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Braksator M, Jachymek M, Witkiewicz K, Witkiewicz W, Peregud-Pogorzelska M, Kotfis K, Kaźmierczak J, Brykczyński M. The Impact of Left Ventricular Diastolic Dysfunction on Respiratory Adverse Events in Cardiac Surgery Patients-An Observational Prospective Single-Center Study. J Clin Med 2023; 12:4960. [PMID: 37568361 PMCID: PMC10419440 DOI: 10.3390/jcm12154960] [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: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LV DD) is the most dominant cause of heart failure with preserved ejection fraction (HFpEF) worldwide. This pathological condition may contribute to postcapillary pulmonary hypertension (pcPH) development. Hypoxemia, often observed in pcPH, may significantly negatively impact the course of hospitalization in patients after cardiac surgery. The aim of our study was to investigate the impact of LV DD on the frequency of postoperative respiratory adverse events (RAE) in patients undergoing Coronary Artery Bypass Grafting (CABG). METHODS The left ventricular (LV) diastolic function was assessed in 56 consecutive patients admitted for CABG. We investigated the relationship between LV DD and postoperative respiratory adverse events (RAE) in groups with normal LV diastolic function and LV DD stage I, II, and III. RESULTS Left ventricular diastolic dysfunction stage I was observed in 11 patients (19.6%) and LV DD stage II or III in 19 patients (33.9%). Arterial blood partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) index during postoperative mechanical ventilation was significantly lower in LV DD stage II or III than in the group with normal LV diastolic function. Patients with DD stage II or III had a higher occurrence of postoperative pneumonia than the group with normal LV diastolic function. CONCLUSIONS Left ventricular diastolic dysfunction is widespread in cardiac surgery patients and is an independent risk factor for lower minimal PaO2/FiO2 index during mechanical ventilation and higher occurrence of pneumonia.
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Affiliation(s)
- Marta Braksator
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Magdalena Jachymek
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Karina Witkiewicz
- Department of Pulmonology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Wojciech Witkiewicz
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Małgorzata Peregud-Pogorzelska
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Jarosław Kaźmierczak
- Department of Cardiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (M.B.); (M.J.); (W.W.); (M.P.-P.); (J.K.)
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, University of Zielona Góra, 65-417 Zielona Góra, Poland;
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Kozakova M, Morizzo C, Penno G, Shore AC, Nilsson J, Palombo C. Plasma Homocysteine and Cardiovascular Organ Damage in a Population with a High Prevalence of Risk Factors. J Clin Endocrinol Metab 2020; 105:5846189. [PMID: 32453833 DOI: 10.1210/clinem/dgaa289] [Citation(s) in RCA: 5] [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: 01/26/2020] [Accepted: 05/22/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE It is unclear whether plasma homocysteine (Hcy) has a direct noxious impact on the cardiovascular (CV) system or whether its association with cardiovascular events (CVEs) is mediated by established risk factors. To explore the role of Hcy in CV impairment, the study evaluated cross-sectional relationships between plasma Hcy and indices of CV organ damage together with the associations of these indices with the history of CVEs. METHODS In 269 patients with a high prevalence of diabetes, dyslipidemia, and hypertension, the carotid intima-media thickness, ankle-brachial index (ABI), reactive hyperemic index, carotid-femoral pulse wave velocity (cfPWV), left ventricular (LV) mass, and cardiac index were measured. RESULTS 132 patients had carotid plaque, 31 ABI < 0.90, 126 endothelial dysfunction, 66 increased cfPWV, 125 LV hypertrophy (LVH), 153 decreased cardiac index, and 115 a history of CVEs. Plasma Hcy levels were related to LV mass and ABI, after adjustment for covariates and creatinine. Significantly higher Hcy levels were found in patients with LVH (8.5 [4.4] vs 7.6 [2.8] μmol/L; adjusted P = .001) and ABI < 0.9 (10.4 [3.8] vs 7.9 [3.4] μmol/L; adjusted P = .001) than in those with LV mass and ABI within limits. Hcy levels were comparable between patients with and without carotid plaques, increased arterial stiffness, impaired endothelial, and LV pump function. Within markers of CV organ damage, only LVH was associated with a history of CVEs. CONCLUSION This study demonstrated an independent association between Hcy and LV mass as well as between LVH and a history of CVEs and suggests that LVH may represent 1 of the pathophysiologic links between Hcy and CV risk.
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Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carmela Morizzo
- Department of Surgical, Medical Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Penno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angela C Shore
- Diabetes and Vascular Medicine, NIHR Exeter Clinical Research Facility and University of Exeter Medical School, Exeter, UK
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Carlo Palombo
- Department of Surgical, Medical Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Gancheva R, Kundurdjiev A, Ivanova M, Kundurzhiev T, Kolarov Z. Evaluation of cardiovascular risk in stages of gout by a complex multimodal ultrasonography. Rheumatol Int 2016; 37:121-130. [PMID: 27577941 DOI: 10.1007/s00296-016-3556-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/22/2016] [Indexed: 12/22/2022]
Abstract
The aim of our work was to assess ultrasound features of cardiovascular (CV) risk in stages of gout. Cross-sectional complex multimodal ultrasound study of 169 age-matched patients, with similar distribution of arterial hypertension, diabetes mellitus, obesity and chronic renal failure, was divided into four groups: 41 with asymptomatic hyperuricemia, 52 gout without tophi, 42 gouty tophi and 34 controls with osteoarthritis. Parameters independently associated with CV risk were measured: renal resistive index (RRI), left ventricular mass index (LVMi), mitral annulus early diastolic velocity (e'), intima-media thickness (IMT) and common carotid artery resistive index (CCARI). Multivariate analyses were performed to evaluate the impact of gout stages and CV risk factors on ultrasound alterations. Gouty tophi increased the risk of having IMT >0.90 mm with an OR 11.51 (95 % CI 2.32-57.21, p = 0.003), gout without tophi raised the risk with an OR 6.25 (95 % CI 1.37-28.44, p = 0.018), while asymptomatic hyperuricemia had no effect on IMT. The category of CCARI >0.70 was influenced by tophi with an OR 11.18 (95 % CI 2.61-47.83, p = 0.001) and by arterial hypertension with an OR 3.22 (95 % CI 1.11-9.36, p = 0.032). Neither asymptomatic hyperuricemia nor gout without tophi modified the development of abnormally high CCARI. Gout stages had no impact on LVMi, e' and RRI. Tophi are related to worsened ultrasonographic parameters evaluating target organs in gout, relative to earlier stages of the disease. They create a strong risk of carotid arteries' changes even beyond arterial hypertension.
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Affiliation(s)
- Rada Gancheva
- Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria.
| | - Atanas Kundurdjiev
- Department of Internal Medicine, Medical Faculty, Clinic of Nephrology, Medical University, University Hospital St. Iv. Rilski, 15, Iv. Geshov St., 1431, Sofia, Bulgaria
| | - Mariana Ivanova
- Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria
| | - Todor Kundurzhiev
- Faculty of Public Health, Medical University, 8, Bialo more St., 1527, Sofia, Bulgaria
| | - Zlatimir Kolarov
- Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria
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Lee DH, Park TH, Lee JE, Cho YR, Park K, Park JS, Kim MH, Kim YD. Left atrial function assessed by left atrial strain in patients with left circumflex branch culprit acute myocardial infarction. Echocardiography 2014; 32:1094-100. [PMID: 25363252 DOI: 10.1111/echo.12828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Although left atrium (LA) has played an important role in diastole, ischemic insult of atrium in acute myocardial infarction (AMI) has not been clearly evaluated. METHODS We hypothesized that LA function would be further decreased in AMI patients with a culprit lesion in the left circumflex branch (LCX). This was an observational cohort study in a single university hospital. Echocardiography was performed to evaluate left ventricular diastolic function, LA volume, and LA function. Systolic (LAS ) and late diastolic (LAA ) LA strain were measured using speckle tracking echocardiography. RESULTS Sixty-eight AMI patients treated with emergent or urgent percutaneous coronary intervention were enrolled. Global LAS strain was significantly lower in patients with a culprit lesion in the LCX than culprit lesions in other vessels (left anterior descending, 27.3 ± 6.8%; left circumflex, 20.1 ± 8.9%; right coronary artery, 23.3 ± 6.5%; P = 0.007). LA volume index did not differ significantly (P = 0.093). Other clinical and conventional echocardiographic parameters, including Doppler measurements, did not differ significantly. CONCLUSIONS Global LAS strain was lower in AMI patients with a culprit lesion in the LCX than those with culprit lesions in other vessels, without any significant difference in LA volume index. The lower global LAS strain might suggest decreased LA function resulting from ischemic insult by AMI with culprit lesions in the LCX.
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Affiliation(s)
- Dong Hyun Lee
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Tae-Ho Park
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Jung Eun Lee
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Kyungil Park
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Jong Sung Park
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Moo-Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Young-Dae Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
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Said K, Shehata A, Ashour Z, El-Tobgi S. Value of conventional and tissue Doppler echocardiography in the estimation of left ventricular filling pressure. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2011.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Al-Daydamony MM, Al-Zaky MM, El-Cekelly MM. WITHDRAWN: Value of diastolic motion of the atrioventricular plane in evaluating left ventricular regional diastolic function in patients with acute myocardial infarction. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Seo JM, Park TH, Lee DY, Cho YR, Baek HK, Park JS, Kim MH, Kim YD, Choi SY, Lee SM, Hong YS. Subclinical Myocardial Dysfunction in Metabolic Syndrome Patients without Hypertension. J Cardiovasc Ultrasound 2011; 19:134-9. [PMID: 22073323 PMCID: PMC3209592 DOI: 10.4250/jcu.2011.19.3.134] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/02/2011] [Accepted: 08/17/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate myocardial function in patients with non-hypertensive metabolic syndrome. METHODS We selected metabolic syndrome patients (n = 42) without evidence of hypertension and compared them to age-matched control individuals (n = 20). All patients were evaluated by two-dimensional and tissue Doppler echocardiography including tissue Doppler derived strain and strain rate measurements. RESULTS There were no significant differences between the two groups in mitral E and A inflow velocities or the E/A ratio. However, systolic and early diastolic myocardial velocities, and strain rate were significantly lower in patients with metabolic syndrome than in the control group (all p < 0.05). Multiple stepwise regression analyses revealed that age, waist circumference, and systolic blood pressure were independently associated with peak systolic myocardial velocity. CONCLUSION These results indicate that metabolic syndrome patients without hypertension may have decrease of myocardial systolic and early diastolic velocities on tissue Doppler imaging, even if they appear to have normal systolic and diastolic function on conventional echocardiography.
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Affiliation(s)
- Jeong-Min Seo
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
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Park YS, Park JH, Ahn KT, Jang WI, Park HS, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW. Usefulness of mitral annular systolic velocity in the detection of left ventricular systolic dysfunction: comparison with three dimensional echocardiographic data. J Cardiovasc Ultrasound 2010; 18:1-5. [PMID: 20661328 DOI: 10.4250/jcu.2010.18.1.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 11/06/2009] [Accepted: 02/22/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the modified Simpson's method is widely used for the assessment of left ventricular ejection fraction (LVEF), it has limitations including relatively high inter- and intra-observer variability and time consuming nature. We want to evaluate whether assessing mitral annular systolic velocity (S' velocity) by tissue Doppler imaging (TDI) can be used to evaluate LV systolic function with comparing LVEF by three dimensional echocardiography (3DE). METHODS We examined 3DE and TDI studies of patients between January and August 2008. 3DE LVEF was measured by offline commercial computer software EchoPac PC(R) (GE, Andover, MA, USA). S' velocity was obtained from the medial side with apical four chamber view by pulsed-wave Doppler with TDI. RESULTS We included 125 patients (78 males (62.4%), mean age: 57.5+/-13.0 years). The mean S' velocity was 7.7+/-1.9 cm/s and the mean LVEF was 57.2+/-10.4%. The S' velocity measured by TDI showed a linear correlation with LVEF measured by 3DE (r=0.688, p<0.001). Study patients were divided into two groups according to the presence of LV systolic dysfunction: Group I (normal LVEF), n=102 and Group II (LVEF <50%), n=23. For prediction of significant LV systolic dysfunction by the receiver operating characteristic curve according to S' velocity, the optimal cutoff value was 6.8 cm/s. At this cutoff value, the sensitivity and specificity were 94.1% and 87%, respectively. CONCLUSION In this study, S' velocity measured by TDI showed a significant correlation with three dimensional LVEF and can be used to detect patients with LV systolic dysfunction.
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Affiliation(s)
- Yun Seon Park
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
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Kim DH, Kim YJ, Kim HK, Chang SA, Kim MS, Sohn DW, Oh BH, Park YB. Usefulness of mitral annulus velocity for the early detection of left ventricular dysfunction in a rat model of diabetic cardiomyopathy. J Cardiovasc Ultrasound 2010; 18:6-11. [PMID: 20661329 DOI: 10.4250/jcu.2010.18.1.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/06/2009] [Accepted: 02/22/2010] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diabetic cardiomyopathy (DMCMP) is characterized by myocardial dysfunction regardless of coronary artery disease in diabetic patients. The features of LV dysfunction in rat model of type 1 DM induced by streptozocin, are variable and controversial. Thus, we tested the usefulness of tissue Doppler imaging in the early detection of ventricular dysfunction in a rat model of DMCMP. METHODS Diabetes was induced by intra-peritoneal injection of streptozocin (70 mg/kg) in 8 weeks of Sprague-Dawley rat. Diagnosis of diabetes was defined as venous glucose level over 350 mg/dL 48 hrs after streptozocin injection. Echocardiography was done at baseline and 10 weeks after diabetes induction both in diabetes group (n=15) and normal control (n=10). After echocardiography at 10 weeks, invasive hemodynamic measurement using miniaturized conductance catheter was done in both groups. RESULTS Ten weeks after diabetes induction, heart and lung mass indexes of diabetes were larger than those of normal control (3.2+/-0.3 vs. 2.4+/-0.2 mg/g, p<0.001, 5.5+/-1.1 vs. 3.6+/-0.6 mg/g, p<0.001, respectively). In echocardiographic data, s' (2.4+/-0.4 vs. 3.1+/-0.5 cm/s, p<0.001), e' velocity of mitral annulus (2.9+/-0.6 vs. 3.8+/-1.1 cm/s, p<0.001), and E/e' ratio (27.1+/-5.6 vs. 19.7+/-2.6, p<0.001) were impaired in diabetes group. In hemodynamic measurement, there were no differences in ejection fraction, peak dP/dt between the diabetic group and normal control. However, load independent indexes of contractility, the slope of the end-systolic pressure volume relation (0.18+/-0.07 vs. 0.62+/-0.18 mmHg/microL, p<0.001) and preload recruitable stroke work (51.8+/-22.0 vs. 90.9+/-22.5 mmHg, p<0.001) were impaired in diabetic group compared to normal control. CONCLUSION In a rat model of diabetic cardiomyopathy, tissue Doppler imaging of mitral annulus can be a good modality for early detection of myocardial dysfunction.
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Affiliation(s)
- Dae-Hee Kim
- Cardiovascular Center, Seoul National University Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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