1
|
Bedir Ö, Evlice M, Kurt İH. Relationship between echocardiographic parameters and ALBI score in patients with rheumatic mitral stenosis. Int J Cardiovasc Imaging 2024; 40:535-543. [PMID: 38104039 DOI: 10.1007/s10554-023-03021-7] [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] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
An increase in the volume and pressure of the heart chambers has been shown to increase liver stiffness. The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. There is no information in the literature regarding changes in ALBI scores in patients with rheumatic mitral stenosis (MS). The aim of our study was to investigate changes in ALBI score and its clinical impact in patients with MS. Of the 247 patients analyzed, 54 were excluded from the study. The remaining 193 patients with MS were divided into two groups: Group I (64 patients with mitral valve area > 1.5 cm2 and mean transmitral gradient < 10 mmHg) and Group II (129 patients with mitral valve area ≤ 1.5 cm2 and mean transmitral gradient ≥ 10 mmHg). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI= (log10 bilirubin [µmol/L] × 0.66) + (albumin [g/L] × - 0.085). A significant correlation was found between the ALBI score and mitral valve area in patients with MS (r = - 0.479, p < 0.001*) (Table 4; Fig. 3A). An ALBI score greater than - 2.61 was associated with severe MS (mitral valve area < 1.5 cm2), with a sensitivity of 72% and a specificity of 69% (Area under the ROC curve = 0.726; p < 0.001; 95% CI 0.650-0.802) (Fig. 4A). A significant correlation was found between the ALBI score and mean transmitral gradient in patients with MS (r = 0.476; p < 0.001*) (Table 4; Fig. 3B). An ALBI score greater than - 2.57 was associated with severe MS (mean transmitral gradient < 10 mmHg), with a sensitivity of 65% and a specificity of 67% (Area under the ROC curve = 0.684; p < 0.001; 95% CI 0.608-0.759) (Fig. 4B). In multivariate linear regression analysis, mitral valve area and mean transmitral gradient were significantly associated with increased ALBI scores (p < 0.05). Mitral valve area, mean transmitral gradient, and NT-proBNP levels were significantly associated with the ALBI score. The ALBI score could provide an information about the severity of MS. The ALBI score is a simple, evidence-based, objective, and discriminatory method for assessing liver function in patients with MS.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Authors and their respective affiliations are correctly identified.
Collapse
Affiliation(s)
- Ömer Bedir
- Department of Cardiology, Health Sciences Hamidiye University -Adana City Training and Research Hospital, Adana, Türkiye.
| | - Mert Evlice
- Department of Cardiology, Health Sciences Hamidiye University -Adana City Training and Research Hospital, Adana, Türkiye
| | - İbrahim H Kurt
- Department of Cardiology, Health Sciences Hamidiye University -Adana City Training and Research Hospital, Adana, Türkiye
| |
Collapse
|
2
|
Maccallini M, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E, Gómez-Otero I, López-López A, Gutiérrez-Feijoo M, Varela-Román A, García-Seara J, Bouzas-Mosquera A, Crespo-Leiro MG. Prognostic value of the tricuspid annular plane systolic excursion/ systolic pulmonary artery pressure ratio in cardiac amyloidosis. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00036-7. [PMID: 38296161 DOI: 10.1016/j.rec.2024.01.001] [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] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/05/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION AND OBJECTIVES The tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/SPAP) ratio is a noninvasive surrogate of right ventricular to pulmonary circulation that has prognostic implications in patients with heart failure (HF) or pulmonary hypertension. Our purpose was to evaluate the prognostic value of the TAPSE/SPAP ratio in patients with cardiac amyloidosis. METHODS We used the database of the AMIGAL study, a prospective, observational registry of patients with cardiac amyloidosis recruited in 7 hospitals of the Autonomous Community of Galicia, Spain, from January 1, 2018 to October 31, 2022. We selected patients whose baseline TAPSE/SPAP ratio was calculated with transthoracic echocardiography. Long-term survival and survival free of HF hospitalization were assessed by means of 5 different multivariable Cox regression models. Median follow-up was 680 days. RESULTS We studied 233 patients with cardiac amyloidosis, among whom 209 (89.7%) had transthyretin type. The baseline TAPSE/SPAP ratio correlated significantly with clinical outcomes. Depending on the multivariable model considered, the adjusted hazard ratios estimated per 0.1mm/mmHg increase of baseline TAPSE/SPAP ratio ranged from 0.76 to 0.84 for all-cause mortality. Similarly, the ratios for all-cause mortality of HF hospitalization ranged from 0.79 to 0.84. The addition of the baseline TAPSE/SPAP ratio to the predictive model of the United Kingdom National Amyloidosis Centre resulted in an increase in Harrell's c-statistic from 0.662 to 0.705 for all-cause mortality and from 0.668 to 0.707 for all-cause mortality or HF hospitalization. CONCLUSIONS Reduced TAPSE/SPAP ratio is an independent adverse prognostic marker in patients with cardiac amyloidosis.
Collapse
Affiliation(s)
- Marta Maccallini
- Department of Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manuel López-Pérez
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ferrol (CHUF), Servicio Galego de Saúde (SERGAS), Ferrol, A Coruña, Spain
| | - Raquel Bilbao-Quesada
- Servicio de Cardiología, Complexo Hospitalario Universitario de Vigo (CHUVI), Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Eva González-Babarro
- Servicio de Cardiología, Complexo Hospitalario Universitario de Pontevedra (CHOP), Servicio Galego de Saúde (SERGAS), Pontevedra, Spain
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Andrea López-López
- Servicio de Cardiología, Hospital Universitario Lucus Augusti (HULA), Servicio Galego de Saúde (SERGAS), Lugo, Spain
| | - Mario Gutiérrez-Feijoo
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ourense (CHUOU), Servicio Galego de Saúde (SERGAS), Ourense, Spain
| | - Alfonso Varela-Román
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Javier García-Seara
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| |
Collapse
|
3
|
Boxhammer E, Dienhart C, Kletzer J, Ramsauer S, Kopp K, Prinz E, Wintersteller W, Blessberger H, Hammerer M, Steinwender C, Lichtenauer M, Hoppe UC. Elevated systolic pulmonary artery pressure is a substantial predictor of increased mortality after transcatheter aortic valve replacement in males, not in females. Clin Res Cardiol 2024; 113:138-155. [PMID: 37750991 PMCID: PMC10808322 DOI: 10.1007/s00392-023-02307-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND While pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) is associated with increased mortality after transcatheter aortic valve replacement (TAVR), there is limited data on gender differences in the effects on long-term survival. OBJECTIVE The aim of this retrospective, multicenter study was to investigate the prognostic impact of pre-interventional PH on survival of TAVR patients with respect to gender. METHODS 303 patients undergoing TAVR underwent echocardiography to detect PH prior to TAVR via measurement of systolic pulmonary artery pressure (sPAP). Different cut-off values were set for the presence of PH. The primary endpoint was all-cause mortality at 1, 3 and 5 years. RESULTS Kaplan-Meier analysis by gender showed that only males exhibited significant increased mortality at elevated sPAP values during the entire follow-up period of 5 years (sPAP ≥ 40 mmHg: p ≤ 0.001 and sPAP ≥ 50 mmHg: p ≤ 0.001 in 1- to 5-year survival), whereas high sPAP values had no effect on survival in females. In Cox regression analysis based on the selected sPAP thresholds, male gender was an independent risk factor for long-term mortality after TAVR in all time courses. CONCLUSION Male gender was an isolated risk factor for premature death after TAVR in patients with echocardiographic evidence of PH and severe AS. This could mean that, the indication for TAVR should be discussed more critically in men with severe AS and an elevated sPAP, while in females, PH should not be an exclusion criterion for TAVR.
Collapse
Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Christiane Dienhart
- Department of Internal Medicine I, Division of Gastroenterology, Hepathology, Nephrology, Metabolism and Diabetology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Joseph Kletzer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Susanne Ramsauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Erika Prinz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Wilfried Wintersteller
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Matthias Hammerer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, Linz, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| |
Collapse
|
4
|
Boxhammer E, Kletzer J, Kellermair J, Scharinger B, Kaufmann R, Hammerer M, Blessberger H, Steinwender C, Lichtenauer M, Hergan K, Hoppe UC, Hecht S. CT measured pulmonary artery to ascending aorta ratio stratified by echocardiographically obtained systolic pulmonary artery pressure values for noninvasive detection of pulmonary hypertension in patients with severe aortic valve stenosis. Clin Res Cardiol 2023; 112:1394-1416. [PMID: 36935421 PMCID: PMC10562282 DOI: 10.1007/s00392-023-02182-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) offers a measurement method for the determination of pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) with determination of maximal tricuspid regurgitation velocity (TRVmax) and systolic pulmonary artery pressure (sPAP). Radiological parameters for noninvasive detection of PH, most importantly computed tomography (CT) based PA/AA-ratio = ratio of pulmonary artery diameter (PA) and ascending aorta diameter (AA), are also included in the latest ESC guidelines. The aim of the present study was to define cut-off values for PA/AA-ratio taking also into account cardiovascular biomarkers to determine criteria for noninvasive diagnosis of PH. METHODS 194 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) underwent pre-procedural TTE and CT with measurement of PA/AA-ratio. Additionally, common cardiovascular biomarkers were determined. RESULTS TAVR patients with an sPAP ≥ 40 mmHg or a TRVmax ≥ 2.9 m/s had a PA/AA-ratio ≥ 0.80 in an AUROC analysis. The cut-off value of ≥ 0.80 resulted in a significantly higher mortality rate (log-rank test: p = 0.034) in these patients in a Kaplan-Meier analysis regarding 1-year survival after TAVR. Significant differences in biomarker expression between patients with a PA/AA-ratio ≥ 0.80 or < 0.80 occurred for BNP (p = 0.001), cTnI (p = 0.032), GDF-15 (p = 0.002) and H-FABP (p = 0.015). CONCLUSION PA/AA-ratio ≥ 0.80 is a promising radiological parameter that can provide information about mortality in patients with severe AS undergoing TAVR; combined with biomarkers it may contribute to noninvasive detection of PH in patients with severe AS.
Collapse
Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Joseph Kletzer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Jörg Kellermair
- Department of Cardiology, Johannes Kepler University Hospital Linz, 4020, Linz, Austria
| | - Bernhard Scharinger
- Department of Radiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Reinhard Kaufmann
- Department of Radiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Matthias Hammerer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Hermann Blessberger
- Department of Cardiology, Johannes Kepler University Hospital Linz, 4020, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Johannes Kepler University Hospital Linz, 4020, Linz, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| |
Collapse
|
5
|
Ansari Damavandi S, Parsaee M, Ahmadi Marzaleh M, Shamspour M. The Effect of L-Arginine Oral Supplementation on the Improvement of Cardiovascular Function and Pulmonary Artery Pressure in Patients with Major and Intermedia β-Thalassemia. Iran J Public Health 2023; 52:1031-1037. [PMID: 37484717 PMCID: PMC10362206 DOI: 10.18502/ijph.v52i5.12721] [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: 01/09/2021] [Accepted: 03/18/2022] [Indexed: 07/25/2023]
Abstract
Background Thalassemia is the most common inherited anemia in worldwide. Heart failure is the most common cause of mortality and morbidity in patients with major and intermedia β-thalassemia. This study aimed to evaluate the effect of oral administration of L-arginine on the improvement of systolic Pulmonary Artery Pressure (PAP) and cardiac function in patients with major and intermedia β-thalassemia. Methods This randomized clinical trial was done on 88 patients with β-thalassemia admitted to Ali Asghar Hospital, Tehran, Iran between 2020 and 2021. Echocardiography was performed for all the patients before the intervention. Afterwards, the patients were randomly divided into two groups of placebo and L-arginine. The patients underwent echocardiography after eight weeks and were compared with respect to the results. Results The mean blood transfusion interval was 20.21 d in the placebo group and 17.14 d in the L-arginine group (P=0.082). The results revealed no significant difference between the two groups regarding the mean levels of Hemoglobin (Hb) and ferritin, frequency of splenectomy. However, the mean PAP significantly decreased from 32.88 to 26.02 in the L-arginine group (P=0.009), but did not change in the placebo group. Nonetheless, no significant change was observed in the mean Ejection Fraction (EF) before and after L-arginine administration. Conclusion L-arginine administration prevented the increase of PAP and was effective in preventing cardiovascular disorders including increased systolic PAP in patients with major and intermedia B-thalassemia. However, the results have to be confirmed in further studies with larger sample sizes.
Collapse
Affiliation(s)
- Shahla Ansari Damavandi
- Department of Hematology-Oncology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Parsaee
- Echocardiography Research Center of Rajaee Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shamspour
- Pediatric Hematology and Oncology, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Ceriani E, Marceca A, Lanfranchi A, De Vita S, Schiavon R, Casella F, Torzillo D, Del Medico M, Ruggiero D, Barosi A, Cogliati C. Early echocardiographic findings in patients hospitalized for COVID-19 pneumonia: a prospective, single center study. Intern Emerg Med 2021; 16:2173-2180. [PMID: 34019253 PMCID: PMC8138842 DOI: 10.1007/s11739-021-02733-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac dysfunction, mainly assessed by biomarker alterations, has been described in COVID-19 infection. However, there are still areas of uncertainty regarding its effective role in disease evolution. Aim of this study was to evaluate early echocardiographic parameters in COVID pneumonia and their association with severity disease and prognosis. METHODS An echocardiographic examination was performed within 72 h from admission in 64 consecutive patients hospitalized for COVID-19 pneumonia in our medium-intensity care unit, from March 30th to May 15th 2020. Six patients were excluded for inadequate acoustic window. RESULTS Fifty-eight consecutive patients were finally enrolled, with a median age of 58 years. Twenty-two (38%) were classifiable as severe COVID-19 disease. Eight out of 58 patients experienced adverse evolution (six died, two were admitted to ICU and received mechanical ventilation), all of them in the severe pneumonia group. Severe pneumonia patients showed higher troponin, IL-6 and D-Dimer values. No significant new onset alterations of left and right ventricular systolic function parameters were observed. Patients with severe pneumonia showed higher mean estimated systolic pulmonary artery pressure (sPAP) (30.7 ± 5.2 mmHg vs 26.2 ± 4.3 mmHg, p = 0.006), even if in the normality range values. No differences in echocardiographic parameters were retrieved in patients with adverse events with respect to those with favorable clinical course. CONCLUSION A mild sPAP increase in severe pneumonia patients with respect to those with milder disease was the only significant finding at early echocardiographic examination, without other signs of new onset major cardiac dysfunction. Future studies are needed to deepen the knowledge regarding minor cardiac functional perturbation in the evolution of a complex systemic disorder, in which the respiratory involvement appears as the main character, at least in non-ICU patients.
Collapse
Affiliation(s)
- Elisa Ceriani
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Via GB Grassi, 20157, Milan, Italy.
| | - Azzurra Marceca
- Cardiovascular Imaging Unit, Department of Cardiology, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Antonio Lanfranchi
- Cardiovascular Imaging Unit, Department of Cardiology, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Stefano De Vita
- Cardiovascular Imaging Unit, Department of Cardiology, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Riccardo Schiavon
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Francesco Casella
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Daniela Torzillo
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Marta Del Medico
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Diego Ruggiero
- Electrophysiology Unit, Department of Cardiology, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Alberto Barosi
- Cardiovascular Imaging Unit, Department of Cardiology, L. Sacco Hospital, University of Milan, Milan, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
| |
Collapse
|
7
|
Arangalage D, Cattan L, Eugène M, Cimadevilla C, Monney P, Iung B, Brochet E, Burwash IG, Vahanian A, Messika-Zeitoun D. Prognostic Value of Peak Exercise Systolic Pulmonary Arterial Pressure in Asymptomatic Primary Mitral Valve Regurgitation. J Am Soc Echocardiogr 2021; 34:932-940. [PMID: 33872700 DOI: 10.1016/j.echo.2021.04.009] [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: 12/21/2020] [Revised: 02/26/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The contribution of exercise echocardiography in primary asymptomatic mitral regurgitation (MR) remains debated. The aim of this study was to gain evidence regarding its usefulness in this setting and to investigate the prognostic value of peak exercise systolic pulmonary artery pressure (SPAP). METHODS One hundred seventy-seven patients (mean age, 56 ± 13 years; 69% men) with moderate to severe (grade 3+) or severe (grade 4+) degenerative MR and preserved left ventricular ejection fraction, in sinus rhythm, referred for clinically indicated exercise echocardiography were identified. The end point, MR-related events, was a composite of all-cause death or occurrence of symptoms, heart failure, atrial fibrillation, left ventricular ejection fraction < 60%, left ventricular end-systolic diameter ≥ 45 mm, or resting SPAP > 50 mm Hg. RESULTS At rest, effective regurgitant orifice area was 48 ± 16 mm2, regurgitant volume 74 ± 26 mL, and SPAP 32 ± 7 mm Hg, and MR was severe in 138 patients (78%). Peak exercise SPAP was 55 ± 10 mm Hg. Positive results on exercise testing motivated surgery in 26 patients, 11 underwent prophylactic surgery, 10 were lost to follow-up, and 130 were included in the outcome analysis. During a follow-up period of 19 ± 7 months, 31 MR-related events (24%) were reported. Peak exercise SPAP was predictive of outcomes in univariate analysis (P = .01) and after adjustment for age, gender, MR severity, and resting SPAP (P < .05). Peak exercise SPAP ≥ 50 mm Hg was associated with worse event-free survival (hazard ratio, 5.24; 95% CI, 1.77-15.53; P = .003), but not the threshold of ≥60 mm Hg proposed in previous guidelines (hazard ratio, 1.70; 95% CI, 0.71-4.03; P = .24). CONCLUSIONS The present findings support the use of exercise echocardiography for risk stratification in patients with asymptomatic primary MR and suggest a lower peak exercise SPAP threshold (50 mm Hg) than previously recommended to define the timing of intervention. Prospective studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Dimitri Arangalage
- Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UMRS1148, INSERM, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Léa Cattan
- Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Eugène
- Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Claire Cimadevilla
- Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Monney
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UMRS1148, INSERM, Paris, France; Université de Paris, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ian G Burwash
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alec Vahanian
- Université de Paris, UMRS1148, INSERM, Paris, France; Université de Paris, Paris, France
| | | |
Collapse
|
8
|
Avcı D, Hartoka Sevinç A, Güler S. The systolic pulmonary artery pressure and the E/e' ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation. Braz J Otorhinolaryngol 2021; 87:497-504. [PMID: 33248927 DOI: 10.1016/j.bjorl.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/29/2020] [Revised: 09/13/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases. OBJECTIVE To investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty. METHODS The prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients. RESULTS Mean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e' ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e' ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05). CONCLUSION The decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e's ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.
Collapse
|
9
|
Liu D, Hu K, Liebner E, Weidemann F, Herrmann S, Ertl G, Frantz S, Nordbeck P. Value of low-dose dobutamine stress echocardiography on defining true severe low gradient aortic stenosis in patients with preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 2018; 34:1877-1887. [PMID: 30039338 PMCID: PMC6245091 DOI: 10.1007/s10554-018-1416-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/17/2018] [Indexed: 12/02/2022]
Abstract
Low-dose dobutamine stress echocardiography (DSE) is a valuable tool to distinguish true-severe (TS) from pseudo-severe (PS) low gradient aortic valve stenosis (LGAS) in patients with reduced left ventricular ejection fraction (LVEF). However, only scanty studies reported the clinical utility of DSE in differentiating TS-LGAS patients with preserved LVEF. We investigated the clinical utility of DSE in LGAS patients with preserved LVEF and the echocardiographic determinants suggestive of TS-LGAS. 130 consecutive LGAS patients [indexed aortic valve area (AVA) ≤ 0.6cm2/m2 and mean trans-aortic pressure gradient (PGmean) < 40mmHg] with preserved (≥ 50%, n = 63) and reduced (< 50%, n = 67) LVEF were included. DSE defined TS-LGAS (projected AVA ≤ 1 cm2) in 61.2% patients with reduced LVEF and in 68.3% patients with preserved LVEF. Multivariate logistic regression analysis showed that baseline AVA was an independent determinant of TS-LGAS both in LVEF ≥ 50% (OR 0.45, P = 0.004) and LVEF < 50% groups (OR 0.55, P = 0.005). Reduced septal and lateral mitral annular plane systolic excursion (MAPSE, OR 0.72 and 0.75, P = 0.013 and 0.016) and septal TDI-s´ were significantly associated with TS-LGAS in patients with LVEF ≥ 50%. Higher systolic pulmonary artery pressure (SPAP, OR 1.43, P = 0.045) was associated with TS-LGAS in patients with LVEF < 50%. DSE is useful to define TS-LGAS also in patients with preserved LVEF. Lower baseline AVA values are linked with TS-LGAS in both patients with reduced and preserved LVEF. Reduced MAPSE and septal TDI-s´ are suggestive of TS-LGAS in patients with preserved LVEF, while higher SPAP is associated with TS-LGAS in patients with reduced LVEF.
Collapse
Affiliation(s)
- Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Eva Liebner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Medizinische Klinik I des Klinikum Vest, Recklinghausen, Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, Würzburg, Germany. .,Medizinische Klinik und Poliklinik I, Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| |
Collapse
|
10
|
Abstract
OBJECTIVE Elevated systolic pulmonary artery pressure (sPAP) is common among elderly patients with cardiac and pulmonary diseases. The lowest level of sPAP associated with increased mortality rate in octogenarians with cardiac diseases is however not sufficiently studied. Therefore, the present study aimed to identify the lowest level of sPAP associated with increased 5-year all-cause mortality in this patient group. DESIGN Of 538 octogenarians presented at the three Sahlgrenska University Hospitals (Sahlgrenska, Östra and Mölndal) with either congestive heart failure (CHF) or acute coronary syndrome (ACS), only 302 patients who had undergone echocardiography with data on sPAP were included in the present study. In order to identify the lowest level of sPAP associated with increased mortality rate, Cox proportional-hazard regression multivariable models were built for sPAP levels as low as 30 mmHg and upward with 5 mmHg intervals. RESULTS sPAP >35 mmHg was identified as the lowest level associated with increased 5-year all-cause mortality (HR = 1.7, 95% of CI = 1.1-2.6 and p = .013). Every increase of 5 mmHg in sPAP was associated with a 10% increased relative risk for all-cause mortality. CONCLUSIONS In octogenarians with cardiac diseases the lowest level of sPAP associated with increased all-cause mortality was >35 mmHg and the mortality rate increased with increasing sPAP.
Collapse
Affiliation(s)
- Salim Bary Barywani
- a Section of Cardiology, Department of Medicine , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Michael Fu
- a Section of Cardiology, Department of Medicine , Sahlgrenska University Hospital , Gothenburg , Sweden
| |
Collapse
|
11
|
Zhu WW, Li YD, Li H, Lu XZ, Kong LY, Ye XG, Cai QZ, Sun LL, Jiang W, Wang L. Integrative Cardiopulmonary Ultrasound for Interstitial Lung Disease Assessment: Correlation between Lung Ultrasound Performance and Cardiac Involvement. Ultrasound Med Biol 2017; 43:744-752. [PMID: 28073593 DOI: 10.1016/j.ultrasmedbio.2016.11.004] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
The aims of this study were to apply integrative cardiopulmonary ultrasound (thoracic ultrasound) to the evaluation of patients with interstitial lung disease (ILD) and to determine the relationship between lung ultrasound signs and echocardiographic parameters such as systolic pulmonary artery pressure (SPAP) and various right ventricular parameters. ILD patients and healthy controls underwent lung ultrasound (LUS) and echocardiographic tests. In addition to traditional echocardiographic parameters, right ventricular free wall longitudinal strain (RVLS_FW) was measured using 2-D speckle-tracking echocardiography. The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored with a semiquantitative scoring method, taking into account multiple LUS signs. Statistical analyses were performed to compare various parameters between ILD patients with and those without pulmonary hypertension. Correlations between the different parameters were then evaluated, and the LUS scores were used to predict pulmonary hypertension using a receiver operating characteristic curve analysis. Among the 90 patients who qualified for entry into this study, 30% (n = 27) had pulmonary hypertension. The patients with pulmonary hypertension had larger right ventricular dimensions, lower RVLS_FW and higher LUS scores. An effective correlation was found between ILD LUS scores and echocardiographic parameters, especially SPAP (r = 0.735, p < 0.001). The groups were comparable with respect to most echocardiographic parameters, with mild, moderate and severe pulmonary fibrosis, whereas SPAP was significantly higher in the moderate and severe groups. RVLS_FW was obviously reduced in the group with severe pulmonary fibrosis. Although RVLS_FW in the mild pulmonary fibrosis group was in the normal range, it was slightly reduced compared with that of the controls. A cutoff of more than 16 LUS points had 85.2% sensitivity and 80.3% specificity in predicting elevated SPAP (>36 mm Hg). Thoracic ultrasound is useful in the assessment of ILD. As ILD progresses, the structure or function of the right ventricle gradually deteriorates. LUS not only detects lung conditions in ILD, but also indirectly reflects SPAP and right ventricular function. Integrated use of LUS and echocardiography will provide an invaluable point-of-care imaging modality to facilitate the diagnosis, management and treatment of patients with ILD.
Collapse
Affiliation(s)
- Wei-Wei Zhu
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Yi-Dan Li
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Hong Li
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhang Lu
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
| | - Ling-Yun Kong
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Guang Ye
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Qi-Zhe Cai
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Lan-Lan Sun
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Jiang
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Echocardiography, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Plesner LL, Schoos MM, Dalsgaard M, Goetze JP, Kjøller E, Vestbo J, Iversen K. Iron Deficiency in COPD Associates with Increased Pulmonary Artery Pressure Estimated by Echocardiography. Heart Lung Circ 2016; 26:101-104. [PMID: 27372430 DOI: 10.1016/j.hlc.2016.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 01/31/2016] [Revised: 04/06/2016] [Accepted: 04/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Iron deficiency (ID) might augment chronic pulmonary hypertension in chronic obstructive pulmonary disease (COPD). This observational study investigates the association between ID and systolic pulmonary artery pressure estimated by echocardiography in non-anaemic COPD outpatients. METHODS Non-anaemic COPD patients (GOLD II-IV) with no history of cardiovascular disease were recruited from outpatient clinics. Iron deficiency was defined as ferritin<100μg/L. Pulmonary artery pressure was estimated from the tricuspid regurgitation maximum velocity (TR Vmax). Tricuspid regurgitation Vmax indicative of pulmonary hypertension was considered present for values ≥ 2.9 m/s. RESULTS In a total of 75 included patients, 31 (41%) had ID. These patients had a significantly higher TR Vmax (3.02 vs. 2.77 m/s, p=0.01) and lower diffusion capacity of carbon monoxide (40% vs. 50% of predicted, p<0.01), though similar in age, sex, pack years, FEV1 and high-sensitive CRP (p>0.05). Ferritin inversely correlated with TR Vmax in ID patients (-0.37 (p=0.04)). The prevalence of TR Vmax ≥ 2.9 m/s was twice as high in patients with ID (58% vs. 29%) and odds ratio of pulmonary hypertension in ID (compared to no ID) was 3.3 (95% CI 1.3-8.6, p=0.015). CONCLUSION Iron deficiency in non-anaemic COPD patients was associated with a modest increase in systolic pulmonary artery pressure and limitation of diffusion capacity.
Collapse
Affiliation(s)
- Louis L Plesner
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark.
| | - Mikkel M Schoos
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Morten Dalsgaard
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Kjøller
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jørgen Vestbo
- Centre for Respiratory Medicine and Allergy, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| |
Collapse
|
13
|
Carratù P, Ventura VA, Maniscalco M, Dragonieri S, Berardi S, Ria R, Quaranta VN, Vacca A, Devito F, Ciccone MM, Phillips BA, Resta O. Echocardiographic findings and plasma endothelin-1 levels in obese patients with and without obstructive sleep apnea. Sleep Breath 2015; 20:613-9. [PMID: 26385777 DOI: 10.1007/s11325-015-1260-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/22/2015] [Revised: 09/06/2015] [Accepted: 09/10/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) and obesity are increasingly prevalent worldwide. Both promote endothelial dysfunction contributing to systemic and pulmonary hypertension over time. Endothelin-1 (ET-1) plays a pivotal role in the development of pulmonary hypertension (PH). The aim of the present study was to assess the association between plasma ET-1 and echocardiographic findings in obese individuals with and without OSA, as well as in non-obese patients with OSA. METHODS Ninety-seven subjects (56 males) were enrolled in the study. All subjects underwent the following tests: venous endothelin-1 levels, pulmonary function testing, and arterial blood gas analysis. All patients except controls underwent transthoracic echocardiography and portable testing for sleep-disordered breathing. RESULTS Plasma ET-1 levels were significantly higher in obese patients, both with and without OSA (respectively, n = 30 (mean value, 268.06 ± 49.56 pg/ml) and n = 32 (mean value, 263.12 ± 65.26 pg/ml)), compared with non-obese patients with OSA or to healthy controls (respectively, n = 20 (mean value, 149.8 ± 23.09 pg/ml) and n = 15 (mean value, 152.3 ± 27.64 pg/ml); p < 0.0001). Pulmonary artery pressure (PAPs) in obese patients with OSA were significantly higher than in obese patients without OSA (p < 0.0001), while there was no statistical difference between PAPs of obese patients without OSA, compared with the group of non-obese OSA patients. Plasma ET-1 levels significantly correlated with systolic PAPs in obese patients both with and without OSA (respectively, n = 30, r = 0.385, p = 0.03567; n = 32, r = 0.3497, p = 0.0497). CONCLUSIONS Our study suggests that endothelin levels are more strongly associated with weight than the presence of sleep-disordered breathing, but pulmonary artery hypertension is associated with both weight and OSA.
Collapse
Affiliation(s)
- Pierluigi Carratù
- Institute of Respiratory Disease, School of Medicine, University of Bari, Piazza G. Cesare 12, 70122, Bari, Italy.
| | - Valentina Anna Ventura
- Institute of Respiratory Disease, School of Medicine, University of Bari, Piazza G. Cesare 12, 70122, Bari, Italy
| | - Mauro Maniscalco
- Section of Respiratory Medicine, Hospital S Maria della Pietà, Casoria, Naples, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Disease, School of Medicine, University of Bari, Piazza G. Cesare 12, 70122, Bari, Italy
| | - Simona Berardi
- Division of Internal Medicine, University of Medicine, Bari, Italy
| | - Roberto Ria
- Division of Internal Medicine, University of Medicine, Bari, Italy
| | - Vitaliano Nicola Quaranta
- Institute of Respiratory Disease, School of Medicine, University of Bari, Piazza G. Cesare 12, 70122, Bari, Italy
| | - Angelo Vacca
- Division of Internal Medicine, University of Medicine, Bari, Italy
| | - Fiorella Devito
- Institute of Cardiovascular Disease, University of Medicine, Bari, Italy
| | | | - Barbara Anne Phillips
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, 40508, USA
| | - Onofrio Resta
- Institute of Respiratory Disease, School of Medicine, University of Bari, Piazza G. Cesare 12, 70122, Bari, Italy
| |
Collapse
|
14
|
Jone PN, Hinzman J, Wagner BD, Ivy DD, Younoszai A. Right ventricular to left ventricular diameter ratio at end-systole in evaluating outcomes in children with pulmonary hypertension. J Am Soc Echocardiogr 2013; 27:172-8. [PMID: 24325962 DOI: 10.1016/j.echo.2013.10.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [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: 04/28/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) increases right ventricular (RV) pressure, resulting in septal shift and RV dilation. Few echocardiographic measures have been used to evaluate severity and outcomes in children with PH. The aims of this study were to compare the RV to left ventricular (LV) diameter ratio at end-systole (RV/LV ratio) in normal controls and patients with PH, to correlate the RV/LV ratio with invasive hemodynamic measures, and to evaluate its association with outcomes in children with PH. METHODS The RV/LV ratio was compared retrospectively between 80 matched normal controls and 84 PH patients without shunts. Of the patients with PH, 49 children underwent 94 echocardiographic studies and cardiac catheterizations within 48 hours (13 patients had simultaneous measurements). The RV/LV ratio was correlated against hemodynamic measures. Kaplan-Meier curves and a Cox proportional-hazards regression model were used to assess relationships between RV/LV ratio and time until an adverse clinical event (initiation of intravenous prostacyclin therapy, atrial septostomy, death, or transplantation). RESULTS RV/LV ratios were lower in controls compared with patients with PH (mean, 0.51 [95% confidence interval, 0.48-0.54] vs 1.47 [95% confidence interval, 1.25-1.70], P < .01). The RV/LV ratio correlated significantly with mean pulmonary artery pressure, systolic pulmonary artery pressure, systolic pulmonary artery pressure as a percentage of systemic pressure, and pulmonary vascular resistance index (r = 0.65 [P < .01], r = 0.6 [P < .01], r = 0.49 [P < .01], and r = 0.43 [P < .01], respectively). Twenty-two patients with PH with RV/LV ratios > 1 had adverse events within a median of 1.1 years from their earliest echocardiographic studies. Increasing RV/LV ratio was associated with an increasing hazard for a clinical event (hazard ratio, 2.49; 95% confidence interval, 1.92-3.24). CONCLUSIONS The RV/LV end-systolic diameter ratio can easily be obtained noninvasively in the clinical setting and can be used in the management of patients with PH. The RV/LV ratio incorporates both pathologic septal shift and RV dilation in children with PH and correlates with invasive measures of PH. An RV/LV ratio > 1 is associated with adverse clinical events.
Collapse
Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
| | - Julie Hinzman
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Brandie D Wagner
- Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - David Dunbar Ivy
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Adel Younoszai
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| |
Collapse
|
15
|
Boerlage-van Dijk K, van Riel AC, de Bruin-Bon RH, Wiegerinck EM, Koch KT, Vis MM, Meregalli PG, Bindraban NR, Mulder BJ, Piek JJ, Bouma BJ, Baan J Jr. Mitral inflow patterns after MitraClip implantation at rest and during exercise. J Am Soc Echocardiogr 2014; 27:24-31.e1. [PMID: 24161483 DOI: 10.1016/j.echo.2013.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND MitraClip implantation reduces mitral regurgitation effectively but decreases mitral valve area, creating iatrogenic mitral stenosis. Evaluation with transesophageal echocardiography intraprocedurally is necessary to measure mitral regurgitation and mitral valve pressure gradient (MVPG) to determine whether it is necessary and safe to place more clips. The aim of this study was to investigate whether these intraprocedural hemodynamics represent postprocedural measurements and whether exercise is affected by the stenosis. METHODS In this retrospective single-center study, 51 patients who underwent MitraClip implantation were included. Measurements were performed intraprocedurally using transesophageal echocardiography and postprocedurally using transthoracic echocardiography. In 23 of these patients, exercise echocardiography was performed at follow-up. RESULTS Intraprocedural mean MVPG was 3.0 ± 1.6 mm Hg and increased to 4.3 ± 2.2 mm Hg postprocedurally (P < .001). During exercise, mean MVPG increased significantly compared with rest conditions (from 3.6 ± 1.7 to 6.3 ± 2.7 mm Hg, P < .001). Six patients had mean resting MVPGs ≥ 5 mm Hg at follow-up and had higher systolic pulmonary artery pressure (sPAPs) than patients with mean MVPGs < 5 mm Hg (47 ± 7 vs 35 ± 12 mm Hg, P = .035). Higher MVPG and sPAP did not lead to more symptoms of heart failure. Receiver operating characteristic curve analysis showed an estimated cutoff point for intraprocedural pressure half-time of 91 msec to identify patients with mitral stenosis and sPAP ≥ 50 mm Hg postprocedurally. CONCLUSIONS Mean MVPG during MitraClip implantation measured by TEE underestimates the hemodynamics in daily life, of which operators should be aware when deciding on placing one or more clips. Pressure half-time seems to be the most robust parameter compared with mean and maximum MVPG and may contribute to this decision. Patients with higher mean MVPGs after MitraClip implantation have higher sPAPs at follow-up. However, more symptoms of heart failure were not detected at follow-up.
Collapse
|