0.028). Patients with Cx lesion were observed to have elevated E/e' at baseline, which normalized at FUE. The present study suggests that culprit coronary artery lesion has a differential impact on myocardial remodelling. This information may potentially aid in understanding the pathophysiological differences in cardiac structure and function amongst patients with ACS.
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Affiliation(s)
- Kirstine Ravnkilde
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Post 835, Copenhagen, Denmark.
| | | | - Gabriela Lladó Grove
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Daniel Modin
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Anne Bjerg Nielsen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | - Allan Zeeberg Iversen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Amil Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Echocardiographic Patterns of Left Ventricular Diastolic Function in Cardiac Amyloidosis: An Updated Evaluation. J Clin Med 2021; 10:jcm10214888. [PMID: 34768408 PMCID: PMC8584963 DOI: 10.3390/jcm10214888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022] Open
Abstract
Aims: Multimodal imaging has allowed cardiac amyloidosis (CA) to be increasingly recognised as a treatable cause of heart failure with preserved ejection fraction, but its prognosis remains poor due to late diagnosis. To assess the left ventricular diastolic function (LVDF) patterns in a large contemporary CA cohort according to the current recommendations and to identify their determinants. Methods and Results: We conducted a monocentric, observational study on a cohort of CA patients from a tertiary CA referral centre. Diastolic function was analysed using standard echocardiography and clinical, laboratory and survival parameters were collected. Four hundred and sixty-four patients with one of the three main type of CA were included: 41% had grade III diastolic dysfunction (restrictive mitral pattern), 25% had grade II diastolic dysfunction, and 25% had grade I diastolic dysfunction; 9% were unclassified. No difference was found between the main CA types. After multivariate analyses, grades II and III were independently associated with dyspnoea, elevated NT-proBNP, cardiac infiltration and systolic dysfunction (global longitudinal strain). Grade I patients had a better prognosis. Conclusions: All LVDF patterns can be observed in CA. One quarter of CA patients have grade I LVDF, reflecting the emergence of earlier stage-related phenotypes with a better prognosis.
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Pavlik G, Kováts T, Kneffel Z, Komka Z, Radák Z, Tóth M, Nemcsik J. Characteristics of the athlete's heart in aged hypertensive and normotensive subjects. J Sports Med Phys Fitness 2021; 62:990-996. [PMID: 34546024 DOI: 10.23736/s0022-4707.21.12699-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Both hypertension and age-related impairment of the cardiac condition are known to be improved by regular physical training. As relatively few studies have been reported about the older, hypertensive patients, the aim of this study was to establish cardiac benefits of active lifestyle in these subjects. METHODS Two-dimensionally guided M-mode, Doppler- and tissue Doppler echocardiography was performed in 199 normo- and hypertensive, active and sedentary older (age>60 yrs.) men (111) and women (88). Results were compared either by ANOVA, or by Kruskall-Wallis test. RESULTS The left ventricular muscle index (LVMI), which is higher in young active than in sedentary persons, proved to be smaller in the active than sedentary older subjects: men normotensives: actives 83 vs. sedentary ones 98, hypertensives: actives 88 vs. sedentary ones 107, women normotensives: actives 77 vs. sedentary ones 89 g/m3. Diastolic function was better in the active groups demonstrated both by the ratio of the early to atrial peak blood flow velocities (men: normotensives: actives 1.03 vs. sedentary ones 0.76, women normotensives: actives 1.21 vs. sedentary ones 0.9, hypertensives: actives 1.04 vs. sedentary ones 0.88). The tissue Doppler results were also better in the active groups; the difference between the active and sedentary groups was more marked in the normotensive male groups than in the hypertensive ones. CONCLUSIONS Active lifestyle prevents age-related pathological LV hypertrophy, and attenuates the LV diastolic dysfunction.
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Affiliation(s)
- Gábor Pavlik
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary -
| | - Tímea Kováts
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary.,The Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kneffel
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary
| | - Zsolt Komka
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary.,The Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Zsolt Radák
- Research Centre for Molecular Exercise Science, University of Physical Education, Budapest, Hungary
| | - Mikós Tóth
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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6
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Liu C, Lai Y, Pei J, Huang H, Zhan J, Ying S, Shen Y. Clinical and Genetic Analysis of KATP Variants With Heart Failure Risk in Patients With Decreased Serum ApoA-I Levels. J Clin Endocrinol Metab 2021; 106:2264-2278. [PMID: 33982099 DOI: 10.1210/clinem/dgab336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Lower serum concentration of apolipoprotein A-I (ApoA-I) is causally associated with heart failure (HF) risk. Adenosine triphosphate-sensitive potassium channels (KATP), as gating channels coupling vascular reactivity and metabolism with ischemic protection, become a new potential target of management for HF. The KATP gene sequence is highly polymorphic and has a high degree of genetic heterogeneity. OBJECTIVE This work aimed to determine whether KATP variants predict the risks of decreased ApoA-I concentration and its related HF. METHODS A total of 634 individuals, including 317 patients with decreased ApoA-I concentration (< 120 mg/dL) and 317 counterpart participants (≥ 120 mg/dL), were retrospectively selected. Five KATP variants were genotyped through the MassARRAY platform. Exosome-derived microRNAs (exo-miRs) expression profiles were identified by next-generation sequencing, and the top 10 differentially expressed (DE) exo-miRs were verified using quantitative polymerase chain reaction in a validation cohort of 240 individuals with decreased ApoA-I concentration. RESULTS KATP rs141294036 was related to an increased risk of lower ApoA-I levels (adjusted odds ratio [OR] = 1.95, P = .002) and HF incidence (adjusted OR = 2.38, P = .009), especially heart failure with preserved ejection fraction (HFpEF; adjusted OR = 2.13, P = .015). After a median 48.6-month follow-up, participants carrying the CC genotype of rs141294036 were associated with an elevated HF rehospitalization risk (adjusted hazard ratio = 1.91, P = .005). Thirty-six exo-miRs were significantly DE between different genotypes of rs141294036 in participants with lower ApoA-I levels, but only 5 exo-miRs (miR-31-5p, miR-126-5p, miR-106a-5p, miR-378i, and miR-181c-5p) were further confirmed. CONCLUSION KATP rs141294036 was associated with increased risks of lower ApoA-I levels, HF incidence (especially HFpEF), and HF rehospitalization in those with the 5 confirmed exo-miRs and its related metabolic pathways.
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Affiliation(s)
- Cheng Liu
- Department of Cardiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, China
| | - Yanxian Lai
- Department of Cardiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, China
| | - Jingxian Pei
- Department of Cardiology, the second affiliated hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Huiling Huang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Junfang Zhan
- Department of Health Management Center, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, China
| | - Songsong Ying
- Department of Gastroenterology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, China
| | - Yan Shen
- Department of Cardiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou 510180, China
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7
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Sørensen MH, Bojer AS, Broadbent DA, Plein S, Madsen PL, Gæde P. Cardiac perfusion, structure, and function in type 2 diabetes mellitus with and without diabetic complications. Eur Heart J Cardiovasc Imaging 2021; 21:887-895. [PMID: 31642902 DOI: 10.1093/ehjci/jez266] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/08/2019] [Accepted: 10/12/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Coronary microvascular disease (CMD) is a known complication in type 2 diabetes mellitus (T2DM). We examined the relationship between diabetic complications, left ventricular (LV) function and structure and myocardial perfusion reserve (MPR) as indicators of CMD in patients with T2DM and control subjects. METHODS AND RESULTS This was a cross-sectional study of 193 patients with T2DM and 25 controls subjects. Patients were grouped as uncomplicated diabetes (n = 71) and diabetes with complications (albuminuria, retinopathy, and autonomic neuropathy). LV structure, function, adenosine stress, and rest myocardial perfusion were evaluated by cardiovascular magnetic resonance. Echocardiography was used to evaluate diastolic function. Patients with uncomplicated T2DM did not have significantly different LV mass and E/e* but decreased MPR (3.8 ± 1.0 vs. 5.1 ± 1.5, P < 0.05) compared with controls. T2DM patients with albuminuria and retinopathy had decreased MPR (albuminuria: 2.4 ± 0.9 and retinopathy 2.6 ± 0.7 vs. 3.8 ± 1.0, P < 0.05 for both) compared with uncomplicated T2DM patients, along with significantly higher LV mass (149 ± 39 and 147 ± 40 vs. 126 ± 33 g, P < 0.05) and E/e* (8.3 ± 2.8 and 8.1 ± 2.2 vs. 7.0 ± 2.5, P < 0.05). When entered in a multiple regression model, reduced MPR was associated with increasing E/e* and albuminuria and retinopathy were associated with reduced MPR. CONCLUSIONS Patients with uncomplicated T2DM have reduced MPR compared with control subjects, despite equivalent LV mass and E/e*. T2DM patients with albuminuria or retinopathy have reduced MPR and increased LV mass and E/e* compared with patients with uncomplicated T2DM. E/e* and MPR are significantly associated after adjustment for age, hypertension, and LV mass, suggesting a link between CMD and cardiac diastolic function. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.org. Unique identifier: NCT02684331.
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Affiliation(s)
- Martin Heyn Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - David Andrew Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Great George St, LS1 3EX, Leeds, UK.,Biomedical Imaging Science Department, University of Leeds, LS2 9JT, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Borgmester Ib Juels Vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Kusy K, Błażejewski J, Gilewski W, Karasek D, Banach J, Bujak R, Zieliński J, Sinkiewicz W, Grześk G. Aging Athlete's Heart: An Echocardiographic Evaluation of Competitive Sprint- versus Endurance-Trained Master Athletes. J Am Soc Echocardiogr 2021; 34:1160-1169. [PMID: 34175421 DOI: 10.1016/j.echo.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sports training triggers exercise-induced cardiac remodeling (EICR). Sprint- and endurance-trained master athletes are exposed to different hemodynamic stimuli accompanied by aging. The aim of this study was to compare EICR types in light of the Morganroth hypothesis, frequency of abnormalities, and relationships between cardiac traits and age. METHODS In this observational cross-sectional study, echocardiographic examinations were conducted in 143 sprint-trained (age range, 36-83 years) and 114 endurance-trained (age range, 38-85 years) competitive master athletes. Structural and functional characteristics were compared with population reference values, and EICR types were identified. Athletic groups were compared using t tests and χ2 tests. Relationships with age were assessed using linear regression. RESULTS In the sprint group, 51.0% of athletes had normal cardiac geometry (nonhypertrophic heart), 4.2% had eccentric hypertrophy, 36.4% had concentric remodeling, and 8.4% had concentric hypertrophy. In their endurance-trained peers, these proportions were 22.8%, 16.7%, 36.8%, and 23.7%, respectively. Many athletes in both groups had structural abnormalities, as assessed using population norms (up to ~81% for septal thickness) but their resting cardiac function was normal. The relationships of structural and functional cardiac characteristics with age were mostly weak to moderate and did not differ between training modalities. CONCLUSIONS Even though many endurance- and sprint-oriented master athletes exceed population norms for cardiac structure, they do not go beyond the "gray zone" and preserve normal cardiac function. Therefore, physiologic adaptations, rather than pathologic abnormalities, are expected in aging but still active athletes. Inconsistent with the Morganroth hypothesis, EICR is shifted toward normal geometry in sprinters and toward concentric remodeling and hypertrophy in endurance runners. A better understanding of the mechanisms behind cardiac remodeling during aging is needed to adequately predict EICR types in master athletes.
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Affiliation(s)
- Krzysztof Kusy
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland.
| | - Jan Błażejewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Wojciech Gilewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Karasek
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Bujak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jacek Zieliński
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland
| | - Władysław Sinkiewicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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9
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Fayol A, Livrozet M, Boutouyrie P, Khettab H, Betton M, Tea V, Blanchard A, Bruno RM, Hulot JS. Cardiac performance in patients hospitalized with COVID-19: a 6 month follow-up study. ESC Heart Fail 2021; 8:2232-2239. [PMID: 33773099 PMCID: PMC8120370 DOI: 10.1002/ehf2.13315] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
Aims Myocardial injury is frequently observed in patients hospitalized with coronavirus disease 2019 (COVID‐19) pneumonia. Different cardiac abnormalities have been reported during the acute COVID‐19 phase, ranging from infra‐clinic elevations of myocardial necrosis biomarkers to acute cardiac dysfunction and myocarditis. There is limited information on late cardiac sequelae in patients who have recovered from acute COVID‐19 illness. We aimed to document the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID‐19 infection. Methods and results We conducted a prospective echocardiographic evaluation of 48 patients (mean age 58 ± 13 years, 69% male) hospitalized 6 ± 1 month earlier for a laboratory‐confirmed and symptomatic COVID‐19. Thirty‐two (66.6%) had pre‐existing cardiovascular risks factors (systemic hypertension, diabetes, or dyslipidaemia), and three patients (6.2%) had a known prior myocardial infarction. Sixteen patients (33.3%) experienced myocardial injury during the index COVID‐19 hospitalization as identified by a rise in cardiac troponin levels. Six months later, 60.4% of patients still reported clinical symptoms including exercise dyspnoea for 56%. Echocardiographic measurements under resting conditions were not different between patients with versus without myocardial injury during the acute COVID‐19 phase. In contrast, low‐level exercise (25W for 3 min) induced a significant increase in the average E/e′ ratio (10.1 ± 4.3 vs. 7.3 ± 11.5, P = 0.01) and the systolic pulmonary artery pressure (33.4 ± 7.8 vs. 25.6 ± 5.3 mmHg, P = 0.02) in patients with myocardial injury during the acute COVID‐19 phase. Sensitivity analyses showed that these alterations of left ventricular diastolic markers were observed regardless of whether of cardiovascular risk factors or established cardiac diseases indicating SARS‐CoV‐2 infection as a primary cause. Conclusions Six months after the acute COVID‐19 phase, significant cardiac diastolic abnormalities are observed in patients who experienced myocardial injury but not in patients without cardiac involvement.
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Affiliation(s)
- Antoine Fayol
- Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Marine Livrozet
- Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Pierre Boutouyrie
- Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.,Department of Pharmacology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Hakim Khettab
- Department of Pharmacology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Maureen Betton
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Victoria Tea
- Department of Cardiology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Anne Blanchard
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Rosa-Maria Bruno
- Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.,Department of Pharmacology and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris, INSERM, PARCC, 56 Rue Leblanc, Paris, F-75015, France.,CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
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10
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Granot Y, Ben-Assa E, Sapir O, Laufer-Perl M, Topilsky Y, Rozenbaum Z. Age-specific mortality risk of mild diastolic dysfunction among hospitalized patients with preserved ejection fraction. Int J Cardiol 2021; 332:216-222. [PMID: 33775792 DOI: 10.1016/j.ijcard.2021.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The conveyed risk of mild diastolic dysfunction (MDD) according to age had not been thoroughly studied. We aimed to investigate the mortality-risk of MDD by age-groups among inpatients with preserved ejection fraction (EF), and determine ranges of diastolic function parameters by prognosis. METHODS In a single-center retrospective study we identified inpatients who underwent echocardiography between 2012 and 2018 and had preserved EF without significant valvulopathies. Propensity scores were used to adjust for baseline characteristics and main diagnoses at discharge. Comparisons for all-cause mortality between MDD and normal diastolic function were conducted by age groups. Using classification and regression trees (CART) modeling we determined age-specific cut-offs according to outcome. RESULTS The cohort consisted of 15,777 inpatients. Mortality rate during a 33.9-months median follow-up was 21.6%. MDD was associated with increased mortality risk among all ages up to 90 years, thereafter no difference was detected. Adjusted hazard ratios inversely related to age - 1.99(95%CI 1.25-3.16, p = 0.004), 1.82(95%CI1.46-2.26, p < 0.001), 1.88(95%CI1.64-2.15, p < 0.001), 1.78(95%CI1.59-2.01, p < 0.001), and 1.32(95%CI0.95-1.83, p = 0.093), for 18-44, 45-59, 60-74, 75-89, and ≥90 years, respectively (Pinteraction = 0.009). New cut-offs of E/e' for ages 75-89(16), e' lateral for ages ≥90(6 cm/s), e' septal for ages 60-74(5 cm/s), and E/A ratio for ages 18-44(1.5), predicted outcome more accurately than guidelines-based recommendations. The remaining cut-offs were not better predictors compared to guidelines-based recommendations. CONCLUSIONS MDD is a consequential finding at all ages up to 90 years among inpatients with preserved EF, although its significance decreases with age. Diastolic function of several age-groups may be better delineated by cut-offs that presage adverse prognoses. Helsinki committee approval number: 0170-17-TLV.
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Affiliation(s)
- Yoav Granot
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eyal Ben-Assa
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Orly Sapir
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA.
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11
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Kim KH, Vallabhajosyula S, Rha SW, Choi BG, Byun JK, Choi CU. Initial diastolic dysfunction is a powerful predictor of 5-year mortality in peripheral arterial disease patients undergoing percutaneous transluminal angioplasty. Heart Vessels 2021; 36:1514-1524. [PMID: 33687543 DOI: 10.1007/s00380-021-01823-0] [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: 01/05/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
Peripheral arterial disease (PAD) and heart failure share common risks and are associated with increased morbidity and mortality. However, it is unknown whether cardiac function can be an independent predictor of long-term mortality in patients with PAD. In total, 902 patients who underwent percutaneous transluminal angioplasty for PAD were enrolled. The patients were categorized into three groups according to the left ventricular ejection fraction (LVEF): reduced EF (< 40%, n = 62); mid-range EF (40-49%, n = 76); and preserved EF (≥ 50%, n = 764). Echocardiographic (EF, ratio of mitral inflow velocity to annular velocity E/e' ≥ 15, and others) and clinical parameters were tested using stepwise logistic regression analysis to determine independent predictors of 5-year mortality. A higher proportion of patients with reduced EF had ischemic heart disease than those with preserved EF (77.4% vs. 56.8%, p < 0.001). Up to 5 years, patients with reduced EF and mid-range EF showed a higher incidence of total death than those with normal EF. However, there was no difference in the incidence of myocardial infarction, stroke, and revascularization among the three groups. After multivariable adjustment, the ratio of E/e' ≥ 15 was the only strong predictor of total mortality (hazard ratio 6.14; 95% confidence interval 3.7-10.1; p < 0.01). Patients with PAD and reduced EF undergoing PTA had a higher incidence of total death during the 5-year follow-up. Initial tissue Doppler E/e' ≥ 15, a non-invasive estimate of left atrial filling pressure, was the only independent predictor of long-term mortality. The relationship between PAD and HF.
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Affiliation(s)
- Kyung-Hee Kim
- Cardiovascular Center, Sejong General Hospital, Incheon, South Korea
| | | | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Seoul, Guro-gu, 08308, South Korea.
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Seoul, Guro-gu, 08308, South Korea
| | - Jae-Kyung Byun
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Seoul, Guro-gu, 08308, South Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Seoul, Guro-gu, 08308, South Korea
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12
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Kapłon-Cieślicka A, Kupczyńska K, Dobrowolski P, Michalski B, Jaguszewski MJ, Banasiak W, Burchardt P, Chrzanowski Ł, Darocha S, Domienik-Karłowicz J, Drożdż J, Fijałkowski M, Filipiak KJ, Gruchała M, Jankowska EA, Jankowski P, Kasprzak JD, Kosmala W, Lipiec P, Mitkowski P, Mizia-Stec K, Szymański P, Tycińska A, Wańha W, Wybraniec M, Witkowski A, Ponikowski P, "Club 30" Of The Polish Cardiac Society OBO. On the search for the right definition of heart failure with preserved ejection fraction. Cardiol J 2020; 27:449-468. [PMID: 32986238 PMCID: PMC8078979 DOI: 10.5603/cj.a2020.0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/21/2020] [Accepted: 09/10/2020] [Indexed: 12/22/2022] Open
Abstract
The definition of heart failure with preserved ejection fraction (HFpEF) has evolved from a clinically based "diagnosis of exclusion" to definitions focused on objective evidence of diastolic dysfunction and/or elevated left ventricular filling pressures. Despite advances in our understanding of HFpEF pathophysiology and the development of more sophisticated imaging modalities, the diagnosis of HFpEF remains challenging, especially in the chronic setting, given that symptoms are provoked by exertion and diagnostic evaluation is largely conducted at rest. Invasive hemodynamic study, and in particular - invasive exercise testing, is considered the reference method for HFpEF diagnosis. However, its use is limited as opposed to the high number of patients with suspected HFpEF. Thus, diagnostic criteria for HFpEF should be principally based on non-invasive measurements. As no single non-invasive variable can adequately corroborate or refute the diagnosis, different combinations of clinical, echocardiographic, and/or biochemical parameters have been introduced. Recent years have brought an abundance of HFpEF definitions. Here, we present and compare four of them: 1) the 2016 European Society of Cardiology criteria for HFpEF; 2) the 2016 echocardiographic algorithm for diagnosing diastolic dysfunction; 3) the 2018 evidence-based H2FPEF score; and 4) the most recent, 2019 Heart Failure Association HFA-PEFF algorithm. These definitions vary in their approach to diagnosis, as well as sensitivity and specificity. Further studies to validate and compare the diagnostic accuracy of HFpEF definitions are warranted. Nevertheless, it seems that the best HFpEF definition would originate from a randomized clinical trial showing a favorable effect of an intervention on prognosis in HFpEF.
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Affiliation(s)
- Agnieszka Kapłon-Cieślicka
- "Club 30", Polish Cardiac Society, Poland.
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Karolina Kupczyńska
- "Club 30", Polish Cardiac Society, Poland
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Piotr Dobrowolski
- "Club 30", Polish Cardiac Society, Poland
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Błażej Michalski
- "Club 30", Polish Cardiac Society, Poland
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Miłosz J Jaguszewski
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Waldemar Banasiak
- "Club 30", Polish Cardiac Society, Poland
- Department of Cardiology, 4th Military Hospital, Wrocław, Poland
| | - Paweł Burchardt
- "Club 30", Polish Cardiac Society, Poland
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland, and Department of Cardiology, J. Strus Hospital, Poznań, Poland
| | - Łukasz Chrzanowski
- "Club 30", Polish Cardiac Society, Poland
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Szymon Darocha
- "Club 30", Polish Cardiac Society, Poland
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Justyna Domienik-Karłowicz
- "Club 30", Polish Cardiac Society, Poland
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Drożdż
- "Club 30", Polish Cardiac Society, Poland
- Department of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Fijałkowski
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Krzysztof J Filipiak
- "Club 30", Polish Cardiac Society, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Gruchała
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Ewa A Jankowska
- "Club 30", Polish Cardiac Society, Poland
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland, and Center for Heart Diseases, University Hospital, Wrocław, Poland
| | - Piotr Jankowski
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jarosław D Kasprzak
- "Club 30", Polish Cardiac Society, Poland
- I Department and Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Wojciech Kosmala
- "Club 30", Polish Cardiac Society, Poland
- Chair and Department of Cardiology, Wroclaw Medical University, Wrocław, Poland, and Center for Heart Diseases, University Hospital, Wrocław, Poland
| | - Piotr Lipiec
- "Club 30", Polish Cardiac Society, Poland
- Department of Rapid Cardiac Diagnostics, Chair of Cardiology, Medical University of Lodz, Łódź, Poland
| | - Przemysław Mitkowski
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, Chair of Cardiology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Katarzyna Mizia-Stec
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr Szymański
- "Club 30", Polish Cardiac Society, Poland
- Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of the Interior in Warsaw, Warsaw, Poland
| | - Agnieszka Tycińska
- "Club 30", Polish Cardiac Society, Poland
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Wojciech Wańha
- "Club 30", Polish Cardiac Society, Poland
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Maciej Wybraniec
- "Club 30", Polish Cardiac Society, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Adam Witkowski
- "Club 30", Polish Cardiac Society, Poland
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Ponikowski
- "Club 30", Polish Cardiac Society, Poland
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland, and Center for Heart Diseases, University Hospital, Wrocław, Poland
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13
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Sud K, Bhatia KS, Vogel B, Bohra C, Argulian E. Prognostic significance of exercise-induced diastolic dysfunction: A systematic review. Echocardiography 2020; 37:1594-1602. [PMID: 32892393 DOI: 10.1111/echo.14841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Recent guidelines recommend diastolic stress testing among patients with unexplained dyspnea. Previous studies have reported exercise related change in diastolic parameters as a prognostic marker for worse outcomes. However, the role of exercise-induced diastolic dysfunction (DD) in predicting adverse outcomes has not been fully established. METHOD We conducted a meta-analysis to explore the prognostic significance of exercise-induced DD. PUBMED/EMBASE/SCOPUS databases were searched for studies reporting adverse outcomes in patients undergoing exercise echocardiography based on diastolic response during exercise. Exercise-induced DD was defined as an increase in E/e' or E/A ratio with stress. Outcomes of interest were cardiovascular mortality or hospitalizations. RESULTS A total of 8 studies were identified, including 4,462 patients who underwent exercise stress echocardiography. The follow-up ranged from 13 months to 5 years. The major indication for stress testing was exertional dyspnea. All studies reported cardiac mortality and hospitalization in the composite outcome. Meta-analysis conducted using random-effects model showed that exercise-induced DD was associated with a higher likelihood of cardiovascular mortality or hospitalization (HR = 1.32, P < .05). Significant heterogeneity was noted among the studies. CONCLUSIONS Exercise-induced DD is associated with worse cardiovascular outcomes. Changes in echocardiographic parameters such as e' with exercise might be useful for risk stratification and identification of high-risk patients.
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Affiliation(s)
- Karan Sud
- Division of Cardiology, Mt Sinai Morningside Hospital, New York, New York, USA
| | | | - Birgit Vogel
- Division of Cardiology, Mt Sinai Morningside Hospital, New York, New York, USA
| | - Chandrashekar Bohra
- Division of Cardiology, Mt Sinai Morningside Hospital, New York, New York, USA
| | - Edgar Argulian
- Division of Cardiology, Mt Sinai Morningside Hospital, New York, New York, USA
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14
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Sunderji I, Singh V, Fraser AG. When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function. Echocardiography 2020; 37:1897-1907. [DOI: 10.1111/echo.14697] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Vickram Singh
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Alan G. Fraser
- Department of Cardiology University Hospital of Wales Cardiff UK
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15
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Grigorescu ED, Lacatusu CM, Floria M, Mihai BM, Cretu I, Sorodoc L. Left Ventricular Diastolic Dysfunction in Type 2 Diabetes-Progress and Perspectives. Diagnostics (Basel) 2019; 9:diagnostics9030121. [PMID: 31533216 PMCID: PMC6787758 DOI: 10.3390/diagnostics9030121] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/17/2022] Open
Abstract
In-depth understanding of early cardiovascular manifestations in diabetes is high on international research and prevention agendas given that cardiovascular events are the leading cause of death for diabetic patients. Our aim was to review recent developments in the echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) as a telltale pre-clinical disturbance preceding diabetic cardiomyopathy. We analyzed papers in which patients had been comprehensively assessed echocardiographically according to the latest LVDD guidelines (2016), and those affording comparisons with previous, widely used recommendations (2009). We found that the updated algorithm for LVDD is more effective in predicting adverse cardiovascular events in patients with established LVDD, and less specific in grading other patients (labelled "indeterminate"). This may prove instrumental for recruiting "indeterminate" LVDD cases among patients with type 2 diabetes mellitus (T2DM) in future screening programs. As an interesting consideration, the elevated values of the index E/e' can point to early diastolic impairment, foretelling diabetic cardiomyopathy. Identifying subclinical signs early makes clinical sense, but the complex nature of T2DM calls for further research. Specifically, longitudinal studies on rigorously selected cohorts of diabetic patients are needed to better understand and predict the subtle, slow onset of cardiac manifestations with T2DM as a complicating backdrop.
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Affiliation(s)
- Elena-Daniela Grigorescu
- Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania (B.-M.M.)
| | - Cristina-Mihaela Lacatusu
- Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania (B.-M.M.)
- “Sf. Spiridon” Emergency Hospital, 700111 Iași, Romania; (M.F.); (L.S.)
- Correspondence: ; Tel.: +40-72-321-1116
| | - Mariana Floria
- “Sf. Spiridon” Emergency Hospital, 700111 Iași, Romania; (M.F.); (L.S.)
- Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Bogdan-Mircea Mihai
- Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania (B.-M.M.)
- “Sf. Spiridon” Emergency Hospital, 700111 Iași, Romania; (M.F.); (L.S.)
| | - Ioana Cretu
- Department Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Laurentiu Sorodoc
- “Sf. Spiridon” Emergency Hospital, 700111 Iași, Romania; (M.F.); (L.S.)
- Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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16
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Chung JW, Seo DI, Park Y, So WY. Echocardiography Evaluation of Left Ventricular Diastolic Function in Elderly Women with Metabolic Syndrome. Open Med (Wars) 2019; 14:633-638. [PMID: 31535035 PMCID: PMC6731540 DOI: 10.1515/med-2019-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/25/2019] [Indexed: 12/04/2022] Open
Abstract
To date, we found no published reports on the effects of metabolic syndrome and physical activity levels on left ventricular (LV) diastolic function in elderly women aged over 65 years. Our study involved patients with echocardiographically normal LV ejection fractions (≥50%) and normal LV dilatation diameters (≤55 mm). Elderly women with metabolic syndrome (n = 20) and healthy elderly women (n = 17) were selected and assessed with the National Cholesterol Education Program Adult Treatment Panel III, a metabolic syndrome diagnostic instrument. We compared the LV function indices and physical activity levels according to the presence (metabolic syndrome group) or absence (normal group) of metabolic syndrome. The LV end-systolic (LVES) diameter was significantly smaller (p = 0.037) and LV outflow tract (LVOT) diameter was significantly larger (p = 0.030) in the metabolic syndrome group. The left arterial dimension at end-systole (p = 0.024), left arterial volume (LAV) index (p = 0.015), early peak mitral inflow velocity (E, p = 0.031), early diastolic mitral annulus motion velocity (E'-septal, p = 0.044), (E'-lateral, p = 0.008), and E/late peak mitral inflow velocity ratio (E/A, p = 0.006) values were significantly lower and physical activity levels (p = 0.034) were significantly higher in the metabolic syndrome group. These results indicated that the metabolic syndrome group had relatively high physical activity levels compared to the normal group, which may have positively affected the LVES, LVOT, left atrial volume index, E, E', and E/A values.
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Affiliation(s)
- Jin-Wook Chung
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Dong-il Seo
- Department of Sport Science, Dongguk University, Gyeongju, Republic of Korea
| | - Yoonjung Park
- Department of Health and Human Performance, College of Liberal Arts and Social Sciences, University of Houston, Texas, USA
| | - Wi-Young So
- College of Humanities and Arts, Sports and Health Care Major, Korea National University of Transportation, 50 Daehak-ro, Chungju-si, Chungbuk 27469, Republic of Korea
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