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de Jesus M, Maheshwary A, Kumar M, da Cunha Godoy L, Kuo CL, Grover P. Association of electrocardiographic and echocardiographic variables with neurological outcomes after ischemic Stroke. Am Heart J Plus 2023; 34:100313. [PMID: 38510950 PMCID: PMC10945909 DOI: 10.1016/j.ahjo.2023.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 03/22/2024]
Abstract
Background Cardiac dysfunction is often seen following neurological injury. Data regarding cardiac involvement after ischemic stroke is sparse. We investigated the association of electrocardiographic (ECG) and echocardiographic variables with neurological outcomes after an acute ischemic stroke. Methods We retrospectively collected baseline characteristics, stroke location, National Institute of Health Stroke Scale (NIHSS) at the time of admission, acute reperfusion treatment, ECG parameters, and echocardiographic data on 174 patients admitted with acute ischemic stroke. Outcomes of the stroke were based on cerebral performance category (CPC) with a CPC score of 1-2 indicating a good outcome and a CPC score of 3-5 indicating a poor outcome. Results Older age (75.31 ± 11.89 vs. 65.16 ± 15.87, p < 0.001, OR = 1.04, 95 % CI 1.01-1.07), higher heart rate (80.63 ± 18.69 vs. 74.45 ± 17.17 bpm, p = 0.024, OR = 1.02, 95 % CI 1.00-1.05) longer QTc interval (461.69 ± 39.94 vs. 450.75 ± 35.24, p = 0.024, OR = 1.01, 95 % CI 0.99-1.02), NIHSS score (60.9 % vs. 17.8 %, p < 0.001, OR = 14.90, 95 % CI 3.83-69.5), and thrombolysis (15 % vs. 5 %, p = 0.049, OR = 0.55, 95 % CI 0.10-2.55) were associated with poor neurological outcomes. However, when adjusted for age and NIHSS, heart rate and QTc were no longer statistically significant. None of the other ECG and echocardiographic variables were associated neurological outcomes. Conclusions Elevated heart rate and longer QTc intervals may potentially predict poor neurological outcomes. Further studies are needed for validation and possible integration of these variables in outcome predicting models.
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Affiliation(s)
| | - Ankush Maheshwary
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Manish Kumar
- Department of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
| | - Lucas da Cunha Godoy
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Chia-Ling Kuo
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Prashant Grover
- Department of Pulmonary and Critical Care Medicine, St. Francis Hospital, Hartford, CT, USA
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2
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Asif T, Gupta A, Murthi M, Soman P, Singh V, Malhotra S. Echocardiographic indices of left ventricular function and filling pressure are not related to blood pool activity on pyrophosphate scintigraphy. J Nucl Cardiol 2023; 30:708-715. [PMID: 35578000 DOI: 10.1007/s12350-022-02989-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pyrophosphate (PYP) imaging has a high diagnostic accuracy for transthyretin cardiac amyloidosis (ATTR-CA). Indeterminate findings are often reported due to persistent blood pool activity, presumed to be from low cardiac output. We evaluated the relationship between blood pool activity on PYP imaging and echocardiographic indices of cardiac function. METHODS Clinical and imaging data of 189 patients referred for PYP scintigraphy were evaluated. All patients underwent planar imaging and SPECT (diagnostic standard). Among those with a negative PYP SPECT, persistent left ventricular blood pool activity on planar images was inferred by a visual score ≥2 or a heart-to-contralateral (HCL) ratio ≥ 1.5. Absence of blood pool activity was inferred when both visual score was < 2 and HCL was < 1.5. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), stroke volume index (SVi), and left atrial pressure (LAP) were calculated from standard transthoracic echocardiograms. RESULTS ATTR-CA was present in 43 (23%) patients. Among those with a negative PYP SPECT, 11 patients had significant blood pool activity. Patients with ATTR-CA had a lower LVEF, SVi, and GLS, with a higher LAP, compared to those without ATTR-CA. Among those without ATTR-CA, there were no significant differences in these parameters. CONCLUSION Approximately 8% of patients with a negative PYP SPECT have significant blood pool activity. Measures of cardiac function are not different among those with and without blood pool activity. PYP SPECT should be routinely performed in all patients to avoid false image interpretation.
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Affiliation(s)
- Talal Asif
- Division of Cardiology, Cook County Health, Chicago, IL, USA
| | - Aman Gupta
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Mukunthan Murthi
- Department of Internal Medicine, Cook County Health, Chicago, IL, USA
| | - Prem Soman
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vasvi Singh
- Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas City, MO, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush Medical College, Chicago, IL, 60612, USA.
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3
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Cui Z, Castagna F, Hanif W, Apple SJ, Zhang L, Tauras JM, Braunschweig I, Kaur G, Janakiram M, Wang Y, Fang Y, Diaz JC, Hoyos C, Marin J, Pellikka PA, Romero JE, Garcia MJ, Verma AK, Shah N, Slipczuk L. Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma. J Clin Med 2023; 12:2595. [PMID: 37048679 PMCID: PMC10095531 DOI: 10.3390/jcm12072595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with multiple myeloma (MM) are at a high risk for developing cardiovascular complications. Global longitudinal strain (GLS) can detect early functional impairment before structural abnormalities develop. It remains unknown if reduced GLS is associated with reduced survival in patients with MM. We conducted a retrospective cohort analysis of patients diagnosed with MM between 1 January 2000 and 31 December 2017 at our institution. Patients with a 2D transthoracic echocardiogram completed within 1 year of MM diagnosis, left ventricular ejection fraction (LVEF) greater than 40%, and no history of myocardial infarction prior to MM diagnosis were included. GLS was measured using an artificial-intelligence-powered software (EchoGo Core), with reduced GLS defined as an absolute value of <18%. The primary outcome of interest was overall survival since myeloma diagnosis. Our cohort included 242 patients with a median follow up of 4.28 years. Fifty-two (21.5%) patients had reduced average GLS. Patients with reduced GLS were more likely to have an IVSd ≥ 1.2cm, E/E' > 9.6, LVEF/GLS > 4.1, higher LV mass index, and low-voltage ECG. A Total of 126 (52.1%) deaths occurred during follow-up. Overall survival was lower among patients with reduced GLS (adjusted HR: 1.81, CI: 1.07-3.05).
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Affiliation(s)
- Zhu Cui
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Waqas Hanif
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Samuel J. Apple
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James M. Tauras
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ira Braunschweig
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gurbakhash Kaur
- Hematology Oncology Division, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Murali Janakiram
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55812, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yanan Fang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Carolina Hoyos
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jorge Marin
- Clínica Las Americas, Medellin 50025, Colombia
| | | | - Jorge E. Romero
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mario J. Garcia
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amit K. Verma
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nishi Shah
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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4
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Wang B, Chen Y, Qiao Q, Dong L, Xiao C, Qi Z. Evaluation of carotid plaque vulnerability with different echoes by shear wave elastography and CEUS. J Stroke Cerebrovasc Dis 2023; 32:106941. [PMID: 36586243 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using shear wave elastography (SWE) and contrast enhanced ultrasound (CEUS)to examine carotid plaques with different echoes, and explore a reliable method to quantify characteristics associated with vulnerable carotid plaques. METHODS 2D ultrasound, SWE and CEUS were performed on 244 carotid plaques, and the echoes were evaluated according to the Gray-Weale classification scale and gray-scale median (GSM), and the mean Young's modulus (YM) of the plaque was measured and the intraplaque neovascularization was observed to investigate the relationship between carotid plaque types with different echo characteristics, GSM and the values of each parameter of YM and CEUS. The relationship between GSM and YM and CEUS values was investigated. RESULTS The differences between GSM values (F = 49.742, P < 0.001), with the maximum, mean, and minimum YM values of ultrasound elastography (P < 0.001), and with the number (P < 0.001) and density (P = 0.047) of neovascularization on CEUS were statistically significant for the different echogenic types of plaques, and the lower the echogenicity of the plaque, the lower the GSM values (r = 0.632, P < 0.001), the smaller the YM values (all r > 0, P < 0.001), and the higher the neovascularization number and density values (r < 0, P < 0.001); and there were also statistically significant differences between the above indicators in the vulnerable and stable plaque groups (all P < 0.05). CONCLUSION GSM, SWE, and CEUS techniques can quantitatively evaluate the vulnerability of different echo carotid plaques in a more comprehensive and objective manner, which may help clinical identification of vulnerable plaques, and provide important reference values for early diagnosis and treatment in clinical practice.
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Affiliation(s)
| | | | - Qi Qiao
- First hospital of Qinhuangdao, Hebei, China
| | - Lili Dong
- First hospital of Qinhuangdao, Hebei, China
| | | | - Zhengqin Qi
- First hospital of Qinhuangdao, Hebei, China.
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5
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Ding N, Gao J, Wang J, Sun W, Fang M, Liu X, Zhao H. Speech recognition in echoic environments and the effect of aging and hearing impairment. Hear Res 2023; 431:108725. [PMID: 36931021 DOI: 10.1016/j.heares.2023.108725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
Temporal modulations provide critical cues for speech recognition. When the temporal modulations are distorted by, e.g., reverberations, speech intelligibility drops, and the drop in speech intelligibility can be explained by the amount of distortions to the speech modulation spectrum, i.e., the spectrum of temporal modulations. Here, we test a condition in which speech is contaminated by a single echo. Speech is delayed by either 0.125 s or 0.25 s to create an echo, and these two conditions notch out the temporal modulations at 2 or 4 Hz, respectively. We evaluate how well young and older listeners can recognize such echoic speech. For young listeners, the speech recognition rate is not influenced by the echo, even when they are exposed to the first echoic sentence. For older listeners, the speech recognition rate drops to less than 60% when listening to the first echoic sentence, but rapidly recovers to above 75% with exposure to a few sentences. Further analyses reveal that both age and the hearing threshold influence the recognition of echoic speech for the older listeners. These results show that the recognition of echoic speech cannot be fully explained by distortions to the modulation spectrum, and suggest that the auditory system has mechanisms to effectively compensate the influence of single echoes.
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Affiliation(s)
- Nai Ding
- College of Biomedical Engineering and Instrument Science,Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiaxin Gao
- College of Biomedical Engineering and Instrument Science,Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Wang
- College of Biomedical Engineering and Instrument Science,Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenhui Sun
- Research Center for Applied Mathematics and Machine Intelligence, Research Institute of Basic Theories, Zhejiang Lab, Hangzhou, Zhejiang, China
| | - Mingxuan Fang
- College of Biomedical Engineering and Instrument Science,Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoling Liu
- College of Biomedical Engineering and Instrument Science,Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Zhao
- College of Biomedical Engineering and Instrument Science,Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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6
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Hakim CH, Teixeira J, Leach SB, Duan D. Physiological Assessment of Muscle, Heart, and Whole Body Function in the Canine Model of Duchenne Muscular Dystrophy. Methods Mol Biol 2023; 2587:67-103. [PMID: 36401025 DOI: 10.1007/978-1-0716-2772-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is a lethal muscle disease caused by dystrophin deficiency. Patients gradually lose motor function, become wheelchair-bound, and die from respiratory and/or cardiac muscle failure. Dystrophin-null dogs have been used as a large animal model for DMD since 1988 and are considered an excellent bridge between rodent models and human patients. While numerous protocols have been published for studying muscle and heart physiology in mice, few such protocols exist for studying skeletal muscle contractility, heart function, and whole-body activity in dogs. Over the last 20 years, we have developed and adapted an array of assays to evaluate whole-body movement, gait, single muscle force, whole limb torque, cardiac electrophysiology, and hemodynamic function in normal and dystrophic dogs. In this chapter, we present detailed working protocols for these assays and lessons we learned during the development and use of these protocols.
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Affiliation(s)
- Chady H Hakim
- Department of Molecular Microbiology and Immunology, School of Medicine, The University of Missouri, Columbia, MO, USA
| | - James Teixeira
- Department of Molecular Microbiology and Immunology, School of Medicine, The University of Missouri, Columbia, MO, USA
| | - Stacy B Leach
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, The University of Missouri, Columbia, MO, USA
| | - Dongsheng Duan
- Department of Molecular Microbiology and Immunology, School of Medicine, The University of Missouri, Columbia, MO, USA.
- Department of Biomedical, Biological & Chemical Engineering, College of Engineering, The University of Missouri, Columbia, MO, USA.
- Department of Neurology, School of Medicine, The University of Missouri, Columbia, MO, USA.
- Department of Biomedical Sciences, College of Veterinary Medicine, The University of Missouri, Columbia, MO, USA.
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7
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Zampella E, Assante R, Acampa W, Gaudieri V, Nappi C, Mannarino T, D'Antonio A, Buongiorno P, Panico M, Mainolfi CG, Spinelli L, Petretta M, Cuocolo A. Incremental value of 18F-FDG cardiac PET imaging over dobutamine stress echocardiography in predicting myocardial ischemia in patients with suspected coronary artery disease. J Nucl Cardiol 2022; 29:3028-3038. [PMID: 34791621 DOI: 10.1007/s12350-021-02852-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/16/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND To assess the incremental value of 18F-fluorodeoxyglucose (FDG) cardiac positron emission tomography (PET) over dobutamine stress echocardiography (DSE) in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD). METHODS Forty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET with 82Rb and DSE followed by cardiac 18F-FDG PET imaging. 18F-FDG images were scored on a 0 (no discernible uptake) to 2 (intense uptake) scale. Logistic regression analysis was performed to identify predictors of stress-induced ischemia. The incremental value of 18F-FDG PET over DSE in detecting ischemia at 82Rb PET cardiac imaging was assessed by the likelihood ratio chi-square and net reclassification index. RESULTS On 82Rb-PET imaging, myocardial ischemia (ischemic total perfusion defect ≥ 5%) was detected in 20 (49%) patients. Inducible ischemia was found in 22 (54%) patients on DSE (biphasic or worsening response pattern in ≥ 1 segment) and in 21 (51%) patients on 18F-FDG PET (uptake score of 2 in ≥ 1 segment). 18F-FDG PET resulted as statistically significant predictor of ischemia on 82Rb-PET. The addition of 18F-FDG PET to DSE increased the likelihood of ischemia on 82Rb-PET (P < .05). 18F-FDG PET was able to reclassify the probability of stress-induced myocardial ischemia on both patient and vessel analyses. CONCLUSION 18F-FDG PET performed after dobutamine stress test may provide incremental value to DSE in the evaluation of myocardial ischemia. These results suggest that stress-induced myocardial ischemia can be imaged directly using 18F-FDG PET after dobutamine stress test.
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Affiliation(s)
- Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
- Institute of Biostructures and Bioimaging, CNR, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Ciro Gabriele Mainolfi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
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8
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Schwartz SE. Narcissism - the refusal of twoness through sexual addiction and pornography. J Anal Psychol 2022; 67:287-305. [PMID: 35417588 DOI: 10.1111/1468-5922.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Proceeding from oneness to twoness is a psychological process of relating inter- and intrapersonally. This article links the perspectives of French psychoanalyst André Green's concepts of the dead mother and narcissism with Hester Solomon, British Jungian analyst writing on the 'as-if' personality. These concepts are elucidated with the composite example of a self-described sexually addicted man. His behaviours attempted to mask the shadows of melancholy, a fragile self, and the absence of self-animation from early emotional wounds. He did not know love or the other. André Green, French psychoanalyst, described feelings of misery, lack, and emptiness. The defence against relatedness arises from fears of replicating the original object losses. He delineated death narcissism and life narcissism as limiting relationships and creating the illusionary. Narcissus could not live if he knew himself. Immersion within singularity occludes relationship to the unconscious and the other, like Echo. Jung's concept of the transcendent function evolves from inclusion of the symbolic through listening to the language of the unconscious. Through the transference and countertransference, the former disowned and split-off others, secreted in the shadows of addictions, open relatedness to self, soul, and world.
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9
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Gaspari R, Weekes A, Adhikari S, Noble VE, Nomura JT, Theodoro D, Woo MY, Atkinson P, Blehar D, Brown SM, Caffery T, Haines C, Lam S, Lanspa M, Lewis M, Liebmann O, Limkakeng A, Platz E, Moore C, Raio C. Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study. Resuscitation 2021; 169:167-172. [PMID: 34798178 DOI: 10.1016/j.resuscitation.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in cohorts defined by ECG and echo. METHODS This is a secondary analysis of a previously published prospective study at twenty hospitals. Patients presenting after out-of-hospital arrest were included. The cardiac electrical activity was defined by ECG and contemporaneous myocardial activity was defined by bedside echo. Myocardial activity by echo was classified as myocardial asystole--the absence of myocardial movement, pulseless myocardial activity (PMA)--visible myocardial movement but no pulse, and myocardial fibrillation--visualized fibrillation. Primary outcome was the prevalence of discordance between electrical activity and myocardial activity. RESULTS 793 patients and 1943 pauses in CPR were included. 28.6% of CPR pauses demonstrated a difference in electrical activity (ECG) and myocardial activity (echo), 5.0% with asystole (ECG) and PMA (echo), and 22.1% with PEA (ECG) and myocardial asystole (echo). Twenty-five percent of the 32 pauses in CPR with a shockable rhythm by echo demonstrated a non-shockable rhythm by ECG and were not defibrillated. Survival for patients with PMA (echo) was 29.1% (95%CI-23.9-34.9) compared to those with PEA (ECG) (21.4%, 95%CI-17.7-25.6). CONCLUSION Patients in cardiac arrest commonly demonstrate different electrical (ECG) and myocardial activity (echo). Further research is needed to better define cardiac activity during cardiac arrest and to explore outcome between groups defined by electrical and myocardial activity.
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Affiliation(s)
- Romolo Gaspari
- University of Massachusetts Medical School, Worcester, MA, United States.
| | - Anthony Weekes
- Atrium Health Carolinas Medical Center, Charlotte, NC, United States
| | | | - Vicki E Noble
- Massachusetts General Hospital, Boston, MA, United States
| | - Jason T Nomura
- Christiana Care Health System, Newark, DE, United States
| | - Daniel Theodoro
- Washington University School of Medicine, St Louis, MO, United States
| | - Michael Y Woo
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | | | - David Blehar
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Samuel M Brown
- Intermountain Medical Center, Univ of Utah, Salt Lake City, UT, United States
| | | | | | - Samuel Lam
- Sutter Medical Center, Sacramento, CA, United States
| | - Michael Lanspa
- Intermountain Medical Center, Univ of Utah, Salt Lake City, UT, United States
| | - Margaret Lewis
- Atrium Health Carolinas Medical Center, Charlotte, NC, United States
| | | | | | - Elke Platz
- Brigham and Women's Hospital, Boston, MA, United States
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10
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Endo S, Takasugi N, Kanamori H, Okura H. Atrial trigeminy induced at a specific pacing cycle length in a patient with residual pulmonary vein conduction gap. J Electrocardiol 2021; 67:84-88. [PMID: 34102557 DOI: 10.1016/j.jelectrocard.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/18/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
We report a case of atrial trigeminy induced only at a specific pacing cycle length in a patient with residual pulmonary vein conduction gap.
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Affiliation(s)
- Susumu Endo
- Division of Cardiovascular Medicine, Gifu University Hospital, Gifu, Japan
| | - Nobuhiro Takasugi
- Division of Cardiovascular Medicine, Gifu University Hospital, Gifu, Japan.
| | - Hiromitsu Kanamori
- Division of Cardiovascular Medicine, Gifu University Hospital, Gifu, Japan
| | - Hiroyuki Okura
- Division of Cardiovascular Medicine, Gifu University Hospital, Gifu, Japan
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11
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Spinelli L, Imbriaco M, Giugliano G, Nappi C, Gaudieri V, Riccio E, Pisani A, Trimarco B, Cuocolo A. Focal reduction in left ventricular 123I-metaiodobenzylguanidine uptake and impairment in systolic function in patients with Anderson-Fabry disease. J Nucl Cardiol 2021; 28:641-649. [PMID: 31087266 DOI: 10.1007/s12350-019-01734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-Fabry disease (AFD). We aimed to investigate the relationship between regional left ventricular (LV) denervation and regional function abnormalities. METHODS Twenty-four AFD patients (43.7 ± 12.8 years) were studied by 123I-metaiodobenzylguanidine (MIBG) cardiac imaging and speckle-tracking echocardiography. Segmental tracer uptake was estimated according to 0 to 4 score, and total defect score (TDS) was calculated for each patient. RESULTS Segmental longitudinal strain worsened as MIBG uptake score increased (P < 0.001). By ROC analysis, a segmental longitudinal strain > - 16.2% predicted a segmental MIBG uptake score ≥1, with 79.7% sensitivity and 65.3% specificity. Segmental MIBG uptake defects were found in 13 out 24 AFD patients. LV mass index (60.8 ± 10.1 vs. 41.4 ± 9.8 g/h2.7), relative wall thickness (0.51 ± 0.06 vs. 0.40 ± 0.06), systolic pulmonary artery pressure (35.2 ± 6.7 vs. 27.2 ± 4.2 mmHg), and longitudinal strain (- 14.3 ± 2.7 vs. -19.4 ± 1.8%) were significantly higher in patients with segmental defect (all P < 0.01). At multivariate linear regression analysis, global longitudinal strain was independently associated with TDS (B = 3.007, 95% confidence interval 1.384 to 4.630, P = 0.001). CONCLUSIONS Reduced cardiac MIBG uptake reflects the severity of cardiac involvement in AFD patients. LV longitudinal function impairment seems to be an earlier disease feature than regional myocardial denervation.
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Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy.
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Eleonora Riccio
- Department of Public Health, Nephrology Unit, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Nephrology Unit, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
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12
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Abstract
Advancing the concept of multimodal voicing as a tool for describing user-generated online humour, this paper reports a study on humorous COVID-19 mask memes. The corpus is drawn from four popular social media platforms and examined through a multimodal discourse analytic lens. The dominant memetic trends are elucidated and shown to rely programmatically on nested (multimodal) voices, whether compatible or divergent, as is the case with the dissociative echoing of individuals wearing peculiar masks or the dissociative parodic echoing of their collective voice. The theoretical thrust of this analysis is that, as some memes are (re)posted across social media (sometimes going viral), the previous voice(s) - of the meme subject/author/poster - can be re-purposed (e.g. ridiculed) or unwittingly distorted. Overall, this investigation offers new theoretical and methodological implications for the study of memes: it indicates the usefulness of the notions of multimodal voicing, intertextuality and echoing as research apparatus; and it brings to light the epistemological ambiguity in lay and academic understandings of memes, the voices behind which cannot always be categorically known.
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Affiliation(s)
- Marta Dynel
- Marta Dynel, Department of Pragmatics,
Institute of English Studies, University of Łódź, ul. Pomorska 171/173, Łódź,
90-236, Poland. Emails: ; https://martadynel.com/; http://anglistyka.uni.lodz.pl/dynel-marta-prof-ul-dr-hab/
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13
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Wedekind G, Schröder S. Evaluating physiology of a human heart during ventricular tachycardia: new insights of mechanical alterations via beat to beat strain analysis-case report. Eur Heart J Case Rep 2021; 4:1-5. [PMID: 33447715 PMCID: PMC7793219 DOI: 10.1093/ehjcr/ytaa398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/23/2020] [Accepted: 09/24/2020] [Indexed: 11/14/2022]
Abstract
Background Ventricular tachycardia can be triggered by myocardial ischaemia. These often fatal events are nearly always accompanied by a significant circulatory depression. However, the exact mechanical alterations and mechanisms of adaption during such arrhythmia episodes are still unknown. Case summary We report on a 71-year-old male patient with a distinct cardiovascular risk profile, recurrent incidences of dizziness and palpitations. A Holter electrocardiogram was performed showing multiple episodes of ventricular tachycardia. He was immediately transferred to our hospital for further monitoring and diagnostics. During echocardiography, one of these episodes could be recorded with a four-dimensional (4D) probe in triplane acquisition mode and strain analysis was done. Afterwards, a heart catheter examination was performed. A one-vessel coronary heart disease was diagnosed and treated with three drug-eluting stents. The burden of non-sustained ventricular tachycardia (nsVT) significantly reduced post-procedure. During the follow-up, new episodes of nsVT occurred after 6 weeks, which were treated by electrophysiological examinations. Discussion Modern 4D echocardiography machines offer the possibility to visualize the entire heart simultaneously. Thus ventricular arrhythmias can be evaluated using off-line strain analysis. This technology allows new real-time insights into the human heart showing compensatory mechanisms to overcome stressful episodes, such as ventricular tachycardia.
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Affiliation(s)
- Georg Wedekind
- Department of Cardiology and Vascular Medicine, ALB FILS KLINIKEN, Klinik am Eichert, Eichertstraße 3, 73035 Göppingen, Germany
| | - Stephen Schröder
- Department of Cardiology and Vascular Medicine, ALB FILS KLINIKEN, Klinik am Eichert, Eichertstraße 3, 73035 Göppingen, Germany
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14
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Phillips LM, Winchester D, Saric M, Lloyd SG, Blankstein R, Al-Mallah MH. Multimodality imaging: Bird's eye view from the 2019 American College of Cardiology Scientific Sessions. J Nucl Cardiol 2020; 27:410-416. [PMID: 31975328 DOI: 10.1007/s12350-019-02016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/30/2022]
Abstract
The 2019 American College of Cardiology Scientific Sessions displayed innovation in many areas for the evaluation and management of cardiovascular disease from preventive evaluation and care to advanced interventions. Imaging played a central role in these developments with a highlight of the conference being the imaging research presented. This review will summarize key imaging studies which were presented at this scientific meeting which will lead to innovation in the evaluation and management of cardiovascular disease. Experts in nuclear imaging (DW/MA), echocardiography (MS), cardiac magnetic resonance (SL), and cardiac computed tomography (RB) selected abstracts which they found to be of particular interest to the multimodality imaging audience and were integrated into this review (LP).
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Affiliation(s)
- Lawrence M Phillips
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA.
| | - David Winchester
- Department of Medicine, Malcom Randall VAMC, University of Florida, Gainesville, FL, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Steven G Lloyd
- Department of Medicine, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, AL, USA
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Imaging) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
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15
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Saku K, Tahara N, Takaseya T, Shintani Y, Takagi K, Shojima T, Kurata S, Fujimoto K, Abe T, Fukumoto Y, Tanaka H. Multimodal imaging of cardiac-calcified amorphous tumor. J Nucl Cardiol 2020; 27:682-685. [PMID: 30421382 DOI: 10.1007/s12350-018-01510-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
Abstract
Cardiac-calcified amorphous tumor (CAT) is a rare non-neoplastic tumor and its origin and pathogenesis are still unclear. In addition, it is difficult to clinically diagnose as cardiac CAT without pathological findings. We present a case of a 78-year-male diagnosed with cardiac CAT after surgical resection. We could evaluate tumor aspects by multimodal imaging including echocardiography, contrast-enhanced computed tomography (CT), magnetic resonance image, and 18F-fluorodeoxyglucose-positron emission tomography/CT before surgery.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Tohru Takaseya
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yusuke Shintani
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Takahiro Shojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Seiji Kurata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
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16
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Gomes A, van Geel PP, Santing M, Prakken NHJ, Ruis ML, van Assen S, Slart RHJA, Sinha B, Glaudemans AWJM. Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques. J Nucl Cardiol 2020; 27:592-608. [PMID: 30066279 PMCID: PMC7174257 DOI: 10.1007/s12350-018-1383-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Multimodality imaging is recommended to diagnose infective endocarditis. Value of additional imaging to echocardiography in patients selected by a previously proposed flowchart has not been evaluated. METHODS An observational single-center study was performed. Adult patients suspected of endocarditis/device infection were prospectively and consecutively enrolled from March 2016 to August 2017. Adherence to a diagnostic imaging-in-endocarditis-flowchart was evaluated in 176 patients. Imaging techniques were compared head-to-head in 46 patients receiving echocardiography (transthoracic plus transesophageal), multi-detector computed tomography angiography (MDCTA), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT). RESULTS 69% of patients (121/176) adhered to the flowchart. Sensitivity of echocardiography, MDCTA, FDG-PET/CT in patients without prosthesis was 71%, 57%, 29% (86% when combined), while specificity was 100%, 75%, 100%, respectively. Sensitivity in patients with prosthesis was 75%, 75%, 83%, respectively (100% when combined), while specificity was 86% for all three modalities. Echocardiography performed best in the assessment of vegetations, morphological valve abnormalities/dehiscence, septum defects, and fistula formation. MDCTA performed best in the assessment of abscesses and ventricular assist device infection. FDG-PET/CT performed best in the assessment of cardiac device infection, extracardiac infectious foci, and alternative diagnoses. CONCLUSIONS This study demonstrates that the evaluated imaging-in-endocarditis-flowchart is applicable in daily clinical practice. Echocardiography, MDCTA, and FDG-PET/CT provide relevant complementary diagnostic information, particularly in patients with intracardiac prosthetic material.
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Affiliation(s)
- Anna Gomes
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands.
| | - Peter Paul van Geel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Santing
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niek H J Prakken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathilde L Ruis
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands
- Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sander van Assen
- Department of Internal Medicine, Infectious Diseases, Treant Care Group, Hoogeveen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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17
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Kossaify A, Bassil E, Kossaify M. Stress Echocardiography: Concept and Criteria, Structure and Steps, Obstacles and Outcomes, Focused Update and Review. Cardiol Res 2020; 11:89-96. [PMID: 32256915 PMCID: PMC7092766 DOI: 10.14740/cr851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 01/28/2020] [Indexed: 01/06/2023] Open
Abstract
Stress echocardiography (SEC) is a technique established more than 35 years ago; however, it is still poorly implemented in many countries and institutions, and this reluctance may be related to many obstacles such as operator skills, lack of awareness or institutional policy. Stress echo was initially used for assessing coronary artery disease (CAD), with respect to myocardial viability, using wall motion response; however, current use of stress echo extends beyond CAD, such as valvular heart disease and diastolic stress test. Dobutamine is a commonly used agent when pharmaceutical approach is implemented. With regard to CAD, there are four stress responses: normal, ischemic, viable and necrotic. A low dose dobutamine protocol is recommended in patients with baseline wall motion abnormalities, and a very low dose dobutamine is used in low flow low gradient aortic stenosis in order to check the flow and contractility reserve. Of note, respecting protocols, indications and contraindications are important to avoid or minimize risks of complications during the procedure. This article presents a focused update and review regarding SEC, along with an overview of the different indications, structures and steps, and obstacles and outcomes; also the article aims to highlight more awareness and sensitization on this useful technique.
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Affiliation(s)
- Antoine Kossaify
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
| | - Elie Bassil
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
| | - Mikhael Kossaify
- Cardiology Division, Echocardiology Unit, University Hospital Notre Dame des Secours, PO Box 3, Byblos, Lebanon.,Holy Spirit University of Kaslik (USEK), School of Medicine, St Charbel Street, Byblos, Lebanon
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18
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Abstract
PURPOSE OF REVIEW A combination of evolving 3D printing technologies, new 3D printable materials, and multi-disciplinary collaborations have made 3D printing applications for transcatheter aortic valve replacement (TAVR) a promising tool to promote innovation, increase procedural success, and provide a compelling educational tool. This review synthesizes the knowledge via publications and our group's experience in this area that exemplify uses of 3D printing for TAVR. RECENT FINDINGS Patient-specific 3D-printed models have been used for TAVR pre-procedural device sizing, benchtop prediction of procedural complications, planning for valve-in-valve and bicuspid aortic valve procedures, and more. Recent publications also demonstrate how 3D printing can be used to test assumptions about why certain complications occur during THV implantation. Finally, new materials and combinations of existing materials are starting to bridge the large divide between current 3D material and cardiac tissue properties. Several studies have demonstrated the utility of 3D printing in understanding challenges of TAVR. Innovative approaches to benchtop testing and multi-material printing have brought us closer to being able to predict how a THV will interact with a specific patient's aortic anatomy. This work to date is likely to open the door for advancements in other areas of structural heart disease, such as interventions involving the mitral valve, tricuspid valve, and left atrial appendage.
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Affiliation(s)
- Dmitry Levin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Mark Reisman
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - James M McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Danny Dvir
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Beth Ripley
- Department of Radiology, University of Washington, Seattle, WA, USA. .,Department of Radiology, VA Puget Sound Health Care System, Seattle, WA, USA.
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19
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Delgado V, Saraste A, Dweck M, Bucciarelli-Ducci C, Bax JJ. Multimodality imaging: Bird's eye view from the European Society of Cardiology Congress 2019 Paris, August 31st-September 4th, 2019. J Nucl Cardiol 2020; 27:53-61. [PMID: 31741328 PMCID: PMC7031173 DOI: 10.1007/s12350-019-01958-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023]
Abstract
At the European Society of Cardiology (ESC) congress of this year 2019, held in Paris from August 31st to September 4th, 4509 abstracts were presented. Of those, 414 (9%) belonged to an imaging category. Experts in echocardiography (VD), nuclear imaging (AS), cardiac computed tomography (CT) (MD) and cardiovascular magnetic resonance (CMR) (CBD), have selected the abstracts in their areas of expertise that were of most interest to them and are summarized in this bird's eye view from this ESC meeting. These abstracts were integrated by one of the Editors of the Journal (JB).
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Affiliation(s)
- Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Marc Dweck
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Jeroen J Bax
- Heart Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands.
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20
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Chiniquy J, Garber ME, Mukhopadhyay A, Hillson NJ. Fluorescent amplification for next generation sequencing (FA-NGS) library preparation. BMC Genomics 2020; 21:85. [PMID: 31992180 PMCID: PMC6988211 DOI: 10.1186/s12864-020-6481-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/10/2020] [Indexed: 01/29/2023] Open
Abstract
Background Next generation sequencing (NGS) has become a universal practice in modern molecular biology. As the throughput of sequencing experiments increases, the preparation of conventional multiplexed libraries becomes more labor intensive. Conventional library preparation typically requires quality control (QC) testing for individual libraries such as amplification success evaluation and quantification, none of which occur until the end of the library preparation process. Results In this study, we address the need for a more streamlined high-throughput NGS workflow by tethering real-time quantitative PCR (qPCR) to conventional workflows to save time and implement single tube and single reagent QC. We modified two distinct library preparation workflows by replacing PCR and quantification with qPCR using SYBR Green I. qPCR enabled individual library quantification for pooling in a single tube without the need for additional reagents. Additionally, a melting curve analysis was implemented as an intermediate QC test to confirm successful amplification. Sequencing analysis showed comparable percent reads for each indexed library, demonstrating that pooling calculations based on qPCR allow for an even representation of sequencing reads. To aid the modified workflow, a software toolkit was developed and used to generate pooling instructions and analyze qPCR and melting curve data. Conclusions We successfully applied fluorescent amplification for next generation sequencing (FA-NGS) library preparation to both plasmids and bacterial genomes. As a result of using qPCR for quantification and proceeding directly to library pooling, the modified library preparation workflow has fewer overall steps. Therefore, we speculate that the FA-NGS workflow has less risk of user error. The melting curve analysis provides the necessary QC test to identify and troubleshoot library failures prior to sequencing. While this study demonstrates the value of FA-NGS for plasmid or gDNA libraries, we speculate that its versatility could lead to successful application across other library types.
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Affiliation(s)
- Jennifer Chiniquy
- Biological Systems & Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA.,U.S. Department of Energy Agile BioFoundry, Emeryville, CA, USA
| | - Megan E Garber
- Biological Systems & Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA.,Department of Comparative Biochemistry, University of California, Berkeley, CA, 94720, USA
| | - Aindrila Mukhopadhyay
- Biological Systems & Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA
| | - Nathan J Hillson
- Biological Systems & Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA. .,U.S. Department of Energy Agile BioFoundry, Emeryville, CA, USA.
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21
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Huang G, Fadl SA, Sukhotski S, Matesan M. Apical variant hypertrophic cardiomyopathy "multimodality imaging evaluation". Int J Cardiovasc Imaging 2019; 36:553-561. [PMID: 31853820 DOI: 10.1007/s10554-019-01739-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/23/2019] [Indexed: 12/21/2022]
Abstract
Apical variant hypertrophic cardiomyopathy (AHCM) is characterized by asymmetric hypertrophy of the left ventricular (LV) apex. T wave inversions of variable degree, particularly in the left precordial leads, and left ventricular hypertrophy (LVH) are common EKG findings in AHCM. Echocardiography is typically the initial imaging modality used in the diagnosis and evaluation of AHCM. The diagnosis is made when the LV apex has apical wall thickness of ≥ 15 mm or a ratio of apical to basal LV wall thickness of ≥ 1.3 at end-diastole. The use of microbubble contrast agents with echocardiography is helpful for visualization of the apex. Cardiac magnetic resonance (CMR) has the advantage of a large field of view and the ability to perform tissue characterization. Late gadolinium enhancement (LGE) sequences are essential in the assessment of potential areas of myocardial scarring. Cardiac computed tomography (CCT) has the advantage of being able to evaluate coronary arteries in addition to assessing cardiac anatomy and function. A "Solar Polar" map pattern is the characteristic feature of AHCM on myocardial perfusion imaging (MPI) in cases not associated with apical aneurysm (APA). Recognition of typical perfusion patterns in AHCM patients is not only important in the diagnostic evaluation of this disease process, but also for avoiding unnecessary and costly tests. The purpose of this article is to review the imaging features of AHCM from different imaging modalities and assess the value added of each modality in the diagnosis of AHCM.
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Affiliation(s)
- Gary Huang
- Department of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Shaimaa A Fadl
- Department of Radiology, Virginia Commonwealth University (VCU) Health System, Richmond, VA, USA.
| | - Stan Sukhotski
- Department of Nuclear medicine, University of Washington Medical Center, Seattle, WA, USA
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Manuela Matesan
- Department of Nuclear medicine, University of Washington Medical Center, Seattle, WA, USA
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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22
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Gibbons PW, Goldberg RJ, Muehlschlegel S. A pilot study evaluating a simple cardiac dysfunction score to predict complications and survival among critically-ill patients with traumatic brain injury. J Crit Care 2019; 54:130-135. [PMID: 31446230 PMCID: PMC6901741 DOI: 10.1016/j.jcrc.2019.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/22/2019] [Accepted: 08/06/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe the frequency of cardiovascular complications and cardiac dysfunction in critically-ill patients with moderate-severe traumatic brain injury (msTBI) and cardiac factors associated with in-hospital survival. METHODS Retrospective analysis of a prospective cohort study at a single Level-1 trauma center with a dedicated neuro-trauma intensive care unit (ICU). Adult patients admitted to the ICU with msTBI were consecutively enrolled in the prospective OPTIMISM study between November 2009 and January 2017. Cardiac dysfunction was measured using a combination of EKG parameters, echocardiography abnormalities, and peak serum troponin-I levels during the index hospitalization. These items were combined into a cardiac dysfunction index (CDI), ranging from 0 to 3 points and modeled in a Cox regression analysis. RESULTS A total of 326 patients with msTBI were included. For every one-point increase in the CDI, the multivariable adjusted risk of dying during the patient's acute hospitalization more than doubled (adjusted HR 2.41; 95% CI 1.29-4.53). CONCLUSION Cardiac dysfunction was common in patients with msTBI and independently associated with more severe brain injury and a reduction in hospital survival in this population. Further research is needed to validate the CDI and create more precise scoring tools.
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Affiliation(s)
| | - Robert J Goldberg
- University of Massachusetts Medical School, Worcester, USA; Department of Quantitative Health Sciences (Division of Epidemiology of Chronic Diseases and Vulnerable Populations), USA
| | - Susanne Muehlschlegel
- University of Massachusetts Medical School, Worcester, USA; Departments of Neurology (Neurocritical Care), Anesthesia/Critical Care and Surgery, USA
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Sheta AA, El-Banna AS, Elmeguid RA, Mohamed HE, Gad NH. A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score. Environ Sci Pollut Res Int 2019; 26:33135-33145. [PMID: 31520378 DOI: 10.1007/s11356-019-06457-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
Aluminum phosphide (AlP) is considered now one of the most common causes of poisoning among agricultural pesticides. Poisoning with AlP is extremely toxic to humans with high mortality rate. The aim of this work was to evaluate the prognostic factors and outcome of acute aluminum phosphide poisoning in Alexandria Main University Hospital during a period of 6 months from 1 November 2017 until the end of April 2018, highlighting the role of SOFA score and echocardiography in predicting the mortality. The prospective study was conducted on all patients admitted with acute AlP poisoning to Alexandria Main University Hospital for those 6 months. Patients' data were collected in a special sheet and included biosocial data, medical history, poisoning history, complete medical examination, investigations, duration of hospital stay, and the outcome. All patients were assessed according to SOFA score on admission. Thirty patients were admitted during the period of the current study. Females outnumbered males in all age groups with a sex ratio of 2.75:1. The mean age of patients was 22.77 ± 12.79 years. 96.6% of patients came from rural areas. 93.3% of the cases were exposed to poisoning at home, where suicidal poisoning accounted for (86.7%) of cases. 43.3% of patients died (n = 13), and the median value of SOFA score among non-survivors was 10, versus 1 among survivors. The median value of ejection fraction among non-survivors (25%) was half its value in survivors (50%). Although there were many predictors of severity of AlP poisoning, SOFA score was the most predictive factor of mortality detected by multivariate analysis.
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Affiliation(s)
- Abeer A Sheta
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Asmaa S El-Banna
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rania Abd Elmeguid
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany E Mohamed
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nehad H Gad
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Spahillari A, McCormick I, Yang JX, Quinn GR, Manning WJ. On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists. BMC Med Educ 2019; 19:213. [PMID: 31200721 PMCID: PMC6567532 DOI: 10.1186/s12909-019-1634-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Transthoracic echocardiograms (TTE) performed and interpreted by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on their interpretive accuracy. Our aims were to determine the discordance rate between TTEs performed and interpreted by cardiology fellows and National Board of Echocardiography certified attending cardiologists and to identify factors associated with discordance. METHODS Consecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by attending cardiologists. Fellow interpretations were classified as concordant or discordant with the attending interpretation. We assessed the association of patient, imaging and fellow characteristics with discordance. RESULTS A total of 777 TTE interpretations (730 patients) were performed/interpreted by 40 first year fellows and overread by 13 attendings. The most common indications were assessment of left ventricular function (40.9%) and pericardial effusion (37.3%). There was a major or minor discordance in 4.1 and 17.4% of studies, respectively with 42.1% of disagreements occurring in assessment of left ventricular size and function. The indication to assess left ventricular function [OR 2.19, 95% CI (1.32, 3.62), P = 0.002 vs. pericardial effusion] and greater duration of echocardiographic image acquisition (OR 1.02, 95% CI 1.01, 1.03, P = 0.004) were independently associated with overall discordance. CONCLUSIONS In this large prospective study we found that attending cardiologists disagreed with 1 in 5 fellow TTE interpretations. Standardized tools for evaluation of echocardiograms performed by fellows are needed to ensure quality of training and patient safety.
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Affiliation(s)
- Aferdita Spahillari
- Department of Medicine (Division of Cardiology), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Departments of Medicine (Cardiovascular Division), Boston, USA
| | - Ian McCormick
- Departments of Medicine (Cardiovascular Division), Boston, USA
| | - Jesse X Yang
- Departments of Medicine (Cardiovascular Division), Boston, USA
| | - Gene R Quinn
- Departments of Medicine (Cardiovascular Division), Boston, USA
- Alaska Heart & Vascular Institute, Anchorage, AK, USA
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division), Boston, USA.
- Departments of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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Hansson NH, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Poulsen SH, Wiggers H, Parner ET, Sörensen J. Test-retest repeatability of myocardial oxidative metabolism and efficiency using standalone dynamic 11C-acetate PET and multimodality approaches in healthy controls. J Nucl Cardiol 2018; 25:1929-1936. [PMID: 29855984 DOI: 10.1007/s12350-018-1302-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial efficiency measured by 11C-acetate positron emission tomography (PET) has successfully been used in clinical research to quantify mechanoenergetic coupling. The objective of this study was to establish the repeatability of myocardial external efficiency (MEE) and work metabolic index (WMI) by non-invasive concepts. METHODS AND RESULTS Ten healthy volunteers (63 ± 4 years) were examined twice, one week apart, using 11C-acetate PET, cardiovascular magnetic resonance (CMR), and echocardiography. Myocardial oxygen consumption from PET was combined with stroke work data from CMR, echocardiography, or PET to obtain MEE and WMI for each modality. Repeatability was estimated as the coefficient of variation (CV) between test and retest. MEECMR, MEEEcho, and MEEPET values were 21.9 ± 2.7%, 16.4 ± 3.7%, and 23.8 ± 4.9%, respectively, P < .001. WMICMR, WMIEcho, and WMIPET values were 4.42 ± 0.90, 4.07 ± 0.63, and 4.58 ± 1.13 mmHg × mL/m2 × 106, respectively, P = .45. Repeatability for MEECMR was superior compared with MEEEcho but did not differ significantly compared with MEEPET (6.3% vs 12.9% and 9.4%, P = .04 and .25). CV values for WMICMR, WMIEcho, and WMIPET were 10.0%, 14.8%, and 12.0%, respectively, (P = .53). CONCLUSIONS Non-invasive measurements of MEE using 11C-acetate PET are highly repeatable. A PET-only approach did not differ significantly from CMR/PET and might facilitate further clinical research due to lower costs and broader applicability.
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Affiliation(s)
| | - Hendrik Johannes Harms
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Tolbod
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
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Sandfort V. "Flying blind" or "in plain sight"? J Emerg Crit Care Med 2018; 2:98. [PMID: 30949621 PMCID: PMC6443247 DOI: 10.21037/jeccm.2018.11.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Veit Sandfort
- NIH Clinical Center, Radiology and Imaging Sciences, Building 10, Room 1C224, 10 Center Drive, Bethesda, MD 20892, USA
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Thomas F, Flint N, Setareh-Shenas S, Rader F, Kobal SL, Siegel RJ. Accuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve Disease: A Systematic Review. Am J Med 2018; 131:1155-1160. [PMID: 29856962 DOI: 10.1016/j.amjmed.2018.04.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 01/12/2023]
Abstract
In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment or replace auscultation as the primary mode of cardiovascular diagnosis has become increasingly more relevant. If widely implemented, HHE has the potential for significant cost savings and better resource utilization. This review examines studies comparing the sensitivities of auscultation, HHE, and standard echocardiography in detecting various valvular lesions and discusses why current evidence supports the use of HHE to augment the physical examination, which can lead to more reliable and rapid bedside diagnoses, triage, and appropriate treatment of structural cardiac abnormalities.
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Affiliation(s)
| | - Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Saman Setareh-Shenas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Mount Sinai St. Luke's-Mount Sinai West Hospital Center, New York, NY
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sergio L Kobal
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
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Koth AM, Axelrod DM, Reddy S, Roth SJ, Tacy TA, Punn R. Institution of Veno-arterial Extracorporeal Membrane Oxygenation Does Not Lead to Increased Wall Stress in Patients with Impaired Myocardial Function. Pediatr Cardiol 2017; 38:539-546. [PMID: 28005156 DOI: 10.1007/s00246-016-1546-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022]
Abstract
The effect of veno-arterial extracorporeal membrane oxygenation (VA ECMO) on wall stress in patients with cardiomyopathy, myocarditis, or other cardiac conditions is unknown. We set out to determine the circumferential and meridional wall stress (WS) in patients with systemic left ventricles before and during VA ECMO. We established a cohort of patients with impaired myocardial function who underwent VA ECMO therapy from January 2000 to November 2013. Demographic and clinical data were collected and inotropic score calculated. Measurements were taken on echocardiograms prior to the initiation of VA ECMO and while on full-flow VA ECMO, in order to derive wall stress (circumferential and meridional), VCFc, ejection fraction, and fractional shortening. A post hoc sub-analysis was conducted, separating those with pulmonary hypertension (PH) and those with impaired systemic output. Thirty-three patients met inclusion criteria. The patients' median age was 0.06 years (range 0-18.7). Eleven (33%) patients constituted the organ failure group (Gr2), while the remaining 22 (66%) patients survived to discharge (Gr1). WS and all other echocardiographic measures were not different when comparing patients before and during VA ECMO. Ejection and shortening fraction, WS, and VCFc were not statistically different comparing the survival and organ failure groups. The patients' position on the VCFc-WS curve did not change after the initiation of VA ECMO. Those with PH had decreased WS as well as increased EF after ECMO initiation, while those with impaired systemic output showed no difference in those parameters with initiation of ECMO. The external workload on the myocardium as indicated by WS is unchanged by the institution of VA ECMO support. Furthermore, echocardiographic measures of cardiac function do not reflect the changes in ventricular performance inherent to VA ECMO support. These findings are informative for the interpretation of echocardiograms in the setting of VA ECMO. ECMO may improve ventricular mechanics in those with PH as the primary diagnosis.
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Affiliation(s)
- Andrew M Koth
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, 750 Welch Road, Suite # 325, Palo Alto, CA, 94304, USA.
| | - David M Axelrod
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, 750 Welch Road, Suite # 325, Palo Alto, CA, 94304, USA
| | - Sushma Reddy
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, 750 Welch Road, Suite # 325, Palo Alto, CA, 94304, USA
| | - Stephen J Roth
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, 750 Welch Road, Suite # 325, Palo Alto, CA, 94304, USA
| | - Theresa A Tacy
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, 750 Welch Road, Suite # 325, Palo Alto, CA, 94304, USA
| | - Rajesh Punn
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, 750 Welch Road, Suite # 325, Palo Alto, CA, 94304, USA
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Alkhalifah M, McLean M, Koshak A. Acute Cardiac Tamponade: An Adult Simulation Case for Residents. MedEdPORTAL 2016; 12:10466. [PMID: 31008244 PMCID: PMC6464418 DOI: 10.15766/mep_2374-8265.10466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/12/2016] [Indexed: 05/02/2023]
Abstract
INTRODUCTION This case was designed to be an interprofessional scenario to assist the learner in the approach to a patient with cardiac tamponade. This resource provides information and materials for a high-fidelity simulation scenario that is appropriate for learners at multiple levels. Each learner has the opportunity to interact with embedded patient actors. This scenario includes the opportunity to conduct a bedside echocardiogram and perform an ultrasound-guided pericardiocentesis. METHODS A 51-year-old female presents to the emergency department with a chief complaint of shortness of breath and with a history of cancer. Her shortness of breath evolves into tachypnea, hypoxia, altered mental status, hypotension, and shock. The physical assessment reveals hypotension, muffled heart tones, and jugular vein distension. One critical action requires the recognition of pericardial effusion on a bedside echocardiogram. The learner needs to interpret the ultrasound findings in conjunction with the physical exam findings to diagnose cardiac tamponade. An emergent ultrasound-guided pericardiocentesis is to be performed. Equipment needed includes a high-fidelity adult mannequin, the low-cost ultrasound pericardiocentesis model (or pericardocentesis model of choice), bedside ultrasound, the PowerPoint presentation containing imaging, and laboratory data. RESULTS A survey was completed by 23 residents who participated in this simulation. Ninety-five percent of those responding felt that this simulation in conjunction with the debriefing was effective in managing a patient presenting with undifferentiated shortness of breath and pericardial tamponade. DISCUSSION This case will be incorporated into the 3-year curriculum for our emergency medicine residency program and assist with evaluation of resident performance of pericardiocentesis.
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Affiliation(s)
- Mohammed Alkhalifah
- Neurocritical Care Fellow, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine
| | - Michelle McLean
- Assistant Director of the Clinical Simulation Center, Central Michigan University College of Medicine
| | - Ahmad Koshak
- Assistant Professor of Emergency Medicine, Central Michigan University College of Medicine
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Nakamura K, Qian K, Ando T, Inokuchi R, Doi K, Kobayashi E, Sakuma I, Nakajima S, Yahagi N. Cardiac Variation of Internal Jugular Vein for the Evaluation of Hemodynamics. Ultrasound Med Biol 2016; 42:1764-1770. [PMID: 27108039 DOI: 10.1016/j.ultrasmedbio.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 02/10/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
Evaluations of intravascular fluid volume are considered to be one of the most important assessments in emergency and intensive care. Focusing on pulse-induced variation of the internal jugular vein (IJV) area, i.e., cardiac variation, we investigated its correlation with various hemodynamic indices using newly developed software. Software that automatically can track and analyze the IJV during ultrasonography was developed. Eleven healthy patients were subjected to an exercise load to increase their stroke volume (SV) and a dehydration load to decrease their central venous pressure (CVP). The cardiac variation in the area of the IJV, CVP, the SV and the respiratory variation in the inferior vena cava (IVC) were evaluated. The exercise protocol increased the patients' mean SV by 14.5 ± 3.7 mL, and the dehydration protocol caused their mean CVP to fall by 3.75 ± 0.33 cm H2O, which resulted in the collapse index (max IJV area - min IJV area/max IJV area) changing from 0.32 ± 0.04 to 0.44 ± 0.06 and 0.49 ± 0.04, respectively (p < 0.05). The SV exhibited a strong positive correlation with the collapse index (r = 0.59, p = 0.006), and CVP showed a strong positive correlation with the body height-adjusted mean area of the IJV (r = 0.72, p < 0.001). Cardiac variation in the area of the great veins is considered to be induced by venous return to the right atrium under negative pressure. It is possible that intravascular dehydration can be detected and hemodynamic indices, such as CVP and SV, can be estimated by evaluating cardiac variation in the area of the IJV.
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Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan; Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Kun Qian
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Takehiro Ando
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Etsuko Kobayashi
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Ichiro Sakuma
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Susumu Nakajima
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Yahagi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Dahine J, Giard A, Chagnon DO, Denault A. Ultrasound findings in critical care patients: the "liver sign" and other abnormal abdominal air patterns. Crit Ultrasound J 2016; 8:2. [PMID: 26968407 PMCID: PMC4788656 DOI: 10.1186/s13089-016-0039-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/01/2016] [Indexed: 11/16/2022] Open
Abstract
In critical care patients, point of care abdominal ultrasound examination, although it has been practiced for over 30 years, is not as widespread as its cardiac or pulmonary counterparts. We report two cases in which detection of air during abdominal ultrasound allowed the early detection of life-threatening pathologies. In the first case, a patient with severe Clostridium difficile was found to have portal venous gas but its significance was confounded by a recent surgery. Serial ultrasonographic exams triggered a surgical intervention. In the second case, we report what we call the “liver sign” a finding in patients with pneumoperitoneum. These findings, all obtained prior to conventional abdominal imaging, had immediate clinical impact and avoided unnecessary delays and radiation. Detection of abdominal air should be part of the routine-focused ultrasonographic exam and for critically ill patients an algorithm is proposed.
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Affiliation(s)
- Joseph Dahine
- Department of Intensive Care, Université de Montréal, Montreal, QC, Canada
| | - Annie Giard
- Department of Emergency Medicine, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - David-Olivier Chagnon
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - André Denault
- Department of Anesthesiology and Division of Critical Care, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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Abstract
Phase analysis of gated myocardial perfusion single-photon emission computed tomography is a widely available and reproducible measure of left ventricular (LV) dyssynchrony, which also provides comprehensive assessment of LV function, global and regional scar burden, and patterns of LV mechanical activation. Preliminary studies indicate potential use in predicting cardiac resynchronization therapy response and elucidation of mechanisms. Because advances in technology may expand capabilities for precise LV lead placement in the future, identification of specific patterns of dyssynchrony may have a critical role in guiding cardiac resynchronization therapy.
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Cain-Hom C, Pabalate R, Pham A, Patel HN, Wiler R, Cox JC. Mammalian Genotyping Using Acoustic Droplet Ejection for Enhanced Data Reproducibility, Superior Throughput, and Minimized Cross-Contamination. ACTA ACUST UNITED AC 2015; 21:37-48. [PMID: 26311060 DOI: 10.1177/2211068215601637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 12/20/2022]
Abstract
Genetically engineered animal models are major tools of a drug discovery pipeline because they facilitate understanding of the molecular and biochemical basis of disease. These highly complex models of human disease often require increasingly convoluted genetic analysis. With growing needs for throughput and consistency, we find that traditional aspiration-and-dispense liquid-handling robots no longer have the required speed, quality, or reproducibility.We present an adaptation and installation of an acoustic droplet ejection (ADE) liquid-handling system for ultra-high-throughput screening of genetically engineered models. An ADE system is fully integrated with existing laboratory processes and platforms to facilitate execution of PCR and quantitative PCR (qPCR) reactions. Such a configuration permits interrogation of highly complex genetic models in a variety of backgrounds. Our findings demonstrate that a single ADE system replaces 8-10 traditional liquid-handling robots while increasing quality and reproducibility.We demonstrate significant improvements achieved by transitioning to an ADE device: extremely low detectable cross-contamination in PCR and qPCR despite extensive use, greatly increased data reproducibility (large increases in data quality and Cq consistency), lowered reaction volumes for large cost savings, and nearly a magnitude increase in speed per instrument. We show several comparisons between traditional- and ADE-based pipetting for a qPCR-based workflow.
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Affiliation(s)
- Carol Cain-Hom
- Department of Transgenic Technology, Genentech Inc., San Francisco, CA, USA
| | - Ryan Pabalate
- Department of Transgenic Technology, Genentech Inc., San Francisco, CA, USA
| | - Anna Pham
- Department of Transgenic Technology, Genentech Inc., San Francisco, CA, USA
| | - Hetal N Patel
- Department of Transgenic Technology, Genentech Inc., San Francisco, CA, USA
| | - Rhonda Wiler
- Department of Transgenic Technology, Genentech Inc., San Francisco, CA, USA
| | - J Colin Cox
- Department of Transgenic Technology, Genentech Inc., San Francisco, CA, USA
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Roberts K, Callis R, Ikeda T, Paunovic A, Simpson C, Tang E, Turton N, Walker G. Implementation and Challenges of Direct Acoustic Dosing into Cell-Based Assays. ACTA ACUST UNITED AC 2015; 21:76-89. [PMID: 26169025 DOI: 10.1177/2211068215595212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Indexed: 12/18/2022]
Abstract
Since the adoption of Labcyte Echo Acoustic Droplet Ejection (ADE) technology by AstraZeneca in 2005, ADE has become the preferred method for compound dosing into both biochemical and cell-based assays across AstraZeneca research and development globally. The initial implementation of Echos and the direct dosing workflow provided AstraZeneca with a unique set of challenges. In this article, we outline how direct Echo dosing has evolved over the past decade in AstraZeneca. We describe the practical challenges of applying ADE technology to 96-well, 384-well, and 1536-well assays and how AstraZeneca developed and applied software and robotic solutions to generate fully automated and effective cell-based assay workflows.
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Affiliation(s)
| | | | - Tim Ikeda
- AstraZeneca, Gatehouse Park, Boston, MA, USA
| | | | | | - Eric Tang
- AstraZeneca PLC, Alderley Park, Cheshire, UK
| | - Nick Turton
- AstraZeneca PLC, Alderley Park, Cheshire, UK
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Chen C, Chen YT, Wang KT, Shih SC, Liu CC, Kuo JY, Hou CJ, Wu YJ, Hung CL, Yeh HI. The association among age, early mitral leaflet closure, cardiac structure, diastolic indices and NT-proBNP in an asymptomatic Taiwanese population. Int J Cardiol Heart Vasc 2015; 8:114-21. [PMID: 28785690 DOI: 10.1016/j.ijcha.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/24/2022]
Abstract
Background Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The association among aging, mitral leaflet closure (EF slope), cardiac structures, and diastolic indices in an asymptomatic Taiwanese population is largely unknown. Methods We studied 8103 asymptomatic participants (49.5 ± 11.6 years, 38.2% women) from a health evaluation cohort (2004–2012) in a tertiary center in Taiwan. Echo-derived LV structure/function, and M-mode based EF slope (mm/s) and serum NT-proBNP level were obtained. The association between EF slope and the other clinical or echo-based parameters was investigated. Results Average values for EF slope among various age groups in the Taiwanese population were determined for both genders. Advanced age was associated with reductions in EF slope (adjusted estimate: − 0.35/per decade). Reduced EF slope was associated with older age, higher blood pressure and greater body mass index in multivariate models (all p < 0.05). Reduced EF slope was correlated with greater cardiac concentricity, abnormal E′ and E/E′ (AUROC: 0.74 and 0.77, respectively, both p < 0.05) and elevated NT-proBNP (Coef: 5.98 pg/mL, per − 10 mm/s EF slope, 95% CI: 7.82 to 4.17, p < 0.001). EF-slope also clearly discriminated individuals with abnormal estimated LV filling (E/E′ categorized by < 8, ≥ 8 & < 15, ≥ 15, ANOVA p < 0.001). Conclusions EF-slope reduction in the asymptomatic Taiwanese population was correlated with age, several unfavorable LV remodeling, and impaired diastolic function parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor E′ and elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups.
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Versteeg H, van 't Sant J, Cramer MJ, Doevendans PA, Pedersen SS, Meine M. Discrepancy between echocardiographic and patient-reported health status response to cardiac resynchronization therapy: results of the PSYHEART-CRT study. Eur J Heart Fail 2013; 16:227-34. [PMID: 24464983 DOI: 10.1002/ejhf.38] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/18/2013] [Accepted: 11/01/2013] [Indexed: 11/11/2022] Open
Abstract
AIMS The current study examined the degree of agreement between echocardiographic and patient-reported health status response to CRT 6 months after implantation, and evaluated the differences in pre-implantation characteristics of patients with concordant and discordant echocardiographic and health status responses. METHODS AND RESULTS Consecutively implanted CRT-defibrillator patients (n = 109, mean age = 65.4 ± 10.1 years, 74 men) were recruited from the University Medical Center Utrecht, The Netherlands. Prior to implantation and 6 months post-implantation, all patients underwent echocardiography and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). Echocardiographic response was defined as a relative reduction of ≥15% in LV end-systolic volume; an improvement of ≥10 points in KCCQ score indicated a health status response. In the 54 patients with discordant responses, 25 (22.9%) had an echocardiographic response but no health status response and 29 (26.6%) had a health status response but no echocardiographic response. Patients with concordant and discordant responses differed on various pre-implantation characteristics, including sex, employment status, LV volumes, and pre-implantation KCCQ score. In multivariable analysis, pre-implantation KCCQ score [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.88-0.95, P < 0.001] and QRS duration (OR = 1.03, 95% CI = 1.01-1.06, P = 0.009) were the only characteristics associated with health status response to CRT. CONCLUSIONS Our results show a large discrepancy between echocardiographic and patient-reported health status response to CRT. The most important predictor of health status response was the pre-implantation health status score. These results emphasize that disease-specific health status measures may have additional value over 'objective' measures of CRT response and should be incorporated in clinical practice.
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Affiliation(s)
- Henneke Versteeg
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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