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Rydman R, Shiina Y, Diller GP, Niwa K, Li W, Uemura H, Uebing A, Barbero U, Bouzas B, Ernst S, Wong T, Pennell DJ, Gatzoulis MA, Babu-Narayan SV. Major adverse events and atrial tachycardia in Ebstein's anomaly predicted by cardiovascular magnetic resonance. Heart 2017; 104:37-44. [PMID: 28684436 PMCID: PMC5749347 DOI: 10.1136/heartjnl-2017-311274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Patients with Ebstein’s anomaly of the tricuspid valve (EA) are at risk of tachyarrhythmia, congestive heart failure and sudden cardiac death. We sought to determine the value of cardiovascular magnetic resonance (CMR) for predicting these outcomes. Methods Seventy-nine consecutive adult patients (aged 37±15 years) with unrepaired EA underwent CMR and were followed prospectively for a median 3.4 (range 0.4–10.9) years for clinical outcomes, namely major adverse cardiovascular events (MACEs: sustained ventricular tachycardia/heart failure hospital admission/cardiac transplantation/death) and first-onset atrial tachyarrhythmia (AT). Results CMR-derived variables associated with MACE (n=6) were right ventricular (RV) or left ventricular (LV) ejection fraction (EF) (HR 2.06, 95% CI 1.168 to 3.623, p=0.012 and HR 2.35, 95% CI 1.348 to 4.082, p=0.003, respectively), LV stroke volume index (HR 2.82, 95% CI 1.212 to 7.092, p=0.028) and cardiac index (HR 1.71, 95% CI 1.002 to 1.366, p=0.037); all remained significant when tested solely for mortality. History of AT (HR 11.16, 95% CI 1.30 to 95.81, p=0.028) and New York Heart Association class >2 (HR 7.66, 95% CI 1.54 to 38.20, p=0.013) were also associated with MACE; AT preceded all but one MACE, suggesting its potential role as an early marker of adverse outcome (p=0.011). CMR variables associated with first-onset AT (n=17; 21.5%) included RVEF (HR 1.55, 95% CI 1.103 to 2.160, p=0.011), total R/L volume index (HR 1.18, 95% CI 1.06 to 1.32, p=0.002), RV/LV end diastolic volume ratio (HR 1.55, 95% CI 1.14 to 2.10, p=0.005) and apical septal leaflet displacement/total LV septal length (HR 1.03, 95% CI 1.00 to 1.07, p=0.041); the latter two combined enhanced risk prediction (HR 6.12, 95% CI 1.67 to 22.56, p=0.007). Conclusion CMR-derived indices carry prognostic information regarding MACE and first-onset AT among adults with unrepaired EA. CMR may be included in the periodic surveillance of these patients.
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Affiliation(s)
- Riikka Rydman
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,Department of Molecular Medicine and Surgery, Section of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Yumi Shiina
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,Cardiovascular Centre, St. Luke's International Hospital, Tokyo, Japan
| | - Gerhard-Paul Diller
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,National Heart and Lung Institute, Imperial College, London, England.,Department of Cardiovascular Medicine, Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Koichiro Niwa
- Cardiovascular Centre, St. Luke's International Hospital, Tokyo, Japan
| | - Wei Li
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England
| | - Hideki Uemura
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England
| | - Anselm Uebing
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England
| | - Umberto Barbero
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Beatriz Bouzas
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England
| | - Sabine Ernst
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,National Heart and Lung Institute, Imperial College, London, England
| | - Tom Wong
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,National Heart and Lung Institute, Imperial College, London, England
| | - Michael A Gatzoulis
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,National Heart and Lung Institute, Imperial College, London, England
| | - Sonya V Babu-Narayan
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, England.,National Heart and Lung Institute, Imperial College, London, England
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Velasco C, Bautista-Hernandez V, Sacristán F, Bouzas B, Portela F, Cuenca JJ. Combined aortic and pulmonic stenosis in an octogenarian: findings from echocardiography, catheterization, and pathology. Circulation 2014; 129:614-5. [PMID: 24493808 DOI: 10.1161/circulationaha.113.005415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos Velasco
- Departments of Cardiovascular Surgery (C.V., V.B.-H., F.P., J.J.C.), Pathology (F.S.), and Cardiology (B.B.), Área de Gestión Integrada de A Coruña, A Coruña, Spain; and Department of Surgery, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (V.B.-H.)
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Shiina Y, Li W, Bouzas B, Rydman R, Kempny A, Karonis T, Tutarel O, Gatzoulis MA, Kilner PJ, Babu-Narayan SV. Cardiac index, left ventricular longitudinal systolic function and atrialised right ventricle size affect exercise capacity in adults with Ebsteins anomaly. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Lee CM, Sheehan FH, Bouzas B, Chen SS, Gatzoulis MA, Kilner PJ. The shape and function of the right ventricle in Ebstein's anomaly. Int J Cardiol 2013; 167:704-10. [DOI: 10.1016/j.ijcard.2012.03.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 03/02/2012] [Accepted: 03/03/2012] [Indexed: 11/27/2022]
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5
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Bautista-Hernandez V, Velasco C, Fernandez L, Garcia-Monje MJ, Solla M, Bouzas B, Fojon S, Cuenca JJ. Spontaneous left atrial hematoma mimicking an acute aortic syndrome: the utility of high-resolution computed tomography. Circulation 2012; 125:1710-2. [PMID: 22474314 DOI: 10.1161/circulationaha.111.059519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victor Bautista-Hernandez
- Department of Cardiovascular Surgery, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba No. 84, A Coruña, Spain.
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Arévalo A, Da Cunha M, Piñón P, Bouzas B, Rivera S, Martínez V, Pombo J, Doval L. La importancia de un soplo tricuspídeo. Rev Clin Esp 2010; 210:e4-6. [DOI: 10.1016/j.rce.2009.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/19/2009] [Accepted: 11/27/2009] [Indexed: 11/30/2022]
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Bouzas-Mosquera A, Peteiro J, Álvarez-García N, Broullón FJ, García-Bueno L, Ferro L, Pérez R, Bouzas B, Fábregas R, Castro-Beiras A. Prognostic Value of Exercise Echocardiography in Patients With Left Bundle Branch Block. JACC Cardiovasc Imaging 2009; 2:251-9. [DOI: 10.1016/j.jcmg.2008.11.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 11/04/2008] [Indexed: 11/30/2022]
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Dumont CA, Monserrat L, Soler R, Rodriguez E, Peteiro J, Fernández X, Rodríguez A, Pérez R, Bouzas B, Castro-Beiras A. Left Ventricular Asynchrony in Patients with Hypertrophic Cardiomyopathy: Its Determinants and its Relation to Left Ventricular Function. J Am Soc Echocardiogr 2007; 20:1247-52. [PMID: 17604956 DOI: 10.1016/j.echo.2007.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 11/15/2022]
Affiliation(s)
- Carlos A Dumont
- Division of Cardiology, Juan Canalejo Hospital, La Coruña, Spain
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Peteiro J, Bouzas B, Soler R, Perez-Gomez A. Images in cardiovascular medicine. Pseudomitral intraventricular valve. Circulation 2007; 116:e306-7. [PMID: 17709645 DOI: 10.1161/circulationaha.107.700799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jesús Peteiro
- Unit of Echocardiography and Department of Cardiology, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain.
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Broberg CS, Ujita M, Prasad S, Li W, Rubens M, Bax BE, Davidson SJ, Bouzas B, Gibbs JSR, Burman J, Gatzoulis MA. Pulmonary arterial thrombosis in eisenmenger syndrome is associated with biventricular dysfunction and decreased pulmonary flow velocity. J Am Coll Cardiol 2007; 50:634-42. [PMID: 17692749 DOI: 10.1016/j.jacc.2007.04.056] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 04/10/2007] [Accepted: 04/15/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to determine what factors are associated with pulmonary artery thrombi in Eisenmenger patients. BACKGROUND Pulmonary artery thrombosis is common in Eisenmenger syndrome, although its underlying pathophysiology is poorly understood. METHODS Adult patients with Eisenmenger syndrome underwent computed tomography pulmonary angiography, cardiac magnetic resonance imaging, and echocardiography. Measurement of ventricular function, pulmonary artery size, and pulmonary artery blood flow were obtained. Hypercoagulability screening and platelet function assays were performed. RESULTS Of 55 consecutive patients, 11 (20%) had a detectable thrombus. These patients were older (p = 0.032), but did not differ in oxygen saturation, hemoglobin, or hematocrit from those without thrombus. Right ventricular ejection fraction by magnetic resonance imaging was lower in those with thrombus (0.41 +/- 0.15 vs. 0.53 +/- 0.13, p = 0.017), as was left ventricular ejection fraction (0.48 +/- 0.12 vs. 0.60 +/- 0.09, p = 0.002), a finding corroborated by tissue Doppler and increased brain natriuretic peptide. Those with thrombus also had a larger main pulmonary artery diameter (48 +/- 14 mm vs. 38 +/- 9 mm, p = 0.007) and a lower peak systolic velocity in the pulmonary artery (p = 0.003). There were no differences in clotting factors, platelet function, or bronchial arteries between groups. Logistic regression showed pulmonary artery velocity to be independently associated with thrombosis. CONCLUSIONS Pulmonary arterial thrombosis among adults with Eisenmenger syndrome is common and relates to older age, biventricular dysfunction, and slow pulmonary artery blood flow rather than degree of cyanosis or coagulation abnormalities. Further work to define treatment efficacy is needed.
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Affiliation(s)
- Craig S Broberg
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and National Heart Lung Institute, Imperial College School of Medicine, London, England.
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Mosquera VX, Portela F, Zavanella C, Juffé A, Raposo I, Bouzas B. [Reconstruction of the right ventricular outflow tract using a Medtronic Freestyle aortic root bioprosthesis]. Rev Esp Cardiol 2007; 60:656-9. [PMID: 17580055 DOI: 10.1157/13107123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uncorrected, long-term pulmonary regurgitation leads to right ventricular dilatation and dysfunction in a significant percentage of patients. We used magnetic resonance imaging (MRI) before and after surgery to assess the effect of pulmonary valve replacement with the Medtronic Freestyle bioprosthesis on right ventricular function and volume in nine patients with pulmonary regurgitation or stenosis. Mean follow-up time was 26 (10) months. We observed a decrease in mean end-diastolic volume from 143.6 (85.1) mL/m2 to 74.1 (12.6) mL/m2 (P=.018) and, in end-systolic volume from 88.0 (50.3) mL/m2 to 35.8 (19.3) mL/m2 (P=.016). In pulmonary valve disease, extensive follow-up by MRI is essential for timely evaluation of the degree of right ventricular dilation or dysfunction and for selecting a suitable time for valve replacement. The Medtronic Freestyle bioprosthesis is a good surgical choice for pulmonary valve replacement as its use is associated with low morbidity and mortality and the successful normalization of ventricular volumes.
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Affiliation(s)
- Víctor X Mosquera
- Servicio de Cirugía Cardiaca, Servicio de Cardiología, Hospital Juan Canalejo, A Coruña, Spain.
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Peteiro J, Bouzas B. Stress echocardiography compared to exercise ECG for the assessment of acute coronary syndrome. Eur Heart J 2007; 28:1912; author reply 1912. [PMID: 17606469 DOI: 10.1093/eurheartj/ehm185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dumont CA, Monserrat L, Peteiro J, Soler R, Rodriguez E, Bouzas A, Fernández X, Pérez R, Bouzas B, Castro-Beiras A. Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy. Am J Cardiol 2007; 99:1454-7. [PMID: 17493479 DOI: 10.1016/j.amjcard.2006.12.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/20/2022]
Abstract
The degree of exercise capacity is poorly predicted by conventional markers of disease severity in patients with hypertrophic cardiomyopathy (HC). The principal mechanism of exercise intolerance in patients with HC is the failure of stroke volume augmentation due to left ventricular (LV) diastolic dysfunction. The role of LV chamber stiffness, assessed noninvasively, as a determinant of exercise tolerance is unknown. Sixty-four patients with HC were studied with Doppler echocardiography, exercise testing, and gadolinium cardiac magnetic resonance. The LV chamber stiffness index was determined as the ratio of pulmonary capillary wedge pressure (derived from the E/Ea ratio) to LV end-diastolic volume (assessed by cardiac magnetic resonance). Maximal exercise tolerance was defined as achieved METs. There were inverse correlations between METs achieved and age (r = -0.38, p = 0.003), heart rate deficit (r = -0.39, p = 0.002), LV outflow tract gradient (r = -0.33, p = 0.009), the E/Ea ratio (r = -0.4, p = 0.001), mean LV wall thickness (r = -0.26, p = 0.04), and LV stiffness (r = -0.56, p <0.001) and a positive correlation between METs achieved and LV end-diastolic volume (r = 0.33, p = 0.01). On multivariate analysis, only LV chamber stiffness was associated with exercise capacity. A LV stiffness level of 0.18 mm Hg/ml had 100% sensitivity and 75% specificity (area under the curve 0.84) for predicting < or =7 METs achieved. In conclusion, LV diastolic dysfunction at rest, as manifested by increased LV chamber stiffness, is a major determinant of maximal exercise capacity in patients with HC.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Analysis of Variance
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/physiopathology
- Contrast Media
- Echocardiography, Doppler, Color
- Exercise Test
- Exercise Tolerance
- Female
- Gadolinium DTPA
- Heart Rate
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Pulmonary Wedge Pressure
- Regression Analysis
- Research Design
- Rest
- Sensitivity and Specificity
- Severity of Illness Index
- Stroke Volume
- Vascular Resistance
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
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Peteiro J, Monserrrat L, Bouzas B, Mariñas J, Castro-Beiras A. Risk Stratification by Treadmill Exercise Echocardiography in Patients with Excellent Exercise Capacity. Echocardiography 2007; 24:385-92. [PMID: 17381647 DOI: 10.1111/j.1540-8175.2006.00407.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The incremental value of exercise echocardiography (EE) has been demonstrated to be maximal in patients with moderate pretest probability for coronary artery disease, but there is a lack of data in patients with low pretest probability or patients with good functional capacity. METHODS To investigate whether such incremental value is maintained in patients with excellent exercise capacity, we studied 1,433 patients who had excellent exercise capacity (>or=8 METs for women, >or=10 METs for men). RESULTS During a follow-up of 2.3 +/- 1.5 years, 42 hard events occurred (cardiac death or nonfatal myocardial infarction). Variables independently associated to hard events were male gender (P = 0.04), % of the age-predicted maximum heart rate (P = 0.02), chronotropic reserve (P = 0.002), and abnormal EE (P = 0.03; incremental P value of EE = 0.03). CONCLUSIONS EE has incremental value over clinical variables, resting echocardiography, and exercise testing variables in patients with excellent exercise capacity. EE may be preferable to ECG exercise testing even in patients expected to have good exercise capacity.
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Affiliation(s)
- Jesús Peteiro
- Unit of Echocardiography and Department of Cardiology, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain.
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Peteiro J, Monserrat L, Piñón P, Bouzas A, Campos R, Mosquera I, Mariñas J, Bouzas B, Castro-Beiras A. Valor pronóstico de la regurgitación mitral en reposo y ejercicio durante la ecocardiografía de ejercicio en pacientes con disfunción ventricular izquierda. Rev Esp Cardiol 2007. [DOI: 10.1157/13100274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peteiro J, Monserrat L, Piñón P, Bouzas A, Campos R, Mosquera I, Mariñas J, Bouzas B, Castro-Beiras A. [Value of resting and exercise mitral regurgitation during exercise echocardiography to predict outcome in patients with left ventricular dysfunction]. Rev Esp Cardiol 2007; 60:234-43. [PMID: 17394868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES The relative value of exercise echocardiography (EE) over resting echocardiography when this last incorporates information on mitral regurgitation (MR) is unknown. Furthermore, limited data exists regarding to the value of MR worsening during exercise in patients with LV dysfunction. We investigated whether: a) EE has incremental value over a resting echo-Doppler study; and b) post-exercise MR increments the value of EE for predicting outcome in patients with LV dysfunction. METHODS 388 consecutive patients with LV dysfunction (LV ejection fraction <50%) were followed for 2.1 (1.5) years. There were 46 hard events (myocardial infarction in 10 and cardiac death in 36). RESULTS There were 43 events in 319 patients with abnormal EE vs 3 events in 69 patients with normal EE (13% vs 4%, P=.04), whereas there were 20 events in the 103 patients with at least moderate resting MR vs 26 events in the 288 with no/mild MR (19% vs 9%, P=.006). Resting MR, peak heart rate x blood pressure, and n masculine of diseased territories on EE were independently associated to hard events. The same variables and MR worsening were independently associated to cardiac death. CONCLUSIONS EE maintains its higher prognostic value over resting echocardiography even when this last incorporates information on MR. MR worsening increments the value of EE for predicting cardiac death in patients with LV dysfunction.
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Affiliation(s)
- Jesús Peteiro
- Unidad de Ecocardiografía, Hospital Juan Canalejo, Universidad de A Coruña, A Coruña, Spain.
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Laredo R, Monserrat L, Hermida-Prieto M, Fernández X, Rodríguez I, Cazón L, Alvariño I, Dumont C, Piñón P, Peteiro J, Bouzas B, Castro-Beiras A. [Beta-myosin heavy-chain gene mutations in patients with hypertrophic cardiomyopathy]. Rev Esp Cardiol 2007; 59:1008-18. [PMID: 17125710 DOI: 10.1157/13093977] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine the frequency of mutations in the beta-myosin heavy-chain gene (MYH7) in a cohort of patients with hypertrophic cardiomyopathy (HCM) and their families, and to investigate correlations between genotype and phenotype. METHODS Single-strand conformation polymorphism analysis and sequencing of fragments with abnormal MYH7 gene mobility were carried out in 128 consecutive index patients with HCM. The phenotypes of patients with and without mutations were compared and the phenotypes of identified families were recorded. RESULTS A total of 11 mutations were found in 13 families (10%); 7/11 had been previously described. The I736T mutation was found in three families and the A797T in two. One patient had two mutations (i.e., I736T and R787H). Mutations were more frequent in patients with a family history of sudden death (31%) and in those with severe hypertrophy (39% had a thickness > or = 30 mm). Mutations were found in 29 of 42 members of the 13 families, including six family members (20%) who were healthy carriers and aged < or = 36 years. Sudden death had occurred in eight members of four families: four in two families with the I736T mutation, one in a family with A797T, one in a family with R870H, and two in a family with A901P. CONCLUSIONS MYH7 mutations were present in 10% of our families. Mutations were more frequent in patients with a family history of sudden death and in those with severe hypertrophy. Most mutations had been described previously. Some appeared in several families. For some mutations, the correlation between genotype and phenotype was stable, while for others, there were marked differences between the phenotypes of the index patients and their relatives, suggesting the presence of additional genetic factors that have yet to be identified.
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Affiliation(s)
- Rafael Laredo
- Servicio de Cardiología, Complejo Hospitalario Universitario Juan Canalejo e Instituto Universitario de Ciencias de la Salud de la Universidad de A Coruña, A Coruña, Spain
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Peteiro J, Bendayan I, Mariñas J, Campos R, Bouzas B, Castro-Beiras A. Prognostic value of mitral regurgitation assessment during exercise echocardiography in patients with left ventricular dysfunction: A follow-up study of 1.7±1.5 years☆. European Journal of Echocardiography 2007; 9:18-25. [PMID: 17241820 DOI: 10.1016/j.euje.2006.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS The value of exercise echocardiography (EE) over resting echocardiography when this last incorporates information on mitral regurgitation (MR) is only partially known. Furthermore, limited data exist regarding the value of MR worsening during exercise in patients with left ventricular (LV) dysfunction. We investigate whether EE has incremental value over a resting echo-Doppler study; and whether post-exercise MR increments the value of EE for predicting outcome in patients with LV dysfunction. METHODS AND RESULTS Three hundred and twenty-three consecutive patients with LV dysfunction (LV ejection fraction < or =45%) referred for EE were followed for 1.7 +/- 1.5 years. There were 43 hard events (myocardial infarction in 9 and cardiac death in 34). Resting MR, peak heart rate x blood pressure, and number of involved territories at exercise were independently associated to hard events (incremental P-value of EE =0.02). Independent variables associated to cardiac death were resting MR, peak heart rate x blood pressure, peak wall motion score index, and MR worsening (incremental P-value of MR worsening = 0.04). CONCLUSIONS EE maintains its prognostic value over resting echocardiography even when this last incorporates information on MR. Exercise-induced MR worsening has independent prognostic value for cardiac death in patients with LV dysfunction.
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Affiliation(s)
- Jesús Peteiro
- Unit of Echocardiography, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain.
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernández X, Peteiro J, Bouzas B, Piñón P, Castro-Beiras A. Significado clínico del realce tardío de gadolinio con resonancia magnética en pacientes con miocardiopatía hipertrófica. Rev Esp Cardiol 2007. [DOI: 10.1157/13097921] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernández X, Peteiro J, Bouzas B, Piñón P, Castro-Beiras A. [Clinical significance of late gadolinium enhancement on cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy]. Rev Esp Cardiol 2007; 60:15-23. [PMID: 17288951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES In patients with hypertrophic cardiomyopathy, myocardial fibrosis can be detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. We investigated the relationships between the extent of LGE, left ventricular morphology and function, and clinical characteristics. METHODS Both cine and gadolinium-enhanced magnetic resonance imaging were performed in 104 patients with hypertrophic cardiomyopathy. RESULTS Fifty patients (48%) showed LGE (range: 1-11 segments). The extent of LGE was positively correlated with maximum left ventricular wall thickness (r=0.53, P< .001), left ventricular mass (r=0.41, P< .001), and the number of hypokinetic segments (r=0.51, P< .001), and inversely correlated with ejection fraction (r=-0.32, P=.001), the magnitude of the subaortic gradient increase during exercise echocardiography (r=-0.26, P=.023), and age at diagnosis (r=-0.20, P=.04). Four of the five patients with an ischemic response on exercise echocardiography had > or =3 segments showing LGE (P=.003). Severe hypertrophy (i.e., > or =30 mm) and nonsustained ventricular tachycardia occurred more frequently as the number of LGE segments increased (P< .001 and P=.04, respectively). CONCLUSIONS Extensive LGE reflects greater disease expression. It is associated with more severe myocardial damage (i.e., a lower ejection fraction and a larger number of hypokinetic segments) and with adverse clinical characteristics (e.g., young age at diagnosis, severe hypertrophy, nonsustained ventricular tachycardia, and an ischemic response on exercise), suggesting that it may be closely linked to prognosis.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/pathology
- Cardiomyopathy, Hypertrophic/physiopathology
- Chi-Square Distribution
- Child
- Contrast Media
- Death, Sudden, Cardiac/etiology
- Echocardiography, Stress/methods
- Female
- Gadolinium DTPA
- Humans
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine/methods
- Male
- Middle Aged
- Myocardium/pathology
- Prognosis
- Regression Analysis
- Risk Factors
- Stroke Volume/physiology
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Carlos A Dumont
- Servicio de Cardiología, Hospital Juan Canalejo, A Coruña, Spain
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Peteiro JC, Monserrat L, Bouzas A, Piñon P, Mariñas J, Bouzas B, Castro-Beiras A. Risk stratification by treadmill exercise echocardiography. J Am Soc Echocardiogr 2006; 19:894-901. [PMID: 16824999 DOI: 10.1016/j.echo.2006.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although exercise echocardiography (EE) has value for the diagnosis of coronary artery disease (CAD), it's not clear whether it may be useful for risk assessment in all categories of patients. To determine whether: 1) there is an incremental value of EE over clinical, exercise and resting echocardiographic variables for the prediction of events according to the pre-test probability of CAD; and 2) the number, location of the diseased territories, and nature of the disease affect the risk stratification, we studied 2436 patients referred for EE that were followed for 2.1 +/- 1.5 years. METHODS Based on a pre-test score, previous myocardial infarction (MI) or revascularizations, 1242 patients were considered as having high, 1038 moderate, and 156 low pre-test probability. RESULTS There were 89 hard events (myocardial infarction or cardiovascular death) in the 1203 patients with abnormal EE vs. 31 events in the 1233 with normal EE (p < 0.0001). Gender, Mets, heart rate x blood pressure, resting wall motion score index and number of involved territories at exercise were independently associated to hard events (final Chi-square = 170, incremental p value of exercise echo <0.0001). The incremental value of exercise echo over other variables was found in patients with the different pre-test probabilities. CONCLUSIONS Exercise echocardiography has incremental value over clinical, exercise and resting echocardiographic variables in patients with different pre-test probabilities of CAD.
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Affiliation(s)
- Jesús C Peteiro
- Unit of Echocardiography and Department of Cardiology, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain.
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernandez X, Peteiro J, Bouzas A, Bouzas B, Castro-Beiras A. Interpretation of electrocardiographic abnormalities in hypertrophic cardiomyopathy with cardiac magnetic resonance. Eur Heart J 2006; 27:1725-31. [PMID: 16774982 DOI: 10.1093/eurheartj/ehl101] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS To clarify the mechanisms of electrocardiographic abnormalities in hypertrophic cardiomyopathy, 102 patients were examined with cardiac magnetic resonance. Distribution and magnitude of hypertrophy and late-enhancement were correlated with electrocardiographic abnormalities. METHODS AND RESULTS Abnormal Q waves were associated with greater upper anterior septal thickness (22+/-7 mm vs. 18+/-5 mm, P=0.001) and increased ratios of upper anterior septum to mean inferolateral (P=0.01), anterolateral (P=0.002), apical (P=0.001), and right ventricular (P=0.001) wall thickness. There was no relation between abnormal Q waves and late-enhancement, except for Q waves >/=40 ms (P=0.02). Conduction disturbances and absent septal Q waves were associated with late-enhancement (89 vs. 45%, P=0.01 and 75 vs. 39%, P=0.002, respectively). The depth of negative T waves was related to an increased ratio of the mean thickness between apical and basal level (P=0.01), and to the presence of apical late-enhancement (P=0.03). CONCLUSION Abnormal Q waves reflect the interrelation between upper anterior septal thickness and other regions of the left and right ventricles, and wider Q waves are associated with late-enhancement. Conduction disturbances and absent septal Q waves are associated with late-enhancement. The depth of negative T waves is related to craniocaudal asymmetry and apical late-enhancement.
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Affiliation(s)
- Carlos A Dumont
- Department of Cardiology, Juan Canalejo Hospital, Xubias de Arriba 84, 15006 La Coruña, Spain
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23
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Diller GP, Dimopoulos K, Okonko D, Li W, Babu-Narayan SV, Broberg CS, Johansson B, Bouzas B, Mullen MJ, Poole-Wilson PA, Francis DP, Gatzoulis MA. Exercise Intolerance in Adult Congenital Heart Disease. Circulation 2005; 112:828-35. [PMID: 16061735 DOI: 10.1161/circulationaha.104.529800] [Citation(s) in RCA: 555] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although some patients with adult congenital heart disease (ACHD) report limitations in exercise capacity, we hypothesized that depressed exercise capacity may be more widespread than superficially evident during clinical consultation and could be a means of assessing risk. METHODS AND RESULTS Cardiopulmonary exercise testing was performed in 335 consecutive ACHD patients (age, 33+/-13 years), 40 non-congenital heart failure patients (age, 58+/-15 years), and 11 young (age, 29+/-5 years) and 12 older (age, 59+/-9 years) healthy subjects. Peak oxygen consumption (peak VO2) was reduced in ACHD patients compared with healthy subjects of similar age (21.7+/-8.5 versus 45.1+/-8.6; P<0.001). No significant difference in peak VO2 was found between ACHD and heart failure patients of corresponding NYHA class (P=NS for each NYHA class). Within ACHD subgroups, peak VO2 gradually declined from aortic coarctation (28.7+/-10.4) to Eisenmenger (11.5+/-3.6) patients (P<0.001). Multivariable correlates of peak VO2 were peak heart rate (r=0.33), forced expiratory volume (r=0.33), pulmonary hypertension (r=-0.26), gender (r=-0.23), and body mass index (r=-0.19). After a median follow-up of 10 months, 62 patients (18.5%) were hospitalized or had died. On multivariable Cox analysis, peak VO2 predicted hospitalization or death (hazard ratio, 0.937; P=0.01) and was related to the frequency and duration of hospitalization (P=0.01 for each). CONCLUSIONS Exercise capacity is depressed in ACHD patients (even in allegedly asymptomatic patients) on a par with chronic heart failure subjects. Lack of heart rate response to exercise, pulmonary arterial hypertension, and impaired pulmonary function are important correlates of exercise capacity, as is underlying cardiac anatomy. Poor exercise capacity identifies ACHD patients at risk for hospitalization or death.
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Affiliation(s)
- Gerhard-Paul Diller
- Adult Congenital Heart Program, Department of Cardiology, Royal Brompton Hospital, London, UK
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25
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Bouzas B, Gatzoulis MA. [Pulmonary arterial hypertension in adults with congenital heart disease]. Rev Esp Cardiol 2005; 58:465-9. [PMID: 15899189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Pulmonary arterial hypertension is a chronic, persistent elevation in pulmonary artery pressure without evidence of left heart failure. Pulmonary hypertension is common in patients with adult congenital heart disease and is usually the result of an increase of pulmonary blood flow through a large left to right shunt. This condition is progressive and patients are symptomatic and usually die between the third and fifth decades of life. To date, there is no standardized treatment for this condition and a general policy of non-intervention to avoid destabilization of the balanced physiology is recommended. Intravenous prostanoids have been shown to have an effect but they are invasive and associated with major side effects. Lung and combined heart and lung transplantation might be a therapeutic option for selected patients. However, donor shortage is a major issue. Oral advanced therapies have been recently shown to improve haemodynamics and survival in idiopathic pulmonary hypertension or in pulmonary hypertension related to scleroderma and may have a role in patients with pulmonary hypertension secondary to congenital heart disease.
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Abstract
Insufficiency of any of the four cardiac valves is a common cause of heart failure in children. Progression of ventricular dysfunction can be predictable, but requires thorough understanding of valvar disease. In valvar regurgitation, the heart has to cope with an increased volume of blood. The pathophysiological sequence is similar for both the right and the left heart. There is initially an increase in end-diastolic volume, followed by an increase in end-systolic volume, and at the end, a decrease in the shortening and ejection fractions. Different compensatory mechanisms and pathophysiologic adaptations develop to maintain the stroke volume for each type of valvar insufficiency, but heart failure eventually ensues. When symptoms of heart failure develop, irreversible ventricular dysfunction is often established, and outcome after surgery may ultimately be compromised. Discerning the optimal time for intervention, before irreversible ventricular dysfunction develops, is a key point in the management of regurgitant valvar heart disease.
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Affiliation(s)
- Beatriz Bouzas
- Adult Congenital Heart Program, Royal Brompton Hospital, London, United Kingdom
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27
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Abstract
Pulmonary regurgitation (PR) is a common complication after surgical or percutaneous relief of pulmonary stenosis and following repair of tetralogy of Fallot. Significant PR is usually well tolerated in childhood. However, in the long term, chronic PR has a detrimental effect on right ventricular (RV) function and exercise capacity and leads to an increased risk of arrhythmia and sudden cardiac death (SCD). Recent advances in non-invasive imaging and, in particular, wider availability of cardiovascular magnetic resonance (CMR), have improved the assessment of PR and RV function in these patients. This in turn has facilitated decision making on the optimal timing for elective pulmonary valve replacement (PVR), which should be performed before irreversible RV dysfunction ensues.
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Affiliation(s)
- Beatriz Bouzas
- Adult Congenital Heart Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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28
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Hermida-Prieto M, Monserrat L, Castro-Beiras A, Laredo R, Soler R, Peteiro J, Rodríguez E, Bouzas B, Alvarez N, Muñiz J, Crespo-Leiro M. Familial dilated cardiomyopathy and isolated left ventricular noncompaction associated with lamin A/C gene mutations. Am J Cardiol 2004; 94:50-4. [PMID: 15219508 DOI: 10.1016/j.amjcard.2004.03.029] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2003] [Revised: 03/01/2004] [Accepted: 03/01/2004] [Indexed: 01/01/2023]
Abstract
LMNA mutations have been associated with familial or sporadic dilated cardiomyopathy (DC), with or without conduction system disease. We studied the LMNA gene in 67 consecutive patients with DC (18 had familial DC, 17 had possible familial DC, and 32 sporadic DC). From genomic DNA, coding regions of the LMNA gene were amplified by polymerase chain reaction, studied by single-strand conformation polymorphism, and cycle sequenced. Mutations were confirmed by restriction fragment length polymorphism. Two disease-causing mutations were found in families A and B. In family A, a novel R349L mutation was present in the mother and her identical twin daughters. They required cardiac transplantation at 36, 18, and 20 years of age. In family B, the R190W mutation was present in 2 cousins with DC and without conduction system disease (1 had cardiac transplantation at 45 years of age and 1 died suddenly at 46 years of age) and in 2 of their sons. The mothers of the 2 affected patients died due to cardiac causes in their 40s (1 died suddenly). One of the carriers fulfilled diagnostic criteria for isolated left ventricular noncompaction. Our data associated the R349L and R190W mutations in LMNA with severe forms of familial DC. LMNA mutations should be considered in the genetic screening of patients with familial DC without conduction system disease. Isolated left ventricular noncompaction may be part of the phenotypic spectrum of the laminopathies.
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Affiliation(s)
- Manuel Hermida-Prieto
- Hospital Juan Canalejo, Instituto Universitario de Ciencias de la Salud, A Coruña, Spain
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Vonder Muhll IF, Cholet A, Stehr K, Bouzas B, Gatzoulis M. 1095-200 Increased metabolic rate as a mechanism for cachexia in adults with congenital heart disease. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Monserrat L, Hermida M, Bouzas B, Mosquera I, Mahon N, Peteiro J, Alvarez N, Penas-Lado M, Crespo M, Castro-Beiras A. [Familial dilated cardiomyopathy in patients transplanted for idiopathic dilated cardiomyopathy]. Rev Esp Cardiol 2002; 55:725-32. [PMID: 12113700 DOI: 10.1016/s0300-8932(02)76691-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the prevalence, clinical features, and pattern of inheritance of familial dilated cardiomyopathy (DCM) in heart transplant patients. PATIENTS AND METHOD Patients with idiopathic DCM who had undergone heart transplantation were invited to participate. Patients with alcohol abuse were excluded. A clinical evaluation, 12-lead ECG, echocardiogram, blood tests, and DNA extraction were performed in patients and relatives. Familial DCM was defined as the presence of at least one relative with idiopathic DCM. Possible familial DCM was considered when at least one relative had left ventricular enlargement (LVE) (> 112% predicted LVEDD). RESULTS One hundred and ninety-nine relatives of 43 families were studied. DCM was familial in 11 probands (25.6%) and possibly familial in 11 (25.6%). Fifteen relatives had DCM (7.5%), 26 (13.1%) LVE, and 5 (2.5%) hypertrophic cardiomyopathy. The pattern of inheritance was autosomal dominant in most families. Five probands (3 with familial DCM) had antecedents of consanguinity and possible recessive inheritance. Six probands (14%, 1 with familial DCM) had relatives with conduction system defects. Creatine kinase was moderately increased in 9 relatives (4.5%), 3 of them with LVE. Fifteen patients had at least moderate alcohol intake. Three of them had familial DCM (relatives without alcohol abuse) and 6 had possible familial DCM. CONCLUSIONS The prevalence of familial DCM is high in patients who undergo heart transplant. Left ventricular enlargement, conduction system abnormalities, and elevated creatine kinase may be early markers of familial disease. Hypertrophic cardiomyopathy is present in some relatives of patients with idiopathic DCM. Familial DCM is present in patients with a previous diagnosis of alcoholic DCM.
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Affiliation(s)
- Lorenzo Monserrat
- Servicio de Cardiología del Hospital Juan Canalejo, A Coruña, Spain.
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31
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Hermida M, Monserrat L, Barral S, Laredo R, Bouzas B, Crespo M, Castro-Beiras A. New mutation in lamin A/C gene associated with severe dilated cardiomyopathy. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Peteiro J, Monserrat L, Bouzas B, Castro-Beiras A. Effect of left ventricular global systolic function, mitral regurgitation, and left ventricular inflow pattern on exercise echocardiography results. Echocardiography 2002; 19:115-23. [PMID: 11926973 DOI: 10.1046/j.1540-8175.2002.00115.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diagnosis of coronary artery disease (CAD) by exercise echocardiography is usually based on rest or exercise-induced regional wall-motion abnormalities. Mitral regurgitation (MR), left ventricular (LV) global systolic function, and LV inflow measurements can be assessed during exercise echocardiography; however, their diagnostic value has not been analyzed consistently. Treadmill exercise echocardiography and coronary angiography were performed in 120 patients (94 male, 26 female; mean age 61 +/- 10 years [+/- 1 SD]) to evaluate known or suspected CAD. Positive exercise echocardiography was defined either as a rest- or exercise-induced regional wall-motion abnormalities. An abnormal response of LV ejection fraction (EF), LV volumes, MR (as assessed by color Doppler), and LV inflow pattern was defined as a fall in LVEF, a LV end-diastolic volume increase, a LV end-systolic volume increase, a new or increased MR, or a change from an impaired relaxation pattern (E < A) to a "pseudonormalized" pattern (E > A) from rest to exercise, respectively. CAD (> or = 50% luminal narrowing in at least one vessel) was found in 89 (74%) patients. EE-based regional wall-motion abnormality analysis was positive in 95 (79%) patients and negative in 25 (21%) patients. Feasible images for regional wall-motion abnormalities, LVEF and volumes, LV inflow, and MR measurements were acquired in 90% of patients. Regional wall-motion abnormality analysis and LVEF decrease provided the greatest sensitivities for CAD (94% and 75%, respectively), while the highest specificity was given by a new or increased MR (90%), the development of a pseudonormalized pattern (88%), and the appearance of angina (87%). A positive electrocardiogram (ECG) finding in patients with interpretable ECGs provided good sensitivity and specificity (67% and 85%, respectively). In conclusion, a complete rest and exercise Doppler echocardiography approach is feasible in most patients. Regional wall-motion abnormalities are the most accurate exercise echocardiography variable for diagnosing CAD, whereas exercise ECG remains a good test in patients with interpretable ECGs. Exercise echocardiography, exercise ECG, newly developed or increased MR, and change to a pseudonormalized LV inflow pattern are highly specific.
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Affiliation(s)
- Jesús Peteiro
- Service of Cardiology, Juan Canalejo Hospital, A Coruña, Spain.
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Crespo-Leiro MG, Paniagua MJ, Mosquera I, Tabuyo T, De la Fuente L, Bouzas B, Rodriguez JA, Hermida LF, Juffé A, Castro-Beiras A. Replacement of cyclosporine by tacrolimus for immunosuppression in heart transplant patients: safety and efficacy. Transplant Proc 2002; 34:113-4. [PMID: 11959213 DOI: 10.1016/s0041-1345(01)02694-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M G Crespo-Leiro
- Programa de Trasplante Cardiaco, Hospital Juan Canalejo, A Coruña, Spain
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Mosquera I, Crespo-Leiro MG, Tabuyo T, Paniagua MJ, Fuente L, Bouzas B, Fojón S, Pastor J, Juffé-Stein A, Castro-Beiras A. Pulmonary hypertension and right ventricular failure after heart transplantation: usefulness of nitric oxide. Transplant Proc 2002; 34:166-7. [PMID: 11959233 DOI: 10.1016/s0041-1345(01)02713-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I Mosquera
- Trasplante Cardiaco, Hospital Juan Canalejo, A Coruña, Spain
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Abstract
Here we describe two Caucasian brothers who developed adult T-cell leukemia/lymphoma (ATLL), within a short period of time. These two patients have never left Argentina. Their parents are dead and according to the family history it is possible that the mother may have been affected by spastic paraparesis. The daughters reported that their mother had suffered from increasing difficulty in walking for many years which finally made it impossible for to her walk. There are no other data to support the presumptive diagnosis. One of the patients presented with acute disease while the other had a lymphoma type disorder. Both were positive for HTLV 1. The first patient died with disease progression ten months after diagnosis and the second is in partial remission 13 months after diagnosis. Immunophenotyping showed CD4+, CD5+, CD3+, CD2+, CD8 (-). Two asymptomatic brothers with positive HTLV 1 serology were detected. This is the first family case that has been reported in Argentina.
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Affiliation(s)
- V Prates
- Instituto de Trasplante de Médula Osea, Fundación Mainetti, La Plata, Argentina
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