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Lekane M, Burnotte P, Gommeren K, Mc Entee K, Merveille AC. Left ventricular eccentricity index to assess precapillary pulmonary hypertension in dogs. J Vet Cardiol 2023; 51:220-231. [PMID: 38246109 DOI: 10.1016/j.jvc.2023.12.003] [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: 04/02/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Interventricular septal flattening, frequently present in pulmonary hypertension (PH) can be quantified by the left ventricular eccentricity index (EI) measured at end-diastole (EId), end-systole (EIs) and at maximal septal flattening (EIm). In humans, EI correlates with invasive pulmonary arterial pressure. The aim of this study was to evaluate if EI correlates with parameters of right heart remodeling (RHR) and if EI is a quantitative marker of PH in dogs. MATERIALS AND METHODS Left ventricular eccentricity indices were retrospectively measured in four groups (no, mild, moderate and severe PH) with interpretable tricuspid and/or pulmonary regurgitation. RESULTS Ninety-seven dogs were included, with no (n = 29), mild (n = 13), moderate (n = 25) and severe (n = 30) PH. The intra- and inter-observer variability for EI measurements ranged from 2 % to 11 %. All EI were significantly elevated in severe compared to no, mild and moderate PH (P < 0.0005). In the moderate group, EIs and EIm were higher compared to the no PH group (P < 0.01). Tricuspid and pulmonary regurgitation pressure gradients and RHR parameters correlated with EId, EIs and EIm in all groups. Optimal cut-off values discriminating moderate and severe PH from no and mild PH were 1.24 (Sensitivity (Se) 60 %; Specificity (Sp) 90 %) for EId, 1.34 (Se 67 %; Sp 95 %) for EIs and 1.37 (Se 76 %; Sp 83 %) for EIm. CONCLUSIONS Left ventricular eccentricity indices are reproducible echocardiographic variables increasing with severity of PH. Dogs with moderate and severe PH can be discriminated from dogs with no or mild PH using EIs and EIm.
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Affiliation(s)
- M Lekane
- Department of Small Animal Veterinary Clinical Sciences, University of Liège, Quartier Vallée 2, Avenue de Cureghem 1, 4000 Liège, Belgium.
| | - P Burnotte
- Department of Small Animal Veterinary Clinical Sciences, University of Liège, Quartier Vallée 2, Avenue de Cureghem 1, 4000 Liège, Belgium
| | - K Gommeren
- Department of Small Animal Veterinary Clinical Sciences, University of Liège, Quartier Vallée 2, Avenue de Cureghem 1, 4000 Liège, Belgium
| | - K Mc Entee
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, ULB, Route de Lennik, 808, 1070 Bruxelles, Belgium
| | - A-C Merveille
- Department of Small Animal Veterinary Clinical Sciences, University of Liège, Quartier Vallée 2, Avenue de Cureghem 1, 4000 Liège, Belgium
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Shi R, Yang ZG, Guo YK, Qian WL, Gao Y, Li XM, Jiang L, Xu HY, Li Y. The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking. Cardiovasc Diabetol 2023; 22:93. [PMID: 37085847 PMCID: PMC10122304 DOI: 10.1186/s12933-023-01806-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND To investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking. METHODS From December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains. RESULTS No differences were found in age (56.98 ± 10.98 vs. 57.37 ± 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 ± 0.21 vs. 1.69 ± 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (- 21.86 ± 4.14 vs. - 24.49 ± 4.47, p = 0.001), RVGCS (- 13.16 ± 3.86 vs. - 14.92 ± 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 ± 8.11 vs. 23.15 ± 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138-0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002-0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028-0.855). CONCLUSIONS In the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.
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Affiliation(s)
- Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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D’Anna C, Franceschini A, Rebonato M, Ciliberti P, Esposito C, Formigari R, Gagliardi MG, Guccione P, Butera G, Galletti L, Chinali M. Left ventricle dysfunction in patients with critical neonatal pulmonary stenosis: echocardiographic predictors. A single-center retrospective study. PeerJ 2022; 10:e14056. [PMID: 36573236 PMCID: PMC9789691 DOI: 10.7717/peerj.14056] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study is to identify echocardiographic predictors of transient left ventricle dysfunction after pulmonary valve balloon dilatation (PVBD), in neonates with pulmonary valve stenosis (PVS) and atresia with intact septum (PAIVS) at birth. Methods The study includes patients admitted at the Bambino Gesù Children Hospital from January 2012 to January 2017. Clinical, echocardiographic and cardiac catheterization data before and after PVBD were retrospectively analyzed. Results Twenty-nine infants were included in the study (21 male and eight female). The median age was 5.8 ± 7.1 days. Eight patients developed transient LV dysfunction (three PAIVS and five PVS) and comparing data before and after the procedure, there was no difference in right ventricle geometrical and functional parameters except for evidence of at least moderate pulmonary valve regurgitation after PVBD. Conclusion Moderate to severe degree pulmonary valve regurgitation was significant associated to LV dysfunction (p < 0.05) in PVS and PAIVS patients.
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Affiliation(s)
- Carolina D’Anna
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Alessio Franceschini
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Micol Rebonato
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Paolo Ciliberti
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Claudia Esposito
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Roberto Formigari
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Maria Giulia Gagliardi
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Paolo Guccione
- Mediterranean Pediatric Cardiology Center “Pediatric Hospital Bambino Gesù”, San Vincenzo Hospital, Taormina, Italy
| | - Gianfranco Butera
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Roma, Roma, Italy
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Claeys M, Petit T, Bogaert J, La Gerche A, Los J, Delcroix M, Willems R, Claessen G, Claus P. Dynamic aspects of ventricular interaction during exercise in HFpEF and in pre-capillary pulmonary hypertension. ESC Heart Fail 2022; 10:650-660. [PMID: 36424844 PMCID: PMC9871663 DOI: 10.1002/ehf2.14216] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022] Open
Abstract
AIMS The contribution of adverse ventricular interdependence remains undervalued in heart failure or pulmonary vascular disease, and not much is known about its dynamic nature during exercise and respiration. In this study, we evaluated ventricular interaction during exercise in patients with heart failure with preserved ejection fraction (HFpEF) and patients with chronic thromboembolic pulmonary hypertension (CTEPH) as compared with healthy controls. METHODS AND RESULTS Forty-six subjects (10 controls, 19 CTEPH patients, and 17 HFpEF patients) underwent cardiac magnetic resonance imaging during exercise. Ventricular interaction was determined through analysis of the septal curvature (SC) of a mid-ventricular short-axis slice at end-diastole, end-systole, and early-diastole, both in expiration and inspiration. Exercise amplified ventricular interaction in CTEPH patients and to a lesser extent in HFpEF patients (P < 0.05 for decrease in SC with exercise). Adverse interaction was most profound in early-diastole and most pronounced in CTEPH patients (P < 0.05 interaction group * exercise) because of a disproportionate increase RV afterload (P < 0.05 to both controls and HFpEF) and diastolic pericardial restraint (P < 0.001 for interaction group * exercise) during exercise. Inspiration enhanced diastolic interdependence in CTEPH and HFpEF patients (P < 0.05 vs. expiration). Both at rest and during exercise, SC strongly correlated with RV volumes and pulmonary artery pressures (all P < 0.05). CONCLUSIONS Exercise amplifies adverse right-left ventricular interactions in CTEPH, while a more moderate effect is observed in isolated post-capillary HFpEF. Given the strong link with RV function and pulmonary hemodynamic, assessing ventricular interaction with exCMR might be valuable from a diagnostic or therapeutic perspective.
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Affiliation(s)
- Mathias Claeys
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium,University Hospitals LeuvenLeuvenBelgium
| | - Thibault Petit
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium,Department of CardiologyZiekenhuis Oost‐LimburgGenkBelgium
| | - Jan Bogaert
- University Hospitals LeuvenLeuvenBelgium,Department of Imaging and PathologyKU LeuvenLeuvenBelgium
| | - Andre La Gerche
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium,Baker Heart and Diabetes InstituteMelbourneAustralia
| | - Jan Los
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium,Department of CardiologyRadboud UMCNijmegenNetherlands
| | - Marion Delcroix
- University Hospitals LeuvenLeuvenBelgium,Department of Chronic Disease, Metabolism and AgeingKU LeuvenLeuvenBelgium
| | - Rik Willems
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium,University Hospitals LeuvenLeuvenBelgium
| | - Guido Claessen
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium,University Hospitals LeuvenLeuvenBelgium
| | - Piet Claus
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium
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Abstract
PURPOSE OF REVIEW Overlapping hemodynamics in constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) often pose difficulties in establishing accurate diagnosis. Echocardiography is the first-line imaging modality used for this purpose, but no single echocardiographic parameter is sufficiently robust for distinguishing between the two conditions. The newer developments may improve the diagnostic accuracy of echocardiography in this setting. RECENT FINDINGS Recent studies have validated multiparametric algorithms, based on conventional echocardiographic parameters, which enable high sensitivity and specificity for distinguishing between CP and RCM. In addition, myocardial deformation analysis using speckle-tracking echocardiography has revealed distinct pattern of abnormalities in the two conditions. CP is characterized by impaired left ventricular apical rotation with relatively preserved longitudinal strain, esp. of ventricular and atrial septum. In contrast, RCM results in global and marked impairment of left ventricular longitudinal strain with initially preserved circumferential mechanics. Combining multiple echocardiographic parameters into step-wise algorithms and incorporation of myocardial deformation analysis help improve the diagnostic accuracy of echocardiography for distinguishing between CP and RCM. The use of machine-learning may allow easy integration of a wide range of echocardiographic and clinical parameters to permit accurate, automated diagnosis, with less dependence on the user expertise.
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Affiliation(s)
- Hardeep Kaur Grewal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India
| | - Manish Bansal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India.
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Cieplucha A, Trojnarska O, Rajewska-Tabor J, Bartczak-Rutkowska A, Kramer L, Pyda M. Left, but not right, ventricular status determines heart failure in adults with Ebstein anomaly - A case-control study based on magnetic resonance. Int J Cardiol 2022:S0167-5273(22)00585-X. [PMID: 35483481 DOI: 10.1016/j.ijcard.2022.04.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/10/2022] [Revised: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ebstein anomaly (EA) is a congenital heart defect affecting the right heart. Heart failure (HF) is a significant complication in adults with EA. It may result not only from the right ventricle (RV), but also from the left ventricle (LV) abnormalities. We evaluate the size and function of both ventricles in patients with EA in cardiac magnetic resonance (CMR); to assess their association with the clinical markers of HF. METHODS Study group: 37 unoperated adults with EA (mean age 43.0 ± 14.4y, 21[56.8%] males). CONTROLS 25 volunteers (mean age 39.9 ± 10.9y, 15[60%] males). Study protocol included: CMR [ejection fraction (EF), end-diastolic (EDVind) and stroke volumes (SVind) indexed by body surface area]; cardiopulmonary test (peak VO2, %peak VO2, VE/VCO2 slope). RESULTS Size and systolic function of LV were reduced comparing to the controls [LVEDVind (ml/m2): 63.7(range 38.7-94.2) vs. 79.3(48.7-105.1), p < 0.001; LV SVind (ml/m2): 35.8(22.9-55.1) vs. 49.2(37.8-71.7), p < 0.0001; LVEF(%): 58.3(34-70.5) vs. 62.0(52.0-77.0), p = 0.009]. RV was enlarged comparing to the controls [RVEDVind (ml/m2): 124.3(52.8-378.9) vs. 83.0(64.0-102.0), p < 0.0001) with impaired systolic function (RV SVind (ml/m2): 22.7(11.1-74.1) vs. 48.0(37.8-71.7), p < 0.0001; RVEF(%): 38.0(21.0-66.1) vs. 59.0(49.0-69.0), p < 0.0001). A significant correlation was found between LVEDVind vs. peakVO2 (r = 0.52, p = 0.001); LV SVind vs. peakVO2 (r = 0.47,p = 0.005). There was no correlation between the right ventricular status and exercise capacity. CONCLUSIONS In adults with Ebstein anomaly the size of left ventricle is reduced, right ventricle is enlarged; the function of both is impaired. Abnormal exercise capacity is associated with left ventricular status. Ventricular interdependence probably plays a role in heart failure pathomechanism.
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Moseley A, Mazur W, Ahmad S. Cardiac magnetic resonance imaging in unclear cases of ventricular interdependence: a case series. Eur Heart J Case Rep 2021; 5:ytab223. [PMID: 34286179 PMCID: PMC8286845 DOI: 10.1093/ehjcr/ytab223] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/01/2020] [Accepted: 05/12/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Diagnosis of constrictive pericarditis requires demonstration of interventricular interdependence which can prove difficult even with invasive haemodynamics. Its treatment requires invasive surgical procedures prior to which diagnostic certainty is necessary. Cardiac magnetic resonance imaging (MRI) is an underutilized tool for identification of this pathology. CASE SUMMARY We present two cases of heart failure due to interventricular interdependence with inconclusive invasive haemodynamic. Prior to recommending invasive surgical treatment, confirmation of the diagnosis was required. This was achieved using cardiac MRI leading to pericardiectomy followed by clinical improvement. DISCUSSION These cases demonstrate the clinical utility, sensitivity, and specificity of cardiac MRI for ventricular interdependence.
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Affiliation(s)
- Alex Moseley
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA
| | - Wojciech Mazur
- Division of Cardiovascular Disease, Department of Internal Medicine, The Christ Hospital, 2139 Auburn Ave, Cincinnati, OH, 45219, USA
| | - Saad Ahmad
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA
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Barry M, Al-Muhaidb S, Fathala A. A case report of constrictive pericarditis: a forgotten cause of refractory ascites. Radiol Case Rep 2020; 15:2565-2568. [PMID: 33082899 PMCID: PMC7550822 DOI: 10.1016/j.radcr.2020.09.053] [Citation(s) in RCA: 2] [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: 09/08/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/30/2023] Open
Abstract
Constrictive pericarditis is well known but rare and commonly forgotten cause of ascites. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs and multiple vague symptoms and its insidious course. In this case report, we present, a 61-year-old male referred for liver transplantation vs transjugular intrahepatic portosystemic shunt work-up for presumptive diagnosis of nonalcoholic steatohepatitis cirrhosis and refractory ascites. Comprehensive work-up before liver transplantation including liver biopsy, liver ultrasound, and Doppler, magnetic resonance imaging was not consistent with liver cirrhosis. Echocardiographic was suggestive of constrictive pericarditis, further work-up with right heart catheterization, cardiovascular magnetic resonance and multidetector cardiac computed tomography confirmed the diagnosis of constrictive pericarditis. Patient underwent surgical pericardiectomy, he reminded stable after surgery and did not require further paracentesis and discharged in stable condition.
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Affiliation(s)
- Mohammad Barry
- Department of Radiology, Cardiothoracic Radiology and Nuclear Medicine divisions, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
| | - Saud Al-Muhaidb
- Department of Radiology, Cardiothoracic Radiology and Nuclear Medicine divisions, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology, Cardiothoracic Radiology and Nuclear Medicine divisions, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
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Baron Toaldo M, Poser H, Menciotti G, Battaia S, Contiero B, Cipone M, Diana A, Mazzotta E, Guglielmini C. Utility of Tissue Doppler Imaging in the Echocardiographic Evaluation of Left and Right Ventricular Function in Dogs with Myxomatous Mitral Valve Disease with or without Pulmonary Hypertension. J Vet Intern Med 2018; 30:697-705. [PMID: 27177623 PMCID: PMC4913565 DOI: 10.1111/jvim.13940] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/22/2014] [Revised: 02/02/2016] [Accepted: 03/07/2016] [Indexed: 11/29/2022] Open
Abstract
Background In human medicine, right ventricular (RV) functional parameters represent a tool for risk stratification in patients with congestive heart failure caused by left heart disease. Little is known about RV alterations in dogs with left‐sided cardiac disorders. Objectives To assess RV and left ventricular (LV) function in dogs with myxomatous mitral valve disease (MMVD) with or without pulmonary hypertension (PH). Animals One‐hundred and fourteen dogs: 28 healthy controls and 86 dogs with MMVD at different stages. Methods Prospective observational study. Animals were classified as healthy or having MMVD at different stages of severity and according to presence or absence of PH. Twenty‐eight morphological, echo‐Doppler, and tissue Doppler imaging (TDI) variables were measured and comparison among groups and correlations between LV and RV parameters were studied. Results No differences were found among groups regarding RV echo‐Doppler and TDI variables. Sixteen significant correlations were found between RV TDI and left heart echocardiographic variables. Dogs with PH had significantly higher transmitral E wave peak velocity and higher E/eʹ ratio of septal (sMV) and lateral (pMV) mitral annulus. These 2 variables were found to predict presence of PH with a sensitivity of 84 and 72%, and a specificity of 71 and 80% at cut‐off values of 10 and 9.33 for sMV E/eʹ and pMV E/eʹ, respectively. Conclusions and clinical importance No association between variables of RV function and different MMVD stage and severity of PH could be detected. Some relationships were found between echocardiographic variables of right and left ventricular function.
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Affiliation(s)
- M Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Ozzano Emilia, Italy
| | - H Poser
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
| | - G Menciotti
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
| | - S Battaia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Ozzano Emilia, Italy
| | - B Contiero
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
| | - M Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Ozzano Emilia, Italy
| | - A Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Ozzano Emilia, Italy
| | - E Mazzotta
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
| | - C Guglielmini
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
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Rungatscher A, Linardi D, Milani E, Ucci G, Nicolato E, Merigo F, Salvetti B, Mazzucco A, Luciani GB, Faggian G. Chronic overcirculation-induced pulmonary arterial hypertension in aorto-caval shunt. Microvasc Res 2014; 94:73-9. [PMID: 24862700 DOI: 10.1016/j.mvr.2014.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 05/09/2014] [Accepted: 05/15/2014] [Indexed: 11/20/2022]
Abstract
Pulmonary arterial hypertension is a common complication of congenital heart defects with left-to-right shunts. Current preclinical models do not reproduce clinical characteristics of shunt-related pulmonary hypertension. Aorto-caval shunt was firstly described as a model of right ventricle volume overload. The pathophysiology and the possible determination of pulmonary arterial hypertension of different periods of shunt exposure are still undefined. A method to create standardized, reproducible aorto-caval shunt was developed in growing rats (260±40 g). Three groups of animals were considered: shunt exposure for 10 weeks, shunt exposure for 20 weeks and control (sham laparotomy). Echocardiography and magnetic resonance revealed increased right ventricular end diastolic area in shunt at 10 weeks compared to control. Hemodynamic analysis demonstrated increased right ventricular afterload and increased effective pulmonary arterial elastance (Ea) in shunt at 20 weeks compared to control (1.29±0.20 vs. 0.14±0.06 mmHg/μl, p=0.004). At the same time point, the maximal slope of end-systolic pressure-volume relationship (Ees) decreased (0.5±0.2 mmHg/ml vs. 1.2±0.3, p<0.001). Consequently, right ventricular-arterial coupling was markedly deteriorated with a ≈50% decrease in the ratio of end-systolic to pulmonary artery elastance (Ees/Ea). Finally, left ventricular preload diminished (≈30% decrease in left ventricular end-diastolic volume). Histology demonstrated medial hypertrophy and small artery luminal narrowing. Chronic exposure to aorto-caval shunt is a reliable model to produce right ventricular volume overload and secondary pulmonary arterial hypertension. This model could be an alternative with low mortality and high reproducibility for investigators on the underlying mechanisms of shunt-related pulmonary hypertension.
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