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Kawasaki T, Nakamura T, Ohtake M, Akimoto T, Manaka H, Hamada K, Sakata K, Iwashita M, Takeuchi I, Yamamoto T. Clinical characteristics of aneurysmal subarachnoid haemorrhage complicated by Takotsubo cardiomyopathy resulting in good neurological outcome. Br J Neurosurg 2024:1-8. [PMID: 38571386 DOI: 10.1080/02688697.2024.2334432] [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: 09/05/2022] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is a well-known complication of subarachnoid haemorrhage (SAH), often accompanied by neurogenic myocardial dysfunction. Although TC has been reported to be associated with higher morbidity and mortality among patients with aneurysmal SAH (aSAH), some patients have been reported to recover, the profiles and follow-up outcomes of these survivors remain unclear. MATERIALS AND METHODS To characterize the profiles of patients with aSAH complicated by TC who experienced favourable outcomes using long-term follow-up data, a consecutive series of patients with aSAH were enrolled and TC diagnosis was based on the revised version of the Mayo Clinic criteria. Clinical outcomes were assessed at 6 months according to modified Rankin Scale scores. RESULTS Among 165 consecutive patients with aSAH, 15 cases were complicated by TC, corresponding to an occurrence rate of 9.0%. Five patients with aSAH complicated by TC (33.3%) experienced a favourable outcome, and the mean value of systolic blood pressure on arrival was significantly lower than in those who experienced an unfavourable outcome (p = 0.032). CONCLUSION According to analysis, it is possible cardiac dysfunction with decreased cerebral perfusion pressure and catecholamine toxicity transiently worsens conscious disturbance in aSAH complicated by TC. Therefore, it is important to carefully screen patients with aSAH to identify those complicated by TC, and for close collaboration of the multidisciplinary team to design appropriate treatment strategies.
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Affiliation(s)
- Takafumi Kawasaki
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Ohtake
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichi Hamada
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masayuki Iwashita
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Shiraz Rizvi SM, Sunny S, Wani IA, Mahdi F, Zaidi ZH, Rajasekaran NS. Influence of electrolyte imbalance on regional wall motion abnormalities in STEMI patients of North Indian origin. Front Cardiovasc Med 2023; 10:1223954. [PMID: 38099220 PMCID: PMC10720728 DOI: 10.3389/fcvm.2023.1223954] [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: 05/17/2023] [Accepted: 10/10/2023] [Indexed: 12/17/2023] Open
Abstract
Assessing regional wall motion abnormalities (RWMA) in the myocardium may provide early diagnosis and treat chronic remodeling in STEMI patients. We assessed RWMA in 217 subjects with anterior STEMI admitted to Era University Hospital in Lucknow, UP, India. Besides abnormalities in the LAD territory, sub-sets of patients exhibited diffuse regional myocardial dysfunction. Interestingly, variations in serum electrolytes, specifically sodium and potassium, significantly affected the distribution and frequency of RWMA. Notably, RWMA occurred in the basal septum, apical septum, apex, and lateral wall in the anterior STEMI group. Additionally, the rate of regional dysfunction varied with serum urea and creatinine levels. This suggests that anterior STEMI can manifest myocardial abnormalities beyond the LAD territory. These findings indicate that ST-segment elevation might not be specific, possibly influenced by electrolyte changes affecting cardiac rhythm. Therefore, diagnosing and correcting region-specific wall motion abnormalities and electrolyte imbalances may improve outcomes in STEMI patients.
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Affiliation(s)
- S. Mohd. Shiraz Rizvi
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Sini Sunny
- Cardiac Aging & Redox Signaling Laboratory, Molecular and Cellular Pathology, Department of Pathology, Birmingham, AL, United States
| | - Irshad A. Wani
- Department of Cardiology, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Farzana Mahdi
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Zeeshan H. Zaidi
- Department of Community Medicine, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Namakkal S. Rajasekaran
- Cardiac Aging & Redox Signaling Laboratory, Molecular and Cellular Pathology, Department of Pathology, Birmingham, AL, United States
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
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3
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Nguyen T, Nguyen P, Tran D, Pham H, Nguyen Q, Le T, Van H, Do B, Tran P, Le V, Nguyen T, Tran L, Pham H. Ensemble learning of myocardial displacements for myocardial infarction detection in echocardiography. Front Cardiovasc Med 2023; 10:1185172. [PMID: 37900571 PMCID: PMC10613081 DOI: 10.3389/fcvm.2023.1185172] [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: 03/13/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
Background Early detection and localization of myocardial infarction (MI) can reduce the severity of cardiac damage through timely treatment interventions. In recent years, deep learning techniques have shown promise for detecting MI in echocardiographic images. Existing attempts typically formulate this task as classification and rely on a single segmentation model to estimate myocardial segment displacements. However, there has been no examination of how segmentation accuracy affects MI classification performance or the potential benefits of using ensemble learning approaches. Our study investigates this relationship and introduces a robust method that combines features from multiple segmentation models to improve MI classification performance by leveraging ensemble learning. Materials and Methods Our method combines myocardial segment displacement features from multiple segmentation models, which are then input into a typical classifier to estimate the risk of MI. We validated the proposed approach on two datasets: the public HMC-QU dataset (109 echocardiograms) for training and validation, and an E-Hospital dataset (60 echocardiograms) from a local clinical site in Vietnam for independent testing. Model performance was evaluated based on accuracy, sensitivity, and specificity. Results The proposed approach demonstrated excellent performance in detecting MI. It achieved an F1 score of 0.942, corresponding to an accuracy of 91.4%, a sensitivity of 94.1%, and a specificity of 88.3%. The results showed that the proposed approach outperformed the state-of-the-art feature-based method, which had a precision of 85.2%, a specificity of 70.1%, a sensitivity of 85.9%, an accuracy of 85.5%, and an accuracy of 80.2% on the HMC-QU dataset. On the external validation set, the proposed model still performed well, with an F1 score of 0.8, an accuracy of 76.7%, a sensitivity of 77.8%, and a specificity of 75.0%. Conclusions Our study demonstrated the ability to accurately predict MI in echocardiograms by combining information from several segmentation models. Further research is necessary to determine its potential use in clinical settings as a tool to assist cardiologists and technicians with objective assessments and reduce dependence on operator subjectivity. Our research codes are available on GitHub at https://github.com/vinuni-vishc/mi-detection-echo.
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Affiliation(s)
- Tuan Nguyen
- VinUni-Illinois Smart Health Center, VinUniversity, Hanoi, Vietnam
- College of Engineering and Computer Science, VinUniversity, Hanoi, Vietnam
| | - Phi Nguyen
- Institute for Artificial Intelligence, VNU University of Engineering and Technology, Hanoi, Vietnam
| | - Dai Tran
- Cardiovascular Center, E Hospital, Hanoi, Vietnam
| | - Hung Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Quang Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Thanh Le
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Hanh Van
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Bach Do
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Phuong Tran
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Vinh Le
- Faculty of Information Technology, VNU University of Engineering and Technology, Hanoi, Vietnam
| | - Thuy Nguyen
- Faculty of Information Technology, VNU University of Engineering and Technology, Hanoi, Vietnam
| | - Long Tran
- Institute for Artificial Intelligence, VNU University of Engineering and Technology, Hanoi, Vietnam
| | - Hieu Pham
- VinUni-Illinois Smart Health Center, VinUniversity, Hanoi, Vietnam
- College of Engineering and Computer Science, VinUniversity, Hanoi, Vietnam
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Negi SL, Chakorvarthy L, Gowda N, Kumar R. Role of transesophageal echocardiography in early detection of myocardial ischemia before electrocardiography changes post arterial switch operation. Ann Card Anaesth 2023; 26:451-453. [PMID: 37861584 PMCID: PMC10691568 DOI: 10.4103/aca.aca_161_22] [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: 09/21/2022] [Revised: 11/05/2022] [Accepted: 02/21/2023] [Indexed: 10/21/2023] Open
Abstract
Myocardial ischemia after arterial switch operation is most commonly associated with imperfect translocation of coronary arteries to the neoaorta. Early post-operative myocardial ischemia is the main cause of morbidity and mortality in these patients. We present a rare case of intra-operative myocardial ischemia after ASO, detected with transesophageal echocardiography before electrocardiography changes.
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Affiliation(s)
- Sunder L. Negi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Loganathan Chakorvarthy
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nischita Gowda
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Wasir AS, Kalra R, Verma P. Takotsubo Cardiomyopathy in a Post-COVID Case. Cureus 2023; 15:e45514. [PMID: 37868474 PMCID: PMC10585193 DOI: 10.7759/cureus.45514] [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] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Takotsubo cardiomyopathy (TTC) is a unique heart disease that mimics the clinical presentation of acute coronary syndrome and is seen more commonly in post-menopausal females. Here, we report a case that presents an ideal documentation of TTC depicting its characteristic clinical features and possible outcomes. TTC usually culminates in a complete reversal of both systolic and diastolic dysfunctions, however in our case of a post-COVID scenario, the persisting, rather worsening diastolic dysfunction might be a residual manifestation of COVID-19 myocarditis. Recent reports have found an increasing prevalence of TTC amidst the COVID-19 pandemic possibly as a result of the emotional and physical stress, and subsequent catecholamine surge caused by the virus in such patients. There might exist an independent association between TTC and the COVID-19 virus. Increased clinical evidence is required to establish the strength of this relationship, if any.
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Affiliation(s)
- Amanpreet S Wasir
- Cardiology, Bharati Vidyapeeth University and Medical College, Pune, IND
| | - Ravi Kalra
- Cardiology, Bharati Vidyapeeth University and Medical College, Pune, IND
| | - Puneet Verma
- Cardiology, ACE Heart and Vascular Institute, Mohali, IND
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6
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Moriyama H, Kawakami T, Kataoka M, Hiraide T, Kimura M, Endo J, Kohno T, Itabashi Y, Seo Y, Fukuda K, Murata M. Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension. J Am Heart Assoc 2020; 9:e018096. [PMID: 33107377 PMCID: PMC7763406 DOI: 10.1161/jaha.120.018096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/20/2022]
Abstract
Background Right ventricular (RV) dysfunction is a prognostic factor for cardiovascular disease. However, its mechanism and pathophysiology remain unknown. We investigated RV function using RV‐specific 3‐dimensional (3D)‐speckle‐tracking echocardiography (STE) in patients with chronic thromboembolic pulmonary hypertension. We also assessed regional wall motion abnormalities in the RV and chronological changes during balloon pulmonary angioplasty (BPA). Methods and Results Twenty‐nine patients with chronic thromboembolic pulmonary hypertension who underwent BPA were enrolled and underwent right heart catheterization and echocardiography before, immediately after, and 6 months after BPA. Echocardiographic assessment of RV function included both 2‐dimensional‐STE and RV‐specific 3D‐STE. Before BPA, global area change ratio measured by 3D‐STE was significantly associated with invasively measured mean pulmonary artery pressure and pulmonary vascular resistance (r=0.671 and r=0.700, respectively). Dividing the RV into the inlet, apex, and outlet, inlet area change ratio showed strong correlation with mean pulmonary artery pressure and pulmonary vascular resistance before BPA (r=0.573 and r=0.666, respectively). Only outlet area change ratio was significantly correlated with troponin T values at 6 months after BPA (r=0.470), and its improvement after BPA was delayed compared with the inlet and apex regions. Patients with poor outlet area change ratio were associated with a delay in RV reverse remodeling after treatment. Conclusions RV‐specific 3D‐STE analysis revealed that 3D RV parameters were novel useful indicators for assessing RV function and hemodynamics in pulmonary hypertension and that each regional RV portion presents a unique response to hemodynamic changes during treatment, implicating that evaluation of RV regional functions might lead to a new guide for treatment strategies.
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Affiliation(s)
- Hidenori Moriyama
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Takashi Kawakami
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Masaharu Kataoka
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Takahiro Hiraide
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Mai Kimura
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Jin Endo
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Takashi Kohno
- Department of Cardiology Kyorin University School of Medicine Tokyo Japan
| | - Yuji Itabashi
- Department of Laboratory Medicine Keio University School of Medicine Tokyo Japan
| | - Yoshihiro Seo
- Department of Cardiology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Keiichi Fukuda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University School of Medicine Tokai University Hachioji Hospital Tokyo Japan
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7
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Davidovich RM, Mathews BM, Iqbal Z, Jean XV, Sutter HA, Almassi GH, Pagel PS. A Figure of Eight and a Circle Within a Circle: Is This Left Ventricular Geometry Responsible for Multiple Embolic Strokes Two Years After Inferior Wall Myocardial Infarction? J Cardiothorac Vasc Anesth 2020; 35:1892-1896. [PMID: 33191043 DOI: 10.1053/j.jvca.2020.10.038] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan M Davidovich
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Benjamin M Mathews
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zafar Iqbal
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Xavier V Jean
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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8
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Punithakumar K, Ben Ayed I, Soliman AS, Goela A, Islam A, Li S, Noga M. 3D Motion Estimation of Left Ventricular Dynamics Using MRI and Track-to-Track Fusion. IEEE J Transl Eng Health Med 2020; 8:1800209. [PMID: 32467779 PMCID: PMC7247756 DOI: 10.1109/jtehm.2020.2989390] [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] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/26/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022]
Abstract
Objective: This study investigates the estimation of three dimensional (3D) left ventricular (LV) motion using the fusion of different two dimensional (2D) cine magnetic resonance (CMR) sequences acquired during routine imaging sessions. Although standard clinical cine CMR data is inherently 2D, the actual underlying LV dynamics lies in 3D space and cannot be captured entirely using single 2D CMR image sequences. By utilizing the image information from various short-axis and long-axis image sequences, the proposed method intends to estimate the dynamic state vectors consisting of the position and velocity information of the myocardial borders in 3D space. Method: The proposed method comprises two main components: tracking myocardial points in 2D CMR sequences and fusion of multiple trajectories correspond to the tracked points. The tracking which yields the set of corresponding temporal points representing the myocardial points is performed using a diffeomorphic nonrigid image registration approach. The trajectories obtained from each cine CMR sequence is then fused with the corresponding trajectories from other CMR views using an unscented Kalman smoother (UKS) and a track-to-track fusion algorithm. Results: We evaluated the proposed method by comparing the results against CMR imaging with myocardial tagging. We report a quantitative performance analysis by projecting the state vector estimates we obtained onto 2D tagged CMR images acquired from the same subjects and comparing them against harmonic phase estimates. The proposed algorithm yielded a competitive performance with a mean root mean square error of 1.3±0.5 pixels (1.8±0.6 mm) evaluated over 118 image sequences acquired from 30 subjects. Conclusion: This study demonstrates that fusing the information from short and long-axis views of CMR improves the accuracy of cardiac tissue motion estimation. Clinical Impact: The proposed method demonstrates that the fusion of tissue tracking information from long and short-axis views improves the binary classification of the automated regional function assessment.
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Affiliation(s)
- Kumaradevan Punithakumar
- 1Department of Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonABT6G 2R3Canada.,2Servier Virtual Cardiac CentreMazankowski Alberta Heart InstituteEdmontonABT6G 2B7Canada.,3Department of Computing ScienceUniversity of AlbertaEdmontonABT6G 2R3Canada
| | - Ismail Ben Ayed
- 4École de Technologie Supérieure (ÉTS)MontrealQCH3C 1K3Canada
| | | | - Aashish Goela
- 6Department of Medical ImagingWestern UniversityLondonONN6A 3K7Canada
| | - Ali Islam
- 7St. Joseph's Health Care LondonLondonONN6A 4V2Canada
| | - Shuo Li
- 6Department of Medical ImagingWestern UniversityLondonONN6A 3K7Canada
| | - Michelle Noga
- 1Department of Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonABT6G 2R3Canada.,2Servier Virtual Cardiac CentreMazankowski Alberta Heart InstituteEdmontonABT6G 2B7Canada
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McGuire S, Horton EJ, Renshaw D, Chan K, Jimenez A, Maddock H, Krishnan N, McGregor G. Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise. Clin Kidney J 2019; 14:1335-1344. [PMID: 33959263 PMCID: PMC8087145 DOI: 10.1093/ckj/sfz159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 08/02/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning. Methods This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twenty exercise-naïve participants on maintenance HD (mean ± SD, 59 ± 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed. Results Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 ± 4, mean 7 ± 4 segments versus total 77 ± 3, mean 5 ± 3, respectively; P = 0.008). Global cardiac function, intra-dialytic haemodynamics and LV volumetric parameters were not significantly altered with exercise. Conclusions Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT was sufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialytic exercise.
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Affiliation(s)
- Scott McGuire
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Elizabeth J Horton
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Derek Renshaw
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Klaris Chan
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Alfonso Jimenez
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Helen Maddock
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Nithya Krishnan
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK.,Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Gordon McGregor
- Faculty of Health and Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK.,Department of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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10
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Affiliation(s)
- Paul Leeson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
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11
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Markin NW, Swaminathan M, Cobey FC. Occam's Foil: When One Diagnosis Isn't Enough. J Cardiothorac Vasc Anesth 2017; 31:2134. [PMID: 29066148 DOI: 10.1053/j.jvca.2017.05.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
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Aggarwal N, Unnikrishnan KP, Biswas I, Karunakaran J, Suneel PR. Intraoperative assessment of transient and persistent regional left ventricular wall motion abnormalities in patients undergoing coronary revascularization surgery using real time three-dimensional transesophageal echocardiography: A prospective observational study. Echocardiography 2017; 34:1649-1659. [PMID: 28833528 DOI: 10.1111/echo.13661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of intraoperative real time three-dimensional echocardiography (RT3DE) for identification and quantification of transient and persistent regional wall motion abnormalities (RWMAs) in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG). DESIGN A prospective observational study SETTING: Single-center study in an academic tertiary care hospital PARTICIPANTS: A series of 42 patients undergoing elective CABG over a 2-year period were included. INTERVENTION After induction of anesthesia, a comprehensive transesophageal echocardiography (TEE) examination was performed to evaluate regional wall motion using two-dimensional wall motion score index (WMSI) and RT3D echocardiographic parameters at three specific time points during the operative phase. MEASUREMENTS AND MAIN RESULTS The 3D assessment of LV function was based on the quantification of change in LV chamber volume over time from each segment excursion. Patients were divided into two groups and subgroups based on TEE findings. There was significant mechanical dyssynchrony in patients with RWMAs (WMSI > 1; systolic dyssynchrony index [SDI] = 7.0 ± 3.66) as compared to the patients having normal wall motion (WMSI = 1; SDI = 2.0 ± 0.95; P = .001). Patients with contractile dysfunction were found to have low values of segmental excursion and high values of negative excursion on parametric imaging. Persistent RWMAs due to hibernating myocardium showed significant resolution of mechanical dyssynchrony after revascularization. Parametric imaging could detect transient RWMAs due to stunning and graft dysfunction. Early activating segments (EAS) on "timing bull's-eye" may represent hypercontractile segments and may influence inotrope administration. CONCLUSION The RT3DE is a valuable modality for precise quantification of regional wall motion during revascularization procedure.
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Affiliation(s)
- Neelam Aggarwal
- Department of Cardiothoracic Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Koniparambil P Unnikrishnan
- Department of Cardiothoracic Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Indranil Biswas
- Department of Cardiothoracic Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Jayakumar Karunakaran
- Department of Cardiothoracic Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Puthuvasseri R Suneel
- Department of Cardiothoracic Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
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13
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Rostamzadeh A, Shojaeifard M, Rezaei Y, Dehghan K. Diagnostic accuracy of myocardial deformation indices for detecting high risk coronary artery disease in patients without regional wall motion abnormality. Int J Clin Exp Med 2015; 8:9412-9420. [PMID: 26309603 PMCID: PMC4538037] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/03/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The prediction of coronary artery disease (CAD) by conventional echocardiographic measurements is principally based on the estimation of ejection fraction and regional wall motion abnormality (RWMA). This study aimed to determine whether strain echocardiography of left ventricle measured by velocity vector imaging (VVI) method could detect patients with a high-risk CAD. METHODS In a prospective study, a total of 119 consecutive patients who were assessed for eligibility were categorized into three groups: (1) without CAD as normal (n=59), (2) 1- or 2-vessel disease as low-risk (n=29), and (3) left main and/or 3-vessel disease as high-risk (n=31). The peaks of systolic strain and strain rate from 18 curves of apical views were averaged as global longitudinal strain and strain rate (GLS and GLSR), respectively; the 6 systolic peaks of strain and strain rate at base- and mid-ventricular of short axis views were averaged as mean radial strain rate (MRSR). RESULTS GLS, GLSR, and basal MRSR of left ventricle were significantly lower in the high-risk group (P=0.047, P=0.004 and P=0.030, respectively). Receiver operating characteristics curve showed that the optimal values of GLS, GLSR, and basal MRSR for detecting the severe CAD were -17%, -1 s(-1), and 1.45 s(-1) with the sensitivities of 77%, 71%, and 71% and the specificities of 63%, 67%, and 62%, respectively. CONCLUSION Decrements in the GLS, GLSR, and basal MRSR of the left ventricle can detect the high-risk CAD cases among patients without RWMA at rest.
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Affiliation(s)
- Alireza Rostamzadeh
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical SciencesUrmia, Iran
| | - Maryam Shojaeifard
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehran, Iran
| | - Yousef Rezaei
- Seyyed-al-Shohada Heart Center, Urmia University of Medical SciencesUrmia, Iran
| | - Kasra Dehghan
- Department of Anesthesiology and Critical Care, Imam Khomeini HospitalSarab, Iran
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