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Peppa M, Manta A, Mavroeidi I, Asimakopoulou A, Syrigos A, Nastos C, Pikoulis E, Kollias A. Changes in Cardiovascular and Renal Biomarkers Associated with SGLT2 Inhibitors Treatment in Patients with Type 2 Diabetes Mellitus. Pharmaceutics 2023; 15:2526. [PMID: 38004506 PMCID: PMC10675228 DOI: 10.3390/pharmaceutics15112526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023] Open
Abstract
Type 2 diabetes mellitus is a major health problem worldwide with a steadily increasing prevalence reaching epidemic proportions. The major concern is the increased morbidity and mortality due to diabetic complications. Traditional but also nontraditional risk factors have been proposed to explain the pathogenesis of type 2 diabetes mellitus and its complications. Hyperglycemia has been considered an important risk factor, and the strict glycemic control can have a positive impact on microangiopathy but not macroangiopathy and its related morbidity and mortality. Thus, the therapeutic algorithm has shifted focus from a glucose-centered approach to a strategy that now emphasizes target-organ protection. Sodium-glucose transporter 2 inhibitors is an extremely important class of antidiabetic medications that, in addition to their glucose lowering effect, also exhibit cardio- and renoprotective effects. Various established and novel biomarkers have been described, reflecting kidney and cardiovascular function. In this review, we investigated the changes in established but also novel biomarkers of kidney, heart and vascular function associated with sodium-glucose transporter 2 inhibitors treatment in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, School of Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (A.M.); (I.M.)
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
| | - Aspasia Manta
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, School of Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (A.M.); (I.M.)
| | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, School of Medicine, Research Institute and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (A.M.); (I.M.)
| | - Athina Asimakopoulou
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
| | - Alexandros Syrigos
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
| | - Constantinos Nastos
- 3rd Department of Surgery, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (C.N.); (E.P.)
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12641 Athens, Greece; (C.N.); (E.P.)
| | - Anastasios Kollias
- 3rd Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.A.); (A.S.); (A.K.)
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Yurdam FS, Gürses E. Myocardial bridge and beta blockers: effect on left ventricular strain parameters. Acta Cardiol 2023:1-7. [PMID: 37171374 DOI: 10.1080/00015385.2023.2209421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To assess the effect of beta-blocker treatment on left ventricular global longitudinal strain (LV Gls) as measured by echocardiography in patients with MB (Myocardial Bridge). PATIENTS AND METHODS Between January 2019 and February 2022, a prospective, single-center study was undertaken in which myocardial bridging was identified in individuals who had coronary angiography. One hundred patients with myocardial bridging were systematically recruited and strain echocardiography was performed. Patient data were analysed in two groups - those who weren't using beta-blockers in the last six months (Group I: n = 50) vs. those who were (Group II: n = 50). RESULTS One hundred patients participated in the study (38 females, 62 males; average age: 57.4 years). There was a statistically significant difference in the mean heart rate between groups I and II (p < 0.001). LV Gls was found to be statistically significantly improved in favour of group II when compared to group I [Group I: (-12.57)±3 vs. Group II: (-15.92)±2.9, p < 0.001]. CONCLUSION The negative chronotropic effect of beta-blocker medication in individuals with MB identified by coronary angiography has a beneficial effect on LV Gls as measured by echocardiography.
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Affiliation(s)
- Ferhat S Yurdam
- Department of Cardiology, Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
| | - Ecem Gürses
- Department of Cardiology, Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
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Normative healthy reference values for global and segmental 3D principal and geometry dependent strain from cine cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2023; 39:115-134. [PMID: 36598686 DOI: 10.1007/s10554-022-02693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/03/2022] [Indexed: 01/07/2023]
Abstract
3-Dimensional (3D) myocardial deformation analysis (3D-MDA) enables novel descriptions of geometry-independent principal strain (PS). Applied to routine 2D cine cardiovascular magnetic resonance (CMR), this provides unique measures of myocardial biomechanics for disease diagnosis and prognostication. However, healthy reference values remain undefined. This study describes age- and sex-stratified reference values from CMR-based 3D-MDA, including 3D PS. One hundred healthy volunteers were prospectively recruited following institutional ethics approval and underwent CMR imaging. 3D-MDA was performed using validated software. Age- and sex-stratified global and segmental strain measures were derived for conventional geometry-dependent [circumferential (CS), longitudinal (LS), and radial (RS)] and geometry-independent [minimum (minPS) and maximum principal (maxPS)] directions of deformation. Layer-specific contraction angle interactions were determined using local minPS vectors. The average age was 43 ± 15 years and 55% were women. Strain measures were higher in women versus men. 3D PS-based assessment of maximum tissue shortening (minPS) and maximum tissue thickening (maxPS) were greater than corresponding geometry-dependent markers of LS and RS, consistent with improved representation of local tissue deformations. Global maxPS amplitude best discriminated both age and sex. Segmental analyses showed greater strain amplitudes in apical segments. Transmural PS contraction angles were higher in females and showed a heterogeneous distribution across segments. In this study we provided age and sex-based reference values for 3D strain from CMR imaging, demonstrating improved capacity for 3D PS to document maximal local tissue deformations and to discriminate age and sex phenotypes. Novel markers of layer-specific strain angles from 3D PS were also described.
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Silverii GA, Toncelli L, Casatori L, Bossini R, Nannelli F, Pala L, Mannucci E. Assessment of left ventricular global longitudinal strain in patients with type 2 diabetes: Relationship with microvascular damage and glycemic control. Nutr Metab Cardiovasc Dis 2022; 32:994-1000. [PMID: 35168822 DOI: 10.1016/j.numecd.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Type 2 Diabetes mellitus (T2DM) is associated with a higher risk of Heart Failure; Left Ventricular (LV) diastolic dysfunction is often considered the first marker of Diabetic cardiomyopathy; however, early preclinical LV systolic dysfunction has also been observed by means of echocardiographic measurement of strain. This study is aimed at assessing determinants of impaired strain and diastolic ventricular dysfunction in patients with T2DM. METHODS AND RESULTS Cross-sectional study, performed on a consecutive series of patients with T2DM aged 30-80 years, BMI<40 kg/m2, free of cardiovascular disease, assessing metabolic control, microvascular complications, echocardiographic measures. Out of 206 patients, 19.6% had GLS lower than 18. GLS showed a significant inverse correlation with HBA1c, (p = 0.016), BMI (p = 0.002), waist (p < 0.0001), and mean L:H Ratio (p = 0.019). In a multivariate regression for LV GLS including HbA1c, age, sex, BMI and mean RR SDNN index, only HbA1c retained statistical significance: (B = -0.050 [-0.091; -0.009], p = 0.01. Among markers of LV diastolic function, only the E/E' ratio was associated with HbA1c at a univariate analysis, and it retained statistical significance in a multivariate regression including HbA1c, age, sex and disease duration (B = 0.038 [0.03; -0.073], p = 0.032). No significant difference in any parameter of systolic or diastolic function was observed between patients with or without microalbuminuria or diabetic retinopathy. CONCLUSION In patients with T2DM, a reduced left ventricular global longitudinal strain appears to be independently associated with impaired glucose control and autonomic neuropathy, regardless of microvascular complications.
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Affiliation(s)
- Giovanni Antonio Silverii
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, Diabetology Unit, Careggi Hospital, University of Florence, Italy.
| | - Loira Toncelli
- Sports Medicine Unit, Careggi Hospital, University of Florence, Italy
| | - Lorenzo Casatori
- Sports Medicine Unit, Careggi Hospital, University of Florence, Italy
| | - Rachele Bossini
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, Diabetology Unit, Careggi Hospital, University of Florence, Italy
| | - Filippo Nannelli
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, Diabetology Unit, Careggi Hospital, University of Florence, Italy
| | - Laura Pala
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, Diabetology Unit, Careggi Hospital, University of Florence, Italy
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences "Mario Serio" Department, Diabetology Unit, Careggi Hospital, University of Florence, Italy
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Shen LT, Jiang L, Zhu YW, Shen MT, Huang S, Shi R, Li Y, Yang ZG. Additive effect of aortic regurgitation degree on left ventricular strain in patients with type 2 diabetes mellitus evaluated via cardiac magnetic resonance tissue tracking. Cardiovasc Diabetol 2022; 21:37. [PMID: 35277181 PMCID: PMC8917654 DOI: 10.1186/s12933-022-01471-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Type 2 diabetes mellitus causes left ventricular (LV) remodeling and increases the risk of aortic regurgitation (AR), which causes further heart damage. This study aimed to investigate whether AR aggravates LV deformation dysfunction and to identify independent factors affecting the global peak strain (PS) of LV remodeling in patients with type 2 diabetes mellitus (T2DM) who presented with AR and those without T2DM. Methods In total, 215 patients with T2DM and 83 age- and sex-matched healthy controls who underwent cardiac magnetic resonance examination were included. Based on the echocardiogram findings, T2DM patients with AR were divided into three groups (mild AR [n = 28], moderate AR [n = 21], and severe AR [n = 17]). LV function and global strain parameters were compared, and multivariate analysis was performed to identify the independent indicators of LV PS. Results The T2DM patients with AR had a lower LV global PS, peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR) in three directions than those without AR and non-T2DM controls. Patients without AR had a lower PS (radial and longitudinal) and PDSR in three directions and higher PSSR (radial and longitudinal) than healthy controls. Further, regurgitation degree was an independent factor of LV global radial, circumferential, and longitudinal PS. Conclusion AR may aggravate LV stiffness in patients with T2DM, resulting in lower LV strain and function. Regurgitation degree and sex were independently correlated with LV global PS in patients with T2DM and AR. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01471-2.
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Zhao X, Liu S, Wang X, Chen Y, Pang P, Yang Q, Lin J, Deng S, Wu S, Fan G, Wang B. Diabetic cardiomyopathy: Clinical phenotype and practice. Front Endocrinol (Lausanne) 2022; 13:1032268. [PMID: 36568097 PMCID: PMC9767955 DOI: 10.3389/fendo.2022.1032268] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) is a pathophysiological condition of cardiac structure and function changes in diabetic patients without coronary artery disease, hypertension, and other types of heart diseases. DCM is not uncommon in people with diabetes, which increases the risk of heart failure. However, the treatment is scarce, and the prognosis is poor. Since 1972, one clinical study after another on DCM has been conducted. However, the complex phenotype of DCM still has not been fully revealed. This dilemma hinders the pace of understanding the essence of DCM and makes it difficult to carry out penetrating clinical or basic research. This review summarizes the literature on DCM over the last 40 years and discusses the overall perspective of DCM, phase of progression, potential clinical indicators, diagnostic and screening criteria, and related randomized controlled trials to understand DCM better.
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Affiliation(s)
- Xudong Zhao
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shengwang Liu
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Xiao Wang
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Yibing Chen
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Pai Pang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Qianjing Yang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Jingyi Lin
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shuaishuai Deng
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shentao Wu
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Guanwei Fan
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Bin Wang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
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Zhou FL, Deng MY, Deng LL, Li YM, Mo D, Xie LJ, Gao Y, Tian HM, Guo YK, Ren Y. Evaluation of the effects of glycated hemoglobin on cardiac function in patients with short-duration type 2 diabetes mellitus: A cardiovascular magnetic resonance study. Diabetes Res Clin Pract 2021; 178:108952. [PMID: 34273454 DOI: 10.1016/j.diabres.2021.108952] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/16/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the association between glycated hemoglobin (HbA1c) and myocardial dysfunction and to determine whether its association is independent of myocardial perfusion. METHODS Sixty-four patients with type 2 diabetes mellitus (T2DM) were recruited. They were divided into groups according to their HbA1c level: the controlled T2DM group (HbA1c < 7%) and uncontrolled T2DM groups (HbA1c ≥ 7%). Meanwhile, 30 age-matched healthy volunteers were included. All patients with T2DM and healthy controls underwent cardiovascular magnetic resonance imaging to evaluate the myocardial mechanics and perfusion parameters. RESULTS The circumferential and longitudinal peak strain (PS) (p = 0.009 and 0.002 respectively) and global radial, circumferential, and longitudinal peak strain diastolic strain rates (PDSRs) (p = 0.002, 0.001, and 0.001 respectively) were lower in the uncontrolled T2DM group than in the controls without diabetes. In multivariable linear regression analysis, HbA1c was independently related to all directions of the PS and PDSR. The myocardial perfusion parameters were not independently associated with the PS or PDSR. CONCLUSIONS Cardiac function is impaired in Chinese T2DM patients with poor glucose control (HbA1c ≥ 7%), with preserved left ventricular (LV) ejection fraction, and disease duration <10 years. Poor blood glucose control is an independent predictor of LV myocardial dysfunction for patients with short-term T2DM.
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Affiliation(s)
- Fang-Li Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China
| | - Ming-Yan Deng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China
| | - Li-Ling Deng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China
| | - Yuan-Mei Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China
| | - Dan Mo
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Hao-Ming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China.
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Zhang Y, Yan WF, Jiang L, Shen MT, Li Y, Huang S, Shi K, Yang ZG. Aggravation of functional mitral regurgitation on left ventricle stiffness in type 2 diabetes mellitus patients evaluated by CMR tissue tracking. Cardiovasc Diabetol 2021; 20:158. [PMID: 34332579 PMCID: PMC8325822 DOI: 10.1186/s12933-021-01354-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Functional mitral regurgitation (FMR) is one of the most common heart valve diseases in diabetes and may increase left ventricular (LV) preload and aggravate myocardial stiffness. This study aimed to investigate the aggravation of FMR on the deterioration of LV strain in type 2 diabetes mellitus (T2DM) patients and explore the independent indicators of LV peak strain (PS). MATERIALS AND METHODS In total, 157 T2DM patients (59 patients with and 98 without FMR) and 52 age- and sex-matched healthy control volunteers were included and underwent cardiac magnetic resonance examination. T2DM with FMR patients were divided into T2DM patients with mild (n = 21), moderate (n = 19) and severe (n = 19) regurgitation. LV function and global strain parameters were compared among groups. Multivariate analysis was used to identify the independent indicators of LV PS. RESULTS The T2DM with FMR had lower LV strain parameters in radial, circumferential and longitudinal direction than both the normal and the T2DM without FMR (all P < 0.05). The mild had mainly decreased peak diastolic strain rate (PDSR) compared to the normal. The moderate had decreased peak systolic strain rate (PSSR) compared to the normal and PDSR compared to the mild and the normal. The severe FMR group had decreased PDSR and PSSR compared to the mild and the normal (all P < 0.05). Multiple linear regression showed that the regurgitation degree was independent associated with radial (β = - 0.272), circumferential (β = - 0.412) and longitudinal (β = - 0.347) PS; the months with diabetes was independently associated with radial (β = - 0.299) and longitudinal (β = - 0.347) PS in T2DM with FMR. CONCLUSION FMR may aggravate the deterioration of LV stiffness in T2DM patients, resulting in decline of LV strain and function. The regurgitation degree and months with diabetes were independently correlated with LV global PS in T2DM with FMR.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Bojer AS, Soerensen MH, Gaede P, Myerson S, Madsen PL. Left Ventricular Diastolic Function Studied with Magnetic Resonance Imaging: A Systematic Review of Techniques and Relation to Established Measures of Diastolic Function. Diagnostics (Basel) 2021; 11:diagnostics11071282. [PMID: 34359363 PMCID: PMC8305340 DOI: 10.3390/diagnostics11071282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: In recent years, cardiac magnetic resonance (CMR) has been used to assess LV diastolic function. In this systematic review, studies were identified where CMR parameters had been evaluated in healthy and/or patient groups with proven diastolic dysfunction or known to develop heart failure with preserved ejection fraction. We aimed at describing the parameters most often used, thresholds where possible, and correlation to echocardiographic and invasive measurements. Methods and results: A systematic literature review was performed using the databases of PubMed, Embase, and Cochrane. In total, 3808 articles were screened, and 102 studies were included. Four main CMR techniques were identified: tagging; time/volume curves; mitral inflow quantification with velocity-encoded phase-contrast sequences; and feature tracking. Techniques were described and estimates were presented in tables. From published studies, peak change of torsion shear angle versus volume changes in early diastole (−dφ′/dV′) (from tagging analysis), early peak filling rate indexed to LV end-diastolic volume <2.1 s−1 (from LV time-volume curve analysis), enlarged LA maximal volume >52 mL/m2, lowered LA total (<40%), and lowered LA passive emptying fractions (<16%) seem to be reliable measures of LV diastolic dysfunction. Feature tracking, especially of the atrium, shows promise but is still a novel technique. Conclusion: CMR techniques of LV untwisting and early filling and LA measures of poor emptying are promising for the diagnosis of LV filling impairment, but further research in long-term follow-up studies is needed to assess the ability for the parameters to predict patient related outcomes.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
- Correspondence:
| | - Martin Heyn Soerensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
| | - Saul Myerson
- Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX1 2JD, UK;
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, 2730 Herlev, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Mella H, Mura J, Sotelo J, Uribe S. A comprehensive comparison between shortest-path HARP refinement, SinMod, and DENSEanalysis processing tools applied to CSPAMM and DENSE images. Magn Reson Imaging 2021; 83:14-26. [PMID: 34242693 DOI: 10.1016/j.mri.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/26/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
We addressed comprehensively the performance of Shortest-Path HARP Refinement (SP-HR), SinMod, and DENSEanalysis using 2D slices of synthetic CSPAMM and DENSE images with realistic contrasts obtained from 3D phantoms. The three motion estimation techniques were interrogated under ideal and no-ideal conditions (with MR induced artifacts, noise, and through-plane motion), considering several resolutions and noise levels. Under noisy conditions, and for isotropic pixel sizes of 1.5 mm and 3.0 mm in CSPAMM and DENSE images respectively, the nRMSE obtained for the circumferential and radial strain components were 10.7 ± 10.8% and 25.5 ± 14.8% using SP-HR, 11.9 ± 2.5% and 29.3 ± 6.5% using SinMod, and 6.4 ± 2.0% and 18.2 ± 4.6% using DENSEanalysis. Overall, the results showed that SP-HR tends to fail for large tissue motions, whereas SinMod and DENSEanalysis gave accurate displacement and strain field estimations, being the last which performed the best.
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Affiliation(s)
- Hernán Mella
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile; Biomedical Imaging Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| | - Joaquín Mura
- Department of Mechanical Engineering, Universidad Técnica Federico Santa María, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile; Biomedical Imaging Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
| | - Sergio Uribe
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Biomedical Imaging Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile.
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11
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Li W, Lv XZ, Liu J, Zeng JH, Ye M, Li CL, Fan R, Lin H, Huang HL, Yao FJ. Assessment of Myocardial Dysfunction by Three-Dimensional Echocardiography Combined With Myocardial Contrast Echocardiography in Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:677990. [PMID: 34164442 PMCID: PMC8215132 DOI: 10.3389/fcvm.2021.677990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to explore the value of combining real-time three-dimensional echocardiography (RT-3DE) and myocardial contrast echocardiography (MCE) in the left ventricle (LV) evaluating myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients. Patients and Methods: A total of 58 T2DM patients and 32 healthy individuals were selected for this study. T2DM patients were further divided into T2DM without microvascular complications (n = 29) and T2DM with microvascular complications (n = 29) subgroups. All participants underwent RT-3DE and MCE. The standard deviation (SD) and the maximum time difference (Dif) of the time to the minimum systolic volume (Tmsv) of the left ventricle were measured by RT-3DE. MCE was performed to obtain the perfusion measurement of each segment of the ventricular wall, including acoustic intensity (A), flow velocity (β), and A·β. Results: There were significant differences in all Tmsv indices except for Tmsv6-Dif among the three groups (all P < 0.05). After heart rate correction, all Tmsv indices of the T2DM with microvascular complications group were prolonged compared with the control group (all P < 0.05). The parameters of A, β, and A·β for overall segments showed a gradually decreasing trend in three groups, while the differences between the three groups were statistically significant (all P < 0.01). For segmental evaluation of MCE, the value of A, β, and A·β in all segments showed a decreasing trend and significantly differed among the three groups (all P < 0.05). Conclusions: The RT-3DE and MCE can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion. Left ventricular dyssynchrony occurred in T2DM patients with or without microvascular complications and was related to left ventricular dysfunction. Myocardial perfusion was reduced in T2DM patients, presenting as diffuse damage, which was aggravated by microvascular complications in other organs.
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Affiliation(s)
- Wei Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Zhou Lv
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Hui Zeng
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Ye
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Cui-Ling Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Fan
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui-Ling Huang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Feng-Juan Yao
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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12
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Philip C, Seifried R, Peterson PG, Liotta R, Steel K, Bittencourt MS, Hulten EA. Cardiac MRI for Patients with Increased Cardiometabolic Risk. Radiol Cardiothorac Imaging 2021; 3:e200575. [PMID: 33969314 DOI: 10.1148/ryct.2021200575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/11/2022]
Abstract
Cardiac MRI (CMR) has rich potential for future cardiovascular screening even though not approved clinically for routine screening for cardiovascular disease among patients with increased cardiometabolic risk. Patients with increased cardiometabolic risk include those with abnormal blood pressure, body mass, cholesterol level, or fasting glucose level, which may be related to dietary and exercise habits. However, CMR does accurately evaluate cardiac structure and function. CMR allows for effective tissue characterization with a variety of sequences that provide unique insights as to fibrosis, infiltration, inflammation, edema, presence of fat, strain, and other potential pathologic features that influence future cardiovascular risk. Ongoing epidemiologic and clinical research may demonstrate clinical benefit leading to increased future use. © RSNA, 2021.
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Affiliation(s)
- Cynthia Philip
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Rebecca Seifried
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - P Gabriel Peterson
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Robert Liotta
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Kevin Steel
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Marcio S Bittencourt
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Edward A Hulten
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
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13
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Zhang Y, Wang J, Ren Y, Yan WF, Jiang L, Li Y, Yang ZG. The additive effects of kidney dysfunction on left ventricular function and strain in type 2 diabetes mellitus patients verified by cardiac magnetic resonance imaging. Cardiovasc Diabetol 2021; 20:11. [PMID: 33413395 PMCID: PMC7792094 DOI: 10.1186/s12933-020-01203-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 02/08/2023] Open
Abstract
Background Patients with type 2 diabetes mellitus (T2DM) are susceptible to coexisted with chronic kidney disease (CKD), which may increase cardiovascular mortality in these patients. The present study aimed to verify whether CKD aggravates the deterioration of left ventricular (LV) myocardial strain in T2DM patients and to explore the risk factors associated with LV strain. Materials and methods In total, 105 T2DM patients and 52 healthy individuals were included and underwent cardiac magnetic resonance examination. Patients were divided into the following two groups: T2DM with CKD (n = 33) and T2DM without CKD (n = 72). The baseline clinical and biochemical indices were obtained from hospital records before the cardiac magnetic resonance scan. Cine sequences, including long-axis views (2-chamber and 4-chamber) and short-axis views, were acquired. LV function and global strain parameters were measured based on cine sequences and compared among three groups. Pearson’s analysis was performed to investigate the correlation between LV strain parameters and clinical indices. Multiple linear regression analysis was used to identify the independent indicators of LV strain. Results Compared with normal controls, T2DM patients without CKD had a significantly decreased magnitude of peak strain (PS; radial), peak systolic strain rate (radial), and peak diastolic strain rate (radial and circumferential) (all P < 0.05). Furthermore, T2DM patients with CKD displayed markedly lower magnitudes of PS (radial, circumferential, and longitudinal) and peak diastolic strain rate (circumferential and longitudinal) than both normal controls and T2DM patients without CKD (all P < 0.05). The eGFR was positively associated with the magnitude of PS (R = radial, 0.392; circumferential, 0.436; longitudinal, 0.556), while uric acid was negatively associated with the magnitude of PS (R = radial, − 0.361; circumferential, − 0.391; longitudinal, − 0.460) (all P < 0.001). Multivariable linear regression indicated that the magnitude of PS was independently associated with eGFR (β = radial, 0.314; circumferential, 0.292; longitudinal, 0.500) and uric acid (β = radial, − 0.239; circumferential, − 0.211; longitudinal, − 0.238) (all P < 0.05). Conclusions Kidney dysfunction may aggravate the deterioration of LV strain in T2DM patients. LV strain is positively associated with the estimated glomerular filtration rate and negatively associated with uric acid, which may be independent risk factors for predicting reduction of LV strain.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Jin Wang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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14
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Tadic M, Cuspidi C, Calicchio F, Grassi G, Mancia G. Diabetic cardiomyopathy: How can cardiac magnetic resonance help? Acta Diabetol 2020; 57:1027-1034. [PMID: 32285200 DOI: 10.1007/s00592-020-01528-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
Diabetes cardiomyopathy is a specific form of cardiac disease characteristic for diabetic patients. Development of echocardiography enabled diagnosis of diabetic cardiomyopathy significantly before the occurrence of heart failure. Previously was believed that left ventricular (LV) diastolic dysfunction represents the first detectable stage of diabetic cardiomyopathy. However, speckle tracking imaging and strain evaluation showed that mechanical changes occur before LV diastolic dysfunction. Nevertheless, it seems that the first detectable stage of diabetic cardiomyopathy is myocardial interstitial fibrosis, which currently could be diagnosed predominantly by cardiac magnetic resonance. T1 mapping evaluation before and after contrast injection enables assessment of extracellular volume (ECV) and provides qualitative and quantitative assessment of interstitial myocardial fibrosis in diabetic patients. Studies showed a strong correlation between ECV-parameter of interstitial fibrosis and level of glycated hemoglobin-main parameter of glucose control in diabetes. This stage of fibrosis is still not LV hypertrophy and it is reversible, which is of a great importance because of timely initiation of treatment. The necessity for early diagnose is significantly increasing due to the fact that diabetes and arterial hypertension are concomitant disorders in the large number of diabetic patients and it has been known that the risk of interstitial myocardial fibrosis is multiplied in patients with both conditions. Future follow-up investigations are essential to determine the causal relationship between interstitial fibrosis and outcome in these patients. The aim of this review was to summarize the current knowledge and clinical usefulness of CMR in diabetic patients.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca, Milan, Italy
- Clinical Research Unit, Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy
| | | | | | - Giuseppe Mancia
- University of Milan-Bicocca, Milan, Italy
- Policlinico di Monza, Monza, Italy
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15
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Navarra JL, Koschalka A, Evertz R, Lotz J, Kutty S, Hasenfuß G, Gutberlet M, Thiele H, Eitel I, Schuster A. Cardiac Magnetic Resonance Myocardial Feature Tracking for Optimized Risk Assessment After Acute Myocardial Infarction in Patients With Type 2 Diabetes. Diabetes 2020; 69:1540-1548. [PMID: 32335515 DOI: 10.2337/db20-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022]
Abstract
Type 2 diabetes predicts outcome following acute myocardial infarction (AMI). Since underlying mechanics are incompletely understood, we investigated left ventricular (LV) and left atrial (LA) pathophysiological changes and their prognostic implications using cardiovascular magnetic resonance (CMR). Consecutive patients (N = 1,147; n = 265 with diabetes, n = 882 without diabetes) underwent CMR 3 days after AMI. Analyses included LV ejection fraction (LVEF); global longitudinal strain (GLS) and circumferential and radial strains; LA reservoir, conduit, and booster pump strains; and infarct size, edema, and microvascular obstruction. Predefined end points were major adverse cardiovascular events (MACE) within 12 months. Patients with diabetes had impaired LA reservoir (19.8% vs. 21.2%, P < 0.01) and conduit (7.6% vs. 9.0%, P < 0.01) strains but not ventricular function or myocardial damage. They were at higher risk of MACE than patients without diabetes (10.2% vs. 5.8%, P < 0.01), with most MACE occurring in patients with LVEF ≥35%. While LVEF (P = 0.045) and atrial reservoir strain (P = 0.024) were independent predictors of MACE in patients without diabetes, GLS was in patients with diabetes (P = 0.010). Considering patients with diabetes and LVEF ≥35% (n = 237), GLS and LA reservoir strain below median were significantly associated with MACE. In conclusion, in patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above that of LVEF.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Jenny-Lou Navarra
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Matthias Gutberlet
- Department of Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
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16
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Haley JE, Zhiqian G, Philip KR, Nicolas ML, Thomas KR, Lawrence DM, Elaine UM. Reduction in myocardial strain is evident in adolescents and young adults with obesity and type 2 diabetes. Pediatr Diabetes 2020; 21:243-250. [PMID: 31825129 DOI: 10.1111/pedi.12961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023] Open
Abstract
AIMS/HYPOTHESIS Heart failure is a complication of type 2 diabetes (T2DM). Echocardiography can identify subclinical systolic dysfunction in adults with T2DM. We hypothesized that reduced systolic strain was present in youth with T2DM. METHODS Global longitudinal strain (GLS) was measured in 151 subjects with T2DM matched to lean (L = 146), and obese (O = 162) subjects (23.0 ± 4.0 years, 35% male, 63% African American). Anthropometrics, BP, HR, labs, and echocardiograms were obtained. ANOVA was performed to compare differences among groups, and ANCOVA to determine if T2DM remained an independent predictor after corrections. RESULTS BP, lipid levels, and metabolic control worsened and GLS was reduced from L to O to T2DM. BMI was lower in L than O or T2DM. Global longitudinal strain rate (GLSR) was lower and LVM/ht2.7 was higher in O and T2DM as compared to L (all P ≤ .05). Presence of T2DM was an independent determinant of GLS and GLSR adjusted for most CV risk factors, but lost significance when BMI was added to the model. GLS = -21.6-age*0.088 - male*1.8 + 0.12*BMI + 0.045*DBP + 0.058*HR - 0.023*HDL (R2 = 0.38, P ≤ .0001); GLSR = -1.20-male*0.093 + WHR*0.48 + DBP*0.0029 (R2 = 0.23, P ≤ .0001). CONCLUSION Both adiposity and T2DM have a deleterious effect on systolic cardiac function. Treatment of obesity in youth is necessary for prevention of future heart failure.
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Affiliation(s)
- Jessica E Haley
- Department of Pediatrics, Division of Pediatric Cardiology, University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Gao Zhiqian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Khoury R Philip
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Madsen L Nicolas
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Kimball R Thomas
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Dolan M Lawrence
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
| | - Urbina M Elaine
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati & University of Cincinnati, Cincinnati, Ohio
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17
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Roberts TJ, Barros-Murphy JF, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A. Reduced Exercise Capacity in Diabetes Mellitus Is Not Associated with Impaired Deformation or Twist. J Am Soc Echocardiogr 2020; 33:481-489. [PMID: 32007323 DOI: 10.1016/j.echo.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise capacity is frequently reduced in people with diabetes mellitus (DM) and may be due to subclinical cardiac dysfunction. Speckle-tracking echocardiography is now widely available; however, the clinical utility and significance of left ventricular (LV) strain and twist parameters remain uncertain. We hypothesized that LV strain and twist would be reduced in DM subjects during exercise. METHODS Adults with type 1 or type 2 DM and age- and sex-matched controls performed cardiopulmonary exercise testing (VO2 peak) and supine bicycle exercise echocardiography. Detailed echocardiographic assessment of biventricular function was performed at baseline and repeated during incremental exercise to maximal intensity. RESULTS Of the 60 participants completing the study protocol, 51 (34 DM, 17 controls; mean age, 42 ± 13 years; 69% male; DM duration, 16 ± 10 years) had sufficient image quality to assess LV deformation and twist mechanics at rest. Of these, 38 (25 DM, 13 controls) were able to be assessed immediately after exercise. Baseline LV systolic and diastolic function using standard echocardiography measurements were similar between groups. Resting LV global longitudinal strain, twist, twist rate and untwist rate, and the corresponding peak exercise and reserve measures did not differ significantly. As compared with the control subjects, exercise capacity was reduced in the DM cohort (VO2 peak 33 ± 10 vs 41 ± 12 mL/minute/kg; P = .02); however, no correlation was observed between VO2 peak and LV twist reserve (R = 0.28, P = .09), LV twist rate reserve (R = 0.14, P = .39), or LV untwist rate reserve (R = 0.24, P = .14). CONCLUSIONS Despite reduced VO2 peak, LV twist mechanics at rest and after maximal intensity exercise did not differ significantly in a cohort of asymptomatic DM subjects with normal resting LV systolic and diastolic function compared with age- and sex-matched controls. This would suggest that exercise capacity can be reduced in the absence of subclinical cardiac dysfunction and that noncardiac factors should be considered as alternative explanations.
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Affiliation(s)
- Timothy J Roberts
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | | | - Andrew T Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - David L Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia; National Centre for Sports Cardiology, Fitzroy, Australia
| | - André La Gerche
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia; National Centre for Sports Cardiology, Fitzroy, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
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Otten J, Andersson J, Ståhl J, Stomby A, Saleh A, Waling M, Ryberg M, Hauksson J, Svensson M, Johansson B, Olsson T. Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus. J Am Heart Assoc 2020; 8:e010634. [PMID: 30652528 PMCID: PMC6497343 DOI: 10.1161/jaha.118.010634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12‐week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function. Methods and Results Twenty‐two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard‐care exercise recommendations (PD) or to a Paleolithic diet plus supervised exercise training 3 hours per week (PD‐EX). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD‐EX group showed significant decreases in myocardial triglycerides levels (−45%, P=0.038) and left ventricle mass to end‐diastolic volume ratio (−13%, P=0.008) while the left ventricle end‐diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group. Conclusions Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01513798.
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Affiliation(s)
- Julia Otten
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Jonas Andersson
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Jens Ståhl
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Andreas Stomby
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Ahmed Saleh
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Maria Waling
- 2 Department of Food and Nutrition Umeå University Umeå Sweden
| | - Mats Ryberg
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Jon Hauksson
- 4 Department of Radiation Sciences Umeå University Umeå Sweden.,5 Department of Radiography and Biomedical Science Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Michael Svensson
- 3 Sports Medicine Unit Department of Community Medicine and Rehabilitation Umeå University Umeå Sweden
| | - Bengt Johansson
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Tommy Olsson
- 1 Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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19
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Jensen MT, Fung K, Aung N, Sanghvi MM, Chadalavada S, Paiva JM, Khanji MY, de Knegt MC, Lukaschuk E, Lee AM, Barutcu A, Maclean E, Carapella V, Cooper J, Young A, Piechnik SK, Neubauer S, Petersen SE. Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy. Circ Cardiovasc Imaging 2019; 12:e009476. [PMID: 31522551 PMCID: PMC7099857 DOI: 10.1161/circimaging.119.009476] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. METHODS Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. RESULTS A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; P=0.065), LV mass (-0.13 g/m2 [-1.6 to 1.3], P=0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], P=0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2: -3.46 mL/m2 [-5.8 to -1.2], P=0.003, right ventricular end-diastolic volume/m2: -4.2 mL/m2 [-6.8 to -1.7], P=0.001, LV stroke volume/m2: -3.0 mL/m2 [-4.5 to -1.5], P<0.001; right ventricular stroke volume/m2: -3.8 mL/m2 [-6.5 to -1.1], P=0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P=0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], P=0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], P=0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P=0.045). CONCLUSIONS In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.
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Affiliation(s)
- Magnus T. Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
- Department of Cardiology, Copenhagen University Hospital Herlev- Gentofte, Hellerup, Denmark (M.T.J.)
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (M.T.J.)
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mohammed Y. Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Martina C. de Knegt
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Ahmet Barutcu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Edd Maclean
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Alistair Young
- Department of Biomedical Engineering, King’s College London, United Kingdom (A.Y.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
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20
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Kul S, Dursun İ, Ayhan S, Sayin MR, Üçüncü Ö, Bülbül NE, Ateş AH, Akyüz AR. Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus. Arq Bras Cardiol 2019; 113:207-215. [PMID: 31365600 PMCID: PMC6777877 DOI: 10.5935/abc.20190134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/14/2018] [Indexed: 12/04/2022] Open
Abstract
Background Myocardial performance index (MPI), demonstrates both systolic and diastolic
functions of the left ventricle. Presystolic wave (PSW) is frequently
detected on Doppler examination of the left ventricular outflow tract and
possible mechanism of PSW is impaired LV compliance and left ventricular
stiffness. Objective To investigate the relationship between PSW and MPI in type 2 diabetic
patients. Method A total of 129 type 2 diabetic patients were included in this study. Patients
were divided into two groups according to the presence of PSW on Doppler
echocardiography. There were 90 patients (38 male, mean age 57.77 ±
10.91 years) in the PSW-positive group and 39 patients (13 male; mean age:
55.31 ± 11.29 years) in the PSW-negative group. The p values of <
0.05 were considered statistically significant. Results MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ±
0.13, p < 0.001). In addition, subclinical left ventricle dysfunction
(LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis
showed that the presence of PSW associated with abnormal MPI (p = 0.031).
Pearson correlation analysis showed that PSW velocity correlated with MPI
(r: 0.286, p = 0.006). Conclusion Presence of the PSW on Doppler examination was associated with subclinical LV
dysfunction in patients with DM type 2. This easy-to-perform
echocardiographic parameter may be related to subclinical LVD among patients
with type 2 DM.
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Affiliation(s)
- Selim Kul
- Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Cardiology, Trabzon - Turkey
| | - İhsan Dursun
- Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Cardiology, Trabzon - Turkey
| | - Semiha Ayhan
- Trabzon Kanuni Egitim Ve Arastirma Hastanesi - Endocrinology, Trabzon - Turkey
| | - Muhammet Rasit Sayin
- Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Cardiology, Trabzon - Turkey
| | - Özge Üçüncü
- Trabzon Kanuni Egitim Ve Arastirma Hastanesi - Endocrinology, Trabzon - Turkey
| | - Nilgün Esen Bülbül
- Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Internal Medicine, Trabzon - Turkey
| | - Ahmet Hakan Ateş
- Samsun Egitim ve Arastirma Hastanesi - Cardiology, Samsun - Turkey
| | - Ali Rıza Akyüz
- Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Cardiology, Trabzon - Turkey
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21
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Barbarotta L, Rossi S, Dedè L, Quarteroni A. A transmurally heterogeneous orthotropic activation model for ventricular contraction and its numerical validation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3137. [PMID: 30070071 DOI: 10.1002/cnm.3137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/19/2018] [Accepted: 07/22/2018] [Indexed: 06/08/2023]
Abstract
Models for cardiac mechanics require an activation mechanism properly representing the stress-strain relations in the contracting myocardium. In this paper, we propose a new activation model that accounts for the transmural heterogeneities observed in myocardial strain measurements. In order to take the anisotropy of the active mechanics into account, our model is based on an active strain formulation. Thanks to multiplicative decomposition of the deformation gradient tensor, in this formulation, the active strains orthogonal to the fibers can be naturally described. We compare the results of our novel formulation against different anisotropic models of the active contraction of the cardiac muscle, as well as against experimental data available in the literature. We show that with the currently available models, the strain distributions are not in agreement with the reported experimental measurements. Conversely, we show that our new transmurally heterogeneous orthotropic activation model improves the accuracy of shear strains related to in-plane rotations and torsion.
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Affiliation(s)
- Luca Barbarotta
- Department of Biomedical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
| | - Simone Rossi
- Department of Mathematics, University of North Carolina, Chapel Hill, North Carolina
| | - Luca Dedè
- Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, Ećole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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22
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Zhu T, Zeng W, Chen Y, Zhang Y, Sun J, Liang Z, Yang Z, Cheng W, Wang L, Song B, Wu B, Wang F, Liang Y, Gong L, Zheng J, Gao F. 2D/3D CMR tissue tracking versus CMR tagging in the assessment of spontaneous T2DM rhesus monkeys with isolated diastolic dysfunction. BMC Med Imaging 2018; 18:47. [PMID: 30477437 PMCID: PMC6258387 DOI: 10.1186/s12880-018-0288-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/30/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Spontaneous T2DM in rhesus monkeys manifests as isolated diastolic dysfunction in the early stage of diabetic cardiomyopathy, similar to humans. Myocardial deformation measurements have emerged as a superior way to measure left ventricular (LV) function in the early stage of cardiac dysfunction, making it possible to further evaluate early-stage LV dysfunction in spontaneous T2DM rhesus monkeys. METHODS Spontaneous T2DM rhesus monkeys with isolated diastolic dysfunction (T2DM-DD, n = 10) and corresponding nondiabetic healthy animals (ND, n = 9) were prospectively scanned for a CMR study. Circumferential and longitudinal peak systolic strain (Ecc, Ell), time to peak strain (tEcc, tEll) and peak diastolic strain rate (CSR, LSR) obtained from 2D/3D CMR-TT were compared with those obtained from CMR tagging separately. In addition, all CMR imaging protocols were performed twice in 9 ND animals to assess test-retest reproducibility. RESULTS Compared with the ND group, the T2DM-DD monkeys demonstrated significantly impaired LV Ecc (- 10.63 ± 3.23 vs - 14.18 ± 3.19, p < 0.05), CSR (65.50 ± 14.48 vs 65.50 ± 14.48, p < 0.01), Ell (- 9.11 ± 2.59 vs - 14.17 ± 1.68, p < 0.05), and LSR (59.43 ± 19.17 vs 108.46 ± 22.33, p < 0.01) with the tagging. Only Ecc (- 13.10 ± 2.47 vs - 19.03 ± 3.69, p < 0.01) and CSR (148.90 ± 31.27 vs 202.00 ± 51.88, p < 0.01) were significantly reduced with 2D CMR-TT, and only Ecc (- 13.77 ± 1.98 vs - 17.26 ± 3.78, p < 0.05) was significantly reduced with 3D CMR-TT. Moreover, 2D/3D CMR-TT-derived Ecc and CSR correlated with the corresponding tagging values collectively, with a statistically significant ICC value (p < 0.05). Test-retest repeatability analysis showed that most tagging-derived biomarkers had acceptable repeatability (p < 0.01). In addition, 2D CMR-TT-derived indicators were poorer than those derived from the tagging method but better than those obtained using the 3D method, with larger ICCs except for tEcc (p < 0.05). CONCLUSIONS LV systolic and diastolic deformations were impaired in spontaneous T2DM rhesus monkeys previously diagnosed with isolated diastolic dysfunction by echocardiography. The 2D CMR-TT-derived Ecc and CSR were effective in the evaluation of the myocardial systolic and diastolic functions of early-diabetic cardiomyopathy, with relatively higher test-retest reproducibility and acceptable correlation with the tagging method compared with the 3D CMR-TT method.
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MESH Headings
- Animals
- Case-Control Studies
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnostic imaging
- Diabetes Mellitus, Type 2/physiopathology
- Disease Models, Animal
- Heart Failure, Diastolic/diagnostic imaging
- Heart Failure, Diastolic/physiopathology
- Humans
- Macaca mulatta
- Magnetic Resonance Imaging, Cine/methods
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Tong Zhu
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Wen Zeng
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
| | - Yushu Chen
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Yu Zhang
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Jiayu Sun
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Zhigang Liang
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
| | - Zunyuan Yang
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
| | - Wei Cheng
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Lei Wang
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Bin Song
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Bing Wu
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
| | - Fangtong Wang
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
| | - Yinan Liang
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
| | - Li Gong
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
| | - Jie Zheng
- 0000 0001 2355 7002grid.4367.6Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO USA
| | - Fabao Gao
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue alley, Chengdu, 610041 Sichuan Province China
- Sichuan Primed Shines Bio-tech Co., Ltd, Chengdu, China
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23
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Liu X, Yang ZG, Gao Y, Xie LJ, Jiang L, Hu BY, Diao KY, Shi K, Xu HY, Shen MT, Ren Y, Guo YK. Left ventricular subclinical myocardial dysfunction in uncomplicated type 2 diabetes mellitus is associated with impaired myocardial perfusion: a contrast-enhanced cardiovascular magnetic resonance study. Cardiovasc Diabetol 2018; 17:139. [PMID: 30373588 PMCID: PMC6206833 DOI: 10.1186/s12933-018-0782-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Early detection of subclinical myocardial dysfunction in patients with diabetes mellitus (DM) is essential for recommending therapeutic interventions that can prevent or reverse heart failure, thereby improving the prognosis in such patients. This study aims to quantitatively evaluate left ventricular (LV) myocardial deformation and perfusion using cardiovascular magnetic resonance (CMR) imaging in patients with type 2 diabetes mellitus (T2DM), and to investigate the association between LV subclinical myocardial dysfunction and coronary microvascular perfusion. METHODS We recruited 71 T2DM patients and 30 healthy individuals as controls who underwent CMR examination. The T2DM patients were subdivided into two groups, namely the newly diagnosed DM group (n = 31, patients with diabetes for ≤ 5 years) and longer-term DM group (n = 40, patients with diabetes > 5 years). LV deformation parameters, including global peak strain (PS), peak systolic strain rate, and peak diastolic strain rate (PSDR), and myocardial perfusion parameters such as upslope, time to maximum signal intensity (TTM), and max signal intensity (Max SI, were measured and compared among the three groups. Pearson's correlation was used to evaluate the correlation between LV deformation and perfusion parameters. RESULTS Pooled data from T2DM patients showed a decrease in global longitudinal, circumferential, and radial PDSR compared to healthy individuals, apart from lower upslope. In addition, increased TTM and reduced Max SI were found in the longer-term diabetics compared to the normal subjects (p < 0.017 for all). Multivariable linear regression analysis showed that T2DM was independently associated with statistically significant CMR parameters, except for TTM (β = 0.137, p = 0.195). Further, longitudinal PDSR was significantly associated with upslope (r = - 0.346, p = 0.003) and TTM (r = 0.515, p < 0.001). CONCLUSIONS Our results imply that a contrast-enhanced 3.0T CMR can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion in the early stages of T2DM, and that the myocardial dysfunction is associated with impaired coronary microvascular perfusion.
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Affiliation(s)
- Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Bi-Yue Hu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China.
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Yoneyama K, Venkatesh BA, Wu CO, Mewton N, Gjesdal O, Kishi S, McClelland RL, Bluemke DA, Lima JAC. Diabetes mellitus and insulin resistance associate with left ventricular shape and torsion by cardiovascular magnetic resonance imaging in asymptomatic individuals from the multi-ethnic study of atherosclerosis. J Cardiovasc Magn Reson 2018; 20:53. [PMID: 30064457 PMCID: PMC6069876 DOI: 10.1186/s12968-018-0472-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 06/20/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although diabetes mellitus (DM) and insulin resistance associate with adverse cardiac events, the associations of left ventricular (LV) remodeling and function with compromised glucose metabolism have not been fully evaluated in a general population. We used cardiovascular magnetic resonance (CMR) to evaluate how CMR indices are associated with DM or insulin resistance among participants before developing cardiac events. METHODS We studied 1476 participants who were free of clinical cardiovascular disease and who underwent tagged CMR in the Multi-Ethnic Study of Atherosclerosis (MESA). LV shape and longitudinal myocardial shortening and torsion were assessed by CMR. A higher sphericity index represents a more spherical LV shape. Multivariable linear regression was used to evaluate the associations of DM or homeostasis model assessment-estimated insulin resistance (HOMA-IR) with CMR indices. RESULTS In multiple linear regression, longitudinal shortening was lower in impaired fasting glucose than normal fasting glucose (NFG) (0.36% lower vs. NFG, p < 0.05); torsion was greater in treated DM (0.24 °/cm greater vs. NFG, p < 0.05) after full adjustments. Among participants without DM, greater log-HOMA-IR was correlated with greater LV mass (3.92 g/index, p < 0.05) and LV mass-to-volume ratio (0.05 /index, p < 0.01), and lower sphericity index (- 1.26/index, p < 0.01). Greater log-HOMA IR was associated with lower longitudinal shortening (- 0.26%/index, p < 0.05) and circumferential shortening (- 0.30%/index, p < 0.05). Torsion was positively correlated with log-HOMA-IR until 1.5 of log-HOMA-IR (0.16 °/cm/index, p = 0.030).), and tended to fall once above 1.5 of log-HOMA-IR (- 0.50 °/cm/index, p = 0.203). The sphericity index was associated negatively with LV mass-to-volume ratio (- 0.02/%, p < 0.001) and torsion (- 0.03°/cm/%, p < 0.001). CONCLUSIONS Glucose metabolism disorders are associated with LV concentric remodeling, less spherical shape, and reduced systolic myocardial shortening in the general population. Although torsion is higher in participants who are treated for DM and impaired insulin resistance, myocardial shortening was progressively decreased with higher HOMA-IR and torsion was increased only with less severe insulin resistance. CLINICAL TRIAL REGISTRATION Multi-Ethnic Study of Atherosclerosis (MESA): A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org/ . Study Start Date: January 1999 ( NCT00005487 ).
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Affiliation(s)
- Kihei Yoneyama
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
- St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Colin O. Wu
- Offices of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD USA
| | - Nathan Mewton
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
| | - Ola Gjesdal
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
| | - Satoru Kishi
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
| | | | - David A. Bluemke
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center, Bethesda, MD USA
| | - João A. C. Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
- Radiology and Epidemiology, Johns Hopkins University, Blalock 524D1, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287 USA
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Abstract
We are now entering the very exciting era of treatment and management of diabetes mellitus (DM) with the emergence of new therapeutic agents, including sodium-glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitor (DPP-4i). From a cardiology and echocardiography perspective, the existence of diabetic cardiomyopathy has been proven through over four decades of discussion. DM is highly prevalent in patients with heart failure (HF). Independent associations are found after adjusting for hypertension (HTN) and coronary artery disease (CAD). In patients with both DM and HF, the prognosis is extremely dismal. In this review, the main focus is on both diabetic cardiomyopathy per se and its typical features (including myocardial additive insult related to DM), diagnosis, and management.
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Affiliation(s)
- Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Royal Hobart Hospital, Hobart, Australia
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26
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Scharrenbroich J, Hamada S, Keszei A, Schröder J, Napp A, Almalla M, Becker M, Altiok E. Use of two-dimensional speckle tracking echocardiography to predict cardiac events: Comparison of patients with acute myocardial infarction and chronic coronary artery disease. Clin Cardiol 2018; 41:111-118. [PMID: 29359809 DOI: 10.1002/clc.22860] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Two-dimensional speckle strain (2D STE) echocardiography can aid in the prognosis of acute myocardial infarction (AMI) and chronic coronary artery disease (CAD). HYPOTHESIS Differences occur in the prediction of cardiac events using 2D STE in AMI vs CAD patients. METHODS In this prospective study, 94 patients with a first AMI and successful revascularization, and 137 patients with stable CAD after complete revascularization were included. In all patients, we performed echocardiography and myocardial deformation analysis for layer-specific global circumferential strain (GCS) and longitudinal strain. Receiver operating characteristic (ROC) curve analysis was used to predict the presence of a cardiac event using strain values and baseline characteristics in different regression models. RESULTS Patients were followed for 3.6 ± 0.8 years. Strain parameters in AMI and CAD patients were significantly different with respect to the occurrence of a cardiac event. Frequency of diabetes and hypertension was associated with the presence of a cardiac event in CAD patients. Furthermore, in CAD patients, ROC analysis demonstrated that the addition of endocardial GCS to baseline characteristics and ejection fraction to a regression model significantly improved the prediction of cardiac events (area under curve = 0.86, cutoff value: 20%, sensitivity: 79%, specificity: 84%). In contrast, the addition of strain parameters in AMI patients did not increase the prediction power for cardiac events. CONCLUSIONS Global strain parameters by 2D STE may be useful for the prediction of cardiac events in patients with CAD but add no supplemental information to baseline characteristic and ejection fraction in patients with AMI.
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Affiliation(s)
- Jörg Scharrenbroich
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Sandra Hamada
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Andras Keszei
- Department of Medical Statistics, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Andreas Napp
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Michael Becker
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, University Hospital Aachen, Rhenish-Westphalian Technical University, Aachen, Germany
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Increased left ventricular mass index is present in patients with type 2 diabetes without ischemic heart disease. Sci Rep 2018; 8:926. [PMID: 29343820 PMCID: PMC5772487 DOI: 10.1038/s41598-018-19229-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/22/2017] [Indexed: 01/13/2023] Open
Abstract
Left ventricular mass index (LVMI) increase has been described in hypertension (HTN), but less is known about its association with type 2 diabetes (T2DM). As these conditions frequently co-exist, we investigated the association of T2DM, HTN and both with echocardiographic parameters, and hypothesized that patients with both had highest LVMI, followed by patients with only T2DM or HTN. Study population included 101 T2DM patients, 62 patients with HTN and no T2DM, and 76 patients with T2DM and HTN, excluded for ischemic heart disease. Demographic and clinical data, biochemical measurements, stress echocardiography, transthoracic 2D Doppler and tissue Doppler echocardiography were performed. Multivariable logistic regression was used to determine the independent association with T2DM. Linear regression models and Pearson's correlation were used to assess the correlations between LVMI and other parameters. Patients with only T2DM had significantly greater LVMI (84.9 ± 20.3 g/m2) compared to patients with T2DM and HTN (77.9 ± 16 g/m2) and only HTN (69.8 ± 12.4 g/m2). In multivariate logistic regression analysis, T2DM was associated with LVMI (OR 1.033, 95%CI 1.003-1.065, p = 0.029). A positive correlation of LVMI was found with fasting glucose (p < 0.001) and HbA1c (p = 0.0003). Increased LVMI could be a potential, pre-symptomatic marker of myocardial structural change in T2DM.
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28
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Biering-Sørensen F, Biering-Sørensen T, Liu N, Malmqvist L, Wecht JM, Krassioukov A. Alterations in cardiac autonomic control in spinal cord injury. Auton Neurosci 2018; 209:4-18. [DOI: 10.1016/j.autneu.2017.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 01/30/2017] [Accepted: 02/14/2017] [Indexed: 01/22/2023]
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Two-dimensional speckle-tracking global longitudinal strain in high-sensitivity troponin-negative low-risk patients with unstable angina: a “resting ischemia test”? Int J Cardiovasc Imaging 2017; 34:561-568. [DOI: 10.1007/s10554-017-1269-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/04/2017] [Indexed: 01/05/2023]
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30
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Ojaghi-Haghighi Z, Mohebbi B, Moladoust H, Haghjoo M, Alizadehasl A, Esmaeilzadeh M, Aghapour S, Bakhshandeh H, Ardeshiri M, Hamidian M. Left ventricular torsional parameters before and after atrial fibrillation ablation: a velocity vector imaging study. Electron Physician 2017; 9:5395-5401. [PMID: 29038727 PMCID: PMC5633243 DOI: 10.19082/5395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIM Effects of atrial fibrillation (AF) and its ablative treatment on LV torsion have not yet been fully investigated. This study aimed to examine whether AF patterns of LV contraction and its ablative correction can exert a significant impact on LV torsion by velocity vector imaging (VVI). METHODS This case-control study conducted in Rajaie Cardiovascular, Medical and Research Center between October 2012 and June 2013. Study participants were 30 consecutive patients with symptomatic paroxysmal AF who met the inclusion criteria. The control group included 24 healthy participants with no history of cardiovascular disease. All individuals were in sinus rhythm at the time of echocardiography before and after the ablation procedure. Two-dimensional (2D) and Doppler echocardiography on a commercially available ultrasound system was performed for all the patients. Scanning was done by a wide-band ultrasound transducer with the frequency range between 2.5-3.5 MHz. The two short-axis views at basal and apical levels were subsequently processed off-line by VVI XStrain software. In order for data analysis, SPSS 16 utilized using paired and independent t-test. p-value ≤0.05 was considered significant. RESULTS LV torsion (°/cm) mean ± SD was significantly lower in paroxysmal AF patients before ablation (0.8±0.3) than the control group (1.5±0.4) (p<0.001) and increased significantly after ablation (1.1±0.5) compared with before ablation (p=0.004), but still significantly lower than the control group (p=0.003). LV Twist, twist rate and untwist rate mean ± SD were significantly lower in paroxysmal AF patients before ablation than the control group and increased significantly after ablation compared with before ablation, but still significantly lower than the control group. CONCLUSION Subclinical LV dysfunction may be detected in paroxysmal AF rhythm by measuring torsional parameters through VVI which improves after AF ablation.
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Affiliation(s)
- Zahra Ojaghi-Haghighi
- Professor, Echocardiography Research Center, Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- M.D., Assistant Professor, Interventional Cardiologist, Department of Cardiology, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Moladoust
- Ph.D., Associate Professor, Healthy Heart Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Majid Haghjoo
- M.D., FESC, FACC, Associate Professor, Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- M.D., Associate Professor, Echocardiologist, Department of Cardiology, Department of Cardiology, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeilzadeh
- M.D., FACC, FCAPSC, Associate Professor, Echocardiologist, Department of Cardiology, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sevil Aghapour
- M.D., Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- M.D., Ph.D., Associate Professor, Epidemiologist, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ardeshiri
- M.D., Assistant Professor of Endocrinology and Metabolism, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Hamidian
- B.Sc. of Nursing, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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31
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Nacif MS, Almeida ALC, Young AA, Cowan BR, Armstrong AC, Yang E, Sibley CT, Hundley WG, Liu S, Lima JA, Bluemke DA. Three-Dimensional Volumetric Assessment of Diastolic Function by Cardiac Magnetic Resonance Imaging: The Multi-Ethnic Study of Atherosclerosis (MESA). Arq Bras Cardiol 2017; 108:552-563. [PMID: 28562831 PMCID: PMC5489326 DOI: 10.5935/abc.20170063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiac Magnetic Resonance is in need of a simple and robust method for diastolic function assessment that can be done with routine protocol sequences. Objective: To develop and validate a three-dimensional (3D) model-based volumetric assessment of diastolic function using cardiac magnetic resonance (CMR) imaging and compare the results obtained with the model with those obtained by echocardiography. Methods: The study participants provided written informed consent and were included if having undergone both echocardiography and cine steady-state free precession (SSFP) CMR on the same day. Guide points at the septal and lateral mitral annulus were used to define the early longitudinal relaxation rate (E'), while a time-volume curve from the 3D model was used to assess diastolic filling parameters. We determined the correlation between 3D CMR and echocardiography and the accuracy of CMR in classifying the diastolic function grade. Results: The study included 102 subjects. The E/A ratio by CMR was positively associated with the E/A ratio by echocardiography (r = 0.71, p < 0.0001). The early diastolic relaxation velocity by tissue Doppler and longitudinal relaxation rate for the lateral mitral annulus displacement were positively associated (p = 0.007), as were the ratio between Doppler E/e' and CMR E/E' (p = 0.01). CMR-determined normalized peak E (NE) and deceleration time (DT) were able to predict diastolic dysfunction (areas under the curve [AUCs] = 0.70 and 0.72, respectively). In addition, the lateral E/E' ratio showed good utility in identifying diastolic dysfunction (AUC = 0.80). Overall, echocardiography and CMR interobserver and intraobserver agreements were excellent (intraclass correlation coefficient range 0.72 - 0.97). Conclusion: 3D modeling of standard cine CMR images was able to identify study subjects with reduced diastolic function and showed good reproducibility, suggesting a potential for a routine diastolic function assessment by CMR. Fundamento: A ressonância magnética cardíaca necessita de um método simples e robusto para a avaliação da função diastólica que pode ser feito com sequências protocolares de rotina. Objetivo: Desenvolver e validar a avaliação volumétrica da função diastólica através de um modelo tridimensional (3D) com utilização de imagens de ressonância magnética cardíaca (RMC) e comparar os resultados obtidos com este modelo com os obtidos por ecocardiografia. Métodos: Os participantes do estudo assinaram um termo de consentimento e foram incluídos se tivessem sido submetidos no mesmo dia tanto à ecocardiografia quanto à cine RMC com precessão livre no estado estacionário (steady-state free precession, SSFP). Pontos-guia foram utilizados no anel mitral septal e lateral para definir a velocidade de estiramento no início da diástole (E'), enquanto curvas de volume-tempo do modelo 3D foram utilizadas para avaliar os parâmetros de enchimento diastólico. Foram determinadas a correlação entre a RMC 3D e a ecocardiografia, além da acurácia da RMC em classificar o grau de função diastólica. Resultados: Ao todo, 102 sujeitos foram incluídos no estudo. A razão E/A pela RMC esteve positivamente associada com a razão E/A obtida pela ecocardiografia (r = 0,71, p < 0,0001). Estiveram positivamente associadas a velocidade de relaxamento diastólico inicial ao Doppler tecidual e a velocidade de relaxamento longitudinal de deslocamento do anel mitral lateral (p = 0,007), bem como a razão entre E/e' por Doppler e E/E' pela RMC (p = 0,01). A velocidade normalizada de pico de enchimento (EM) determinada pela RMC e o tempo de desaceleração (TD) foram capazes de predizer a disfunção diastólica (áreas sob a curva [AUCs] = 0,70 e 0,72, respectivamente). Além disso, a razão E/E' lateral mostrou boa utilidade para a identificação da disfunção diastólica (AUC = 0,80). No geral, a ecocardiografia e a RMC apresentaram excelente concordância interobservador e intraobservador (coeficiente de correlação intraclasse 0,72 - 0,97). Conclusão: Uma modelagem 3D de imagens padrões de cine RMC foi capaz de identificar os indivíduos do estudo com função diastólica reduzida e mostrou uma boa reprodutibilidade, sugerindo ter potencial na avaliação rotineira da função diastólica por RMC.
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Affiliation(s)
- Marcelo S Nacif
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA.,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Radiology Department, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Andre L C Almeida
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alistair A Young
- Auckland MRI Research Group, University of Auckland, Auckland, New Zealand
| | - Brett R Cowan
- Auckland MRI Research Group, University of Auckland, Auckland, New Zealand
| | - Anderson C Armstrong
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eunice Yang
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Christopher T Sibley
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - W Gregory Hundley
- Department of Internal Medicine and Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Songtao Liu
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Joao Ac Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA.,Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
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Abstract
Diabetic cardiomyopathy (DCM) is a cardiac dysfunction which affects approximately 12% of diabetic patients, leading to overt heart failure and death. However, there is not an efficient and specific methodology for DCM diagnosis, possibly because molecular mechanisms are not fully elucidated, and it remains asymptomatic for many years. Also, DCM frequently coexists with other comorbidities such as hypertension, obesity, dyslipidemia, and vasculopathies. Thus, human DCM is not specifically identified after heart failure is established. In this sense, echocardiography has been traditionally considered the gold standard imaging test to evaluate the presence of cardiac dysfunction, although other techniques may cover earlier DCM detection by quantification of altered myocardial metabolism and strain. In this sense, Phase-Magnetic Resonance Imaging and 2D/3D-Speckle Tracking Echocardiography may potentially diagnose and stratify diabetic patients. Additionally, this information could be completed with a quantification of specific plasma biomarkers related to related to initial stages of the disease. Cardiotrophin-1, activin A, insulin-like growth factor binding protein-7 (IGFBP-7) and Heart fatty-acid binding protein have demonstrated a stable positive correlation with cardiac hypertrophy, contractibility and steatosis responses. Thus, we suggest a combination of minimally-invasive diagnosis tools for human DCM recognition based on imaging techniques and measurements of related plasma biomarkers.
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Sulemane S, Panoulas VF, Bratsas A, Grapsa J, Brown EA, Nihoyannopoulos P. Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction. Int J Cardiovasc Imaging 2017; 33:687-698. [PMID: 28120157 PMCID: PMC5383685 DOI: 10.1007/s10554-016-1059-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/30/2016] [Indexed: 01/20/2023]
Abstract
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
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Affiliation(s)
- Samir Sulemane
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK.
| | - Vasileios F Panoulas
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
- Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Athanasios Bratsas
- Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Julia Grapsa
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
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Argulian E, Sengupta PP. Speckle Tracking Echocardiographic Imaging in Metabolic Cardiomyopathies. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Bjornstad P, Truong U, Pyle L, Dorosz JL, Cree-Green M, Baumgartner A, Coe G, Regensteiner JG, Reusch JEB, Nadeau KJ. Youth with type 1 diabetes have worse strain and less pronounced sex differences in early echocardiographic markers of diabetic cardiomyopathy compared to their normoglycemic peers: A RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) Study. J Diabetes Complications 2016; 30:1103-10. [PMID: 27133451 PMCID: PMC4949075 DOI: 10.1016/j.jdiacomp.2016.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/09/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Diabetic cardiomyopathy is a major cause of morbidity, but limited data are available on early cardiac abnormalities in type 1 diabetes (T1D). We investigated differences in myocardial strain in adolescents with and without T1D. We hypothesized that adolescents with T1D would have worse strain than their normoglycemic peers, which boys would have worse strain than girls, and that strain would correlate with glycemic control and adipokines. METHODS We performed fasting laboratory measures and echocardiograms with speckle tracking to evaluate traditional echocardiographic measures in addition to longitudinal (LS) and circumferential (CS) strain, and in adolescents (15±2years) with (19 boys; 22 girls) and without (16 boys; 32 girls) type 1 diabetes. RESULTS Compared to controls, adolescents with type 1 diabetes had significantly lower CS (-20.9 vs. -22.7%, p=0.02), but not LS (p=0.83). Boys with T1D had significantly lower LS than girls with T1D (-17.5 vs. -19.7%, p=0.047), adjusted for Tanner stage. The significant sex differences observed in indexed left ventricular mass, left end-diastolic volume, diastolic septal and posterior wall thickness in our controls were lacking in adolescents with T1D. CONCLUSIONS Our observations suggest that youth with T1D have worse myocardial strain than normoglycemic peers. In addition, the relatively favorable cardiac profile observed in girls vs. boys in the control group, was attenuated in T1D. These early cardiovascular changes in youth with T1D are concerning and warrant longitudinal and mechanistic studies.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Uyen Truong
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Jennifer L Dorosz
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E B Reusch
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Division of Endocrinology, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
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Bjornstad P, Truong U, Dorosz JL, Cree-Green M, Baumgartner A, Coe G, Pyle L, Regensteiner JG, Reusch JEB, Nadeau KJ. Cardiopulmonary Dysfunction and Adiponectin in Adolescents With Type 2 Diabetes. J Am Heart Assoc 2016; 5:e002804. [PMID: 26994128 PMCID: PMC4943257 DOI: 10.1161/jaha.115.002804] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Myocardial mechanics are altered in adults with obesity and type 2 diabetes (T2D); insulin resistance and adipokines have been implicated as important risk factors for cardiovascular disease, but these relationships are poorly described in adolescents. We hypothesized that obese adolescents and adolescents with T2D would have abnormal cardiac function compared to lean adolescents. In addition, we hypothesized that insulin sensitivity (IS), adiposity, and adipokines would be associated with altered cardiac strain and cardiopulmonary fitness in adolescents with T2D. Methods and Results Adolescents (15±2 years) with T2D (n=37), obesity without diabetes (n=41), and lean controls (n=31) of similar age and pubertal stage underwent echocardiography with speckle tracking, assessment of IS by hyperinsulinemic–euglycemic clamp, body composition by dual‐energy x‐ray absorptiometry, peak oxygen consumption (VO2peak) by cycle ergometry, adiponectin, and leptin. Compared to lean and to obese controls, adolescents with T2D had significantly lower cardiac circumferential strain (CS) (−18.9±4.6 [T2D] versus −21.5±3.5 [obese] versus −22.0±4.2% [lean], P=0.04) and VO2peak (37.6±7.5 [T2D] versus 43.4±8.2 [obese] versus 47.6±8.6 mL/lean kg/min [lean], P<0.0001). In T2D youth, VO2peak was associated with CS, and the association remained significant after adjusting for age, sex, and IS (β±SE: −0.73±0.26, P=0.02). Among adolescents with T2D, CS was also associated with adiponectin, longitudinal strain with leptin, and VO2peak with adiponectin and IS. Conclusions Adolescents with T2D had abnormal CS and reduced VO2peak compared to obese and lean controls, which may represent the earliest evidence of cardiac functional impairment in T2D. Low adiponectin, rather than conventional risk factors and IS, correlated with CS, while both adiponectin and IS related to cardiopulmonary fitness.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Uyen Truong
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Jennifer L Dorosz
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
| | - Judith G Regensteiner
- Divisions of General Internal Medicine and Cardiology, Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO
| | - Jane E B Reusch
- Division of Endocrinology, Center for Women's Health Research, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO
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Hollekim-Strand SM, Høydahl SF, Follestad T, Dalen H, Bjørgaas MR, Wisløff U, Ingul CB. Exercise Training Normalizes Timing of Left Ventricular Untwist Rate, but Not Peak Untwist Rate, in Individuals with Type 2 Diabetes and Diastolic Dysfunction: A Pilot Study. J Am Soc Echocardiogr 2016; 29:421-430.e2. [PMID: 26948543 DOI: 10.1016/j.echo.2016.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is limited information regarding the role of left ventricular (LV) twist and the effect of exercise in type 2 diabetes (T2D). The aim of this study was to compare LV twist parameters in patients with T2D versus healthy control subjects and the effects of high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on LV twist in patients with T2D with diastolic dysfunction. METHODS This study, which included both prospective and retrospective components, included 47 patients with T2D and diastolic dysfunction and 37 healthy individuals. Patients with T2D were randomized to HIIE (4 × 4 min at 90%-95% of maximal heart rate, three times a week, 120 min/wk; n = 24) or MIE (210 min/wk; n = 23) for 12 weeks and examined with echocardiography (LV twist by speckle-tracking method) at baseline and posttest. The control subjects received no intervention and were matched according to age, gender, and body mass index to those completing the intervention. RESULTS In total, 37 subjects completed 12 weeks of MIE (n = 17) or HIIE (n = 20). LV peak untwist rate (UTR) was similar in patients with T2D and control subjects (P ˃ .05). At baseline, LV peak UTR, relative to total diastolic period, occurred 5.8 percentage points later in patients with T2D compared with control subjects (P = .004). Time to peak UTR was shortened by 6.5 percentage points (P = .002) and 7.7 percentage points (P < .001) after MIE and HIIE, respectively. Time to peak UTR was similar to that in control subjects after exercise interventions. CONCLUSIONS In patients with T2D and diastolic dysfunction, LV peak UTR was similar, but time to peak LV UTR was delayed compared with control subjects. Twelve weeks of endurance exercise normalized the timing of UTR.
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Affiliation(s)
- Siri Marte Hollekim-Strand
- K. G. Jebsen Centre of Exercise in Medicine at the Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigve Fredrik Høydahl
- K. G. Jebsen Centre of Exercise in Medicine at the Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and technology, Trondheim, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
| | - Marit Rokne Bjørgaas
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Endocrinology, St Olav's Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- K. G. Jebsen Centre of Exercise in Medicine at the Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte Björk Ingul
- K. G. Jebsen Centre of Exercise in Medicine at the Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Chen Q, Gan Y, Li ZY. Left ventricular diastolic dysfunction in type 2 diabetes patients: a novel 2D strain analysis based on cardiac magnetic resonance imaging. Comput Methods Biomech Biomed Engin 2016; 19:1330-8. [PMID: 26838334 DOI: 10.1080/10255842.2016.1139093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study was to develop a strain analysis method to evaluate the left ventricular (LV) functions in type 2 diabetic patients with an asymptomatic LV diastolic dysfunction. METHODS Two groups (10 asymptomatic type 2 diabetic subjects and 10 control ones) were considered. All of the subjects had normal ejection fraction values but impaired diastolic functions assessed by the transmitral blood flow velocity. For each subject, based on cardiac MRI, global indexes including LV volume, LV myocardial mass, cardiac index (CI), and transmitral peak velocity, were measured, and regional indexes (i.e., LV deformation, strain and strain rate) were calculated through an image-registration technology. RESULTS Most of the global indexes did not differentiate between the two groups, except for the CI, LV myocardial mass and transmitral peak velocity. While for the regional indexes, the global LV diastolic dysfunction of the diabetic indicated an increased strain (0.08 ± 0.044 vs. -0.031 ± 0.077, p = 0.001) and a reduced strain rate (1.834 ± 0.909 vs. 3.791 ± 2.394, p = 0.033) compared to the controls, moreover, the local LV diastolic dysfunction reflected by the strain and strain rate varied, and the degree of dysfunction gradually decreased from the basal level to the apical level. CONCLUSIONS The results showed that the strain and strain rates are effective to capture the subtle alterations of the LV functions, and the proposed method can be used to estimate the LV myocardial function based on cardiac MRI.
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Affiliation(s)
- Qiang Chen
- a Biomechanics Laboratory, School of Biological Science and Medical Engineering , Southeast University , Nanjing , P.R. China
| | - Yan Gan
- a Biomechanics Laboratory, School of Biological Science and Medical Engineering , Southeast University , Nanjing , P.R. China
| | - Zhi-Yong Li
- a Biomechanics Laboratory, School of Biological Science and Medical Engineering , Southeast University , Nanjing , P.R. China.,b School of Chemistry, Physics and Mechanical Engineering , Queensland University of Technology , Brisbane , Australia
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Cassidy S, Thoma C, Hallsworth K, Parikh J, Hollingsworth KG, Taylor R, Jakovljevic DG, Trenell MI. High intensity intermittent exercise improves cardiac structure and function and reduces liver fat in patients with type 2 diabetes: a randomised controlled trial. Diabetologia 2016; 59:56-66. [PMID: 26350611 PMCID: PMC4670457 DOI: 10.1007/s00125-015-3741-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Cardiac disease remains the leading cause of mortality in type 2 diabetes, yet few strategies to target cardiac dysfunction have been developed. This randomised controlled trial aimed to investigate high intensity intermittent training (HIIT) as a potential therapy to improve cardiac structure and function in type 2 diabetes. The impact of HIIT on liver fat and metabolic control was also investigated. METHODS Using an online random allocation sequence, 28 patients with type 2 diabetes (metformin and diet controlled) were randomised to 12 weeks of HIIT (n = 14) or standard care (n = 14). Cardiac structure and function were measured by 3.0 T MRI and tagging. Liver fat was determined by 1H-magnetic resonance spectroscopy and glucose control by an OGTT. MRI analysis was performed by an observer blinded to group allocation. All study procedures took place in Newcastle upon Tyne, UK. RESULTS Five patients did not complete the study and were therefore excluded from analysis: this left 12 HIIT and 11 control patients for the intention-to-treat analysis. Compared with controls, HIIT improved cardiac structure (left ventricular wall mass 104 ± 17 g to 116 ± 20 g vs. 107 ± 25 g to 105 ± 25 g, p < 0.05) and systolic function (stroke volume 76 ± 16 ml to 87 ± 19 ml vs. 79 ± 14 ml to 75 ± 15 ml, p < 0.01). Early diastolic filling rates increased (241 ± 84 ml/s to 299 ± 89 ml/s vs. 250 ± 44 ml/s to 251 ± 47 ml/s, p < 0.05) and peak torsion decreased (8.1 ± 1.8° to 6.9 ± 1.6° vs. 7.1 ± 2.2° to 7.6 ± 1.9°, p < 0.05) in the treatment group. Following HIIT, there was a 39% relative reduction in liver fat (p < 0.05) and a reduction in HbA1c (7.1 ± 1.0% [54.5 mmol/mol] to 6.8 ± 0.9% [51.3 mmol/mol] vs. 7.2 ± 0.5% [54.9 mmol/mol] to 7.4 ± 0.7% [57.0 mmol/mol], p < 0.05). Changes in liver fat correlated with changes in HbA1c (r = 0.70, p < 0.000) and 2 h glucose (r = 0.57, p < 0.004). No adverse events were recorded. CONCLUSIONS/INTERPRETATION This is the first study to demonstrate improvements in cardiac structure and function, along with the greatest reduction in liver fat, to be recorded following an exercise intervention in type 2 diabetes. HIIT should be considered by clinical care teams as a therapy to improve cardiometabolic risk in patients with type 2 diabetes. TRIAL REGISTRATION www.isrctn.com 78698481 FUNDING: : Medical Research Council.
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Affiliation(s)
- Sophie Cassidy
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- UKRC Centre for Ageing and Vitality, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Christian Thoma
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Kate Hallsworth
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- UKRC Centre for Ageing and Vitality, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Jehill Parikh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Kieren G Hollingsworth
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Roy Taylor
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- UKRC Centre for Ageing and Vitality, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael I Trenell
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
- Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
- UKRC Centre for Ageing and Vitality, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 2015; 21:77-94. [DOI: 10.1007/s10741-015-9521-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rasalingam R, Holland MR, Cooper DH, Novak E, Rich MW, Miller JG, Pérez JE. Patients with Diabetes and Significant Epicardial Coronary Artery Disease Have Increased Systolic Left Ventricular Apical Rotation and Rotation Rate at Rest. Echocardiography 2015; 33:537-45. [PMID: 26593856 DOI: 10.1111/echo.13124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction. DESIGN A prospective observational study. SETTING Diagnosis of epicardial CAD in patients with diabetes. PATIENTS AND METHODS Eighty-four patients with diabetes suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization. MAIN OUTCOME MEASURES Measurement of longitudinal strain, strain rate, apical rotation, and rotation rate, using speckle tracking echocardiography. RESULTS Eighty-four patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9 ± 5.1 vs. 11.0 ± 4.8 degrees, P < 0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4 ± 29 vs. 68.1 ± 22.2 degrees/sec, P < 0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR = 1.17, P = 0.004 and peak systolic apical rotation rate OR = 1.05, P < 0.001). CONCLUSIONS Patients with diabetes with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counterclockwise rotation and rotation rate detected by echocardiography, suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected noninvasively at rest.
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Affiliation(s)
- Ravi Rasalingam
- Cardiovascular Division, Boston Veterans Affairs Medical Center, West Roxbury, Massachusetts
| | - Mark R Holland
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana
| | - Daniel H Cooper
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Michael W Rich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - James G Miller
- Department of Physics, Washington University in St. Louis, St. Louis, Missouri
| | - Julio E Pérez
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
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Goland S, Perelman S, Asalih N, Shimoni S, Walfish O, Hallak M, Hagay Z, George J, Shotan A, Blondheim DS. Shortness of Breath During Pregnancy: Could a Cardiac Factor Be Involved? Clin Cardiol 2015; 38:598-603. [PMID: 26412409 DOI: 10.1002/clc.22452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no overt cardiac or extra cardiac etiology is found, a subtle cardiac source must be excluded. HYPOTHESIS Pregnancy may induce or unmask myocardial dysfunction that may cause SOB. METHODS Healthy pregnant women with significant SOB were recruited for this study. We performed a comprehensive echocardiographic assessment including tissue Doppler imaging (TDI) and 2- dimensional strain imaging (2DS). The echocardiographic data obtained were compared with that of a control group of pregnant women without SOB. RESULTS Thirty pregnant women with SOB were enrolled in the study (age, 31.8 ± 4.9 years, and gestation, 38.2 ± 2.8 weeks) for whom no overt etiology for SOB was detected. Patients with SOB compared with controls had thicker hearts (septum: 10.1 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.001; posterior wall: 9.4 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.01), shorter E-wave deceleration time (158.0 ± 50.1 vs 187.1 ± 37.6 msec; P = 0.01), and higher pulmonary artery pressure (26.8 ± 6.2 vs 19.0 ± 6.5 mm Hg, P < 0.01). Women with SOB tended to have a lower S' velocity TDI (P = 0.05) and a trend toward increased torsion on 2DS (P = 0.09). CONCLUSIONS Significant SOB during otherwise normal pregnancy is associated with significant echocardiographic findings that may suggest a subtle cardiac involvement. Further investigation is necessary to verify such an association, which may have therapeutic implications for treating SOB of pregnancy.
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Affiliation(s)
- Sorel Goland
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
| | - Sharon Perelman
- Department of Obstetrics, Kaplan Medical Center, Rehovot, Israel
| | - Nardin Asalih
- Department of Obstetrics, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated With the Technion School of Medicine, Haifa, Israel
| | - Sara Shimoni
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
| | - Osnat Walfish
- Department of Obstetrics, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated With the Technion School of Medicine, Haifa, Israel
| | - Mordechai Hallak
- Department of Obstetrics, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated With the Technion School of Medicine, Haifa, Israel
| | - Zion Hagay
- Department of Obstetrics, Kaplan Medical Center, Rehovot, Israel
| | - Jacob George
- Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
| | - Avraham Shotan
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated With the Technion School of Medicine, Haifa, Israel
| | - David S Blondheim
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel, Affiliated With the Technion School of Medicine, Haifa, Israel
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Collins JD. Global and regional functional assessment of ischemic heart disease with cardiac MR imaging. Radiol Clin North Am 2015; 53:369-95. [PMID: 25727001 DOI: 10.1016/j.rcl.2014.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac MR imaging (CMR) combines assessment of myocardial function and tissue characterization, and is therefore ideally suited to evaluating patients with ischemic heart disease (IHD). This article discusses evaluation of left ventricular global function at CMR, reviewing the literature supporting global parameters in risk stratification and assessment of treatment response in IHD. Techniques for assessment of regional myocardial function are reviewed, and normal myocardial motion and fiber arrangement discussed. Despite barriers to clinical adoption, integration of this assessment into clinical routine should improve the ability to detect functional consequences of early myocardial structural alterations in patients with IHD.
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Affiliation(s)
- Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611, USA.
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Cassidy S, Hallsworth K, Thoma C, MacGowan GA, Hollingsworth KG, Day CP, Taylor R, Jakovljevic DG, Trenell MI. Cardiac structure and function are altered in type 2 diabetes and non-alcoholic fatty liver disease and associate with glycemic control. Cardiovasc Diabetol 2015; 14:23. [PMID: 25849783 PMCID: PMC4330943 DOI: 10.1186/s12933-015-0187-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/28/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Both non-alcoholic fatty liver disease (NAFLD) and Type 2 diabetes increase the risk of developing cardiovascular disease. The metabolic processes underlying NAFLD and Type 2 diabetes are part of an integrated mechanism but little is known about how these conditions may differentially affect the heart. We compared the impact of NAFLD and Type 2 diabetes on cardiac structure, function and metabolism. METHODS 19 adults with Type 2 diabetes (62 ± 8 years), 19 adults with NAFLD (54 ± 15 years) and 19 healthy controls (56 ± 14 years) underwent assessment of cardiac structure, function and metabolism using high resolution magnetic resonance imaging, tagging and spectroscopy at 3.0 T. RESULTS Adults with NAFLD and Type 2 diabetes demonstrate concentric remodelling with an elevated eccentricity ratio compared to controls (1.05 ± 0.3 vs. 1.12 ± 0.2 vs. 0.89 ± 0.2 g/ml; p < 0.05). Despite this, only the Type 2 diabetes group demonstrate significant systolic and diastolic dysfunction evidenced by a reduced stroke index (31 ± 7vs. controls, 38 ± 10, p < 0.05 ml/m2) and reduced E/A (0.9 ± 0.4 vs. controls, 1.9 ± 1.4, p < 0.05) respectively. The torsion to shortening ratio was higher in Type 2 diabetes compared to NAFLD (0.58 ± 0.16 vs. 0.44 ± 0.13; p < 0.05). Significant associations were observed between fasting blood glucose/HbA1c and diastolic parameters as well as the torsion to shortening ratio (all p < 0.05). Phosphocreatine/adenosine triphosphate ratio was not altered in NAFLD or Type 2 diabetes compared to controls. CONCLUSIONS Changes in cardiac structure are evident in adults with Type 2 diabetes and NAFLD without overt cardiac disease and without changes in cardiac energy metabolism. Only the Type 2 diabetes group display diastolic and subendocardial dysfunction and glycemic control may be a key mediator of these cardiac changes. Therapies should be explored to target these preclinical cardiac changes to modify cardiovascular risk associated with Type 2 diabetes and NAFLD.
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Affiliation(s)
- Sophie Cassidy
- />Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Hallsworth
- />Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Christian Thoma
- />Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Guy A MacGowan
- />Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- />Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- />Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher P Day
- />Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Roy Taylor
- />Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Michael I Trenell
- />Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Kuetting D, Sprinkart AM, Doerner J, Schild H, Thomas D. Comparison of magnetic resonance feature tracking with harmonic phase imaging analysis (CSPAMM) for assessment of global and regional diastolic function. Eur J Radiol 2014; 84:100-107. [PMID: 25467225 DOI: 10.1016/j.ejrad.2014.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/11/2014] [Accepted: 10/13/2014] [Indexed: 11/27/2022]
Abstract
AIMS Complex post-processing is required for strain-derived assessment of diastolic dysfunction (DD) using CMR-tagging (TAG). Feature-tracking (FT), allows for rapid systolic strain assessment using conventional steady-state free precession (SSFP)-Cine sequences. Aim of this study was to investigate whether FT may be employed for the clinically applicable quantification of DD. METHODS AND RESULTS 40 individuals (20 patients with DD I-III°, 20 controls) were investigated. CSPAMM and SSFP-Cine sequences were acquired in identical short-axis locations. Global and regional early diastolic strain rate (EDSR), peak diastolic strain rate (PDSR), twist, untwist and torsion were calculated from tagged and SSFP-Cine datasets. DD indices were compared, intra- as well inter-observer variability assessed. RESULTS for global EDSR correlated strongly (r=0.94), revealed good agreement and no significant differences between both methods. Correlation for regional EDSR was lower, results differed significantly in the anterior wall (p<0.05). Correlation for PDSR was moderate (r=0.63), results in the healthy control group differed significantly (p<0.05). FT derived rotational indices correlated poorly with TAG (twist: r=0.28; untwist: r=0.02; torsion: r=0.26), subgroup analysis revealed significant differences (p<0.05). Intra- and inter-observer variability for FT derived global EDSR and PDSR were comparable to TAG, but significantly higher for regional EDSR and rotational indices. CONCLUSION FT derived global EDSR allows for rapid clinical determination of diastolic dysfunction, revealing good agreement with TAG and low intra- as well as interobserver variability. However, TAG analysis not only yields higher accuracy and reproducibility of global- and regional diastolic strain, but also delivers reliable information about diastolic rotational and untwisting dynamics.
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Affiliation(s)
- D Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53105 Bonn, Germany
| | - A M Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53105 Bonn, Germany
| | - J Doerner
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53105 Bonn, Germany
| | - H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53105 Bonn, Germany
| | - D Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53105 Bonn, Germany.
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Stankovic I, Putnikovic B, Cvjetan R, Milicevic P, Panic M, Kalezic-Radmili T, Mandaric T, Vidakovic R, Cvorovic V, Neskovic AN. Visual assessment vs. strain imaging for the detection of critical stenosis of the left anterior descending coronary artery in patients without a history of myocardial infarction. Eur Heart J Cardiovasc Imaging 2014; 16:402-9. [PMID: 25336543 DOI: 10.1093/ehjci/jeu206] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We sought to determine the prevalence of overt and subclinical LV dysfunction in patients with critical left anterior descending coronary artery (LAD) stenosis but without a history of myocardial infarction and to compare diagnostic value of routine echocardiographic parameters with myocardial strain analysis for detection of critical LAD stenosis. METHODS AND RESULTS We retrospectively studied 269 patients with suspected coronary artery disease (CAD)-209 consecutive patients with critical LAD stenosis and 60 consecutive patients with atypical chest pain and without CAD. Conventional visual assessment of LV asynergy in the LAD territory was compared with global, regional, and segmental peak systolic longitudinal strain (PSLS) parameters derived by two-dimensional speckle tracking echocardiography (2D STE). Wall motion abnormalities in the LAD territory were found in 41% of patients with critical LAD stenosis, whereas, depending on the cut-off value, global longitudinal strain (GLS) was impaired in 42-69% of patients. GLS with an area under the receiver operating characteristic curve (AUC) of 0.85 showed better discriminative power for detecting critical LAD stenosis than conventional wall motion score index (AUC 0.73, P < 0.05, for the difference between the AUCs). PSLS values were significantly lower in basal and midventricular segments supplied by critically narrowed LAD, particularly if they also appeared dysfunctional on visual assessment. CONCLUSIONS Detection of subclinical LV dysfunction by 2D STE might improve identification of patients with critical LAD stenosis, although visually apparent regional LV dysfunction in the LAD territory is not uncommon finding in this subset of patients.
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Affiliation(s)
- Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Biljana Putnikovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Radosava Cvjetan
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Predrag Milicevic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Milos Panic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Tijana Kalezic-Radmili
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Tijana Mandaric
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Radosav Vidakovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Vojkan Cvorovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
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Pokharel P, Yoon AJ, Bella JN. Noninvasive measurement and clinical relevance of myocardial twist and torsion. Expert Rev Cardiovasc Ther 2014; 12:1305-15. [DOI: 10.1586/14779072.2014.970179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Tadic M, Ilic S, Cuspidi C, Stojcevski B, Ivanovic B, Bukarica L, Jozika L, Celic V. Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study. Echocardiography 2014; 32:947-55. [DOI: 10.1111/echo.12790] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Marijana Tadic
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”; Belgrade Serbia
| | - Sanja Ilic
- Department of Endocrinology; University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”; Belgrade Serbia
| | - Cesare Cuspidi
- Clinical Research Unit; University of Milan-Bicocca and Istituto Auxologico Italiano; Meda Italy
| | - Biljana Stojcevski
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”; Belgrade Serbia
| | - Branislava Ivanovic
- Clinic of Cardiology; Clinical Center of Serbia; Belgrade Serbia
- Faculty of Medicine; Belgrade Serbia
| | | | - Ljilja Jozika
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”; Belgrade Serbia
| | - Vera Celic
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”; Belgrade Serbia
- Faculty of Medicine; Belgrade Serbia
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49
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Dei Cas A, Fonarow GC, Gheorghiade M, Butler J. Concomitant diabetes mellitus and heart failure. Curr Probl Cardiol 2014; 40:7-43. [PMID: 25499908 DOI: 10.1016/j.cpcardiol.2014.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of patients with concomitant diabetes mellitus (DM) and heart failure (HF) is growing exponentially. Patients with HF and DM show specific metabolic, neurohormonal, and structural heart abnormalities, which potentially contribute to worse HF outcomes than seen in patients without comorbid DM. Subgroup analysis of recent trials suggest that patients with HF and DM may respond differently to standard therapy, and data are emerging on the possible increase in the risk of hospitalizations for HF in patients with DM treated with specific class of antidiabetic agents, pointing to the need of developing specific medications to be tested in dedicated future studies to address the unique metabolic and hemodynamic alterations seen in these patients.
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Larghat AM, Swoboda PP, Biglands JD, Kearney MT, Greenwood JP, Plein S. The microvascular effects of insulin resistance and diabetes on cardiac structure, function, and perfusion: a cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 2014; 15:1368-76. [PMID: 25117473 PMCID: PMC4240406 DOI: 10.1093/ehjci/jeu142] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aims Type 2 diabetes mellitus is an independent risk factor for the development of heart failure. To better understand the mechanism by which this occurs, we investigated cardiac structure, function, and perfusion in patients with and without diabetes. Methods and results Sixty-five patients with no stenosis >30% on invasive coronary angiography were categorized into diabetes (19) and non-diabetes (46) which was further categorized into prediabetes (30) and controls (16) according to the American Diabetes Association guidelines. Each patient underwent comprehensive cardiovascular magnetic resonance assessment. Left-ventricular (LV) mass, relative wall mass (RWM), Lagrangian circumferential strain, LV torsion, and myocardial perfusion reserve (MPR) were calculated. LV mass was higher in diabetics than non-diabetics (112.8 ± 39.7 vs. 91.5 ± 21.3 g, P = 0.01) and in diabetics than prediabetics (112.8 ± 39.7 vs. 90.3 ± 18.7 g, P = 0.02). LV torsion angle was higher in diabetics than non-diabetics (9.65 ± 1.90 vs. 8.59 ± 1.91°, P = 0.047), and MPR was lower in diabetics than non-diabetics (2.10 ± 0.76 vs. 2.84 ± 1.25 mL/g/min, P = 0.01). There was significant correlation between MPR and early diastolic strain rate (r = −0.310, P = 0.01) and LV torsion (r = −0.306, P = 0.01). In multivariable linear regression analysis, non-diabetics waist–hip ratio, but not body mass index, had a significant association with RWM (Beta = 0.34, P = 0.02). Conclusion Patients with diabetes have increased LV mass, LV torsion, and decreased MPR. There is a significant association between decreased MPR and increased LV torsion suggesting a possible mechanistic link between microvascular disease and cardiac dysfunction in diabetes.
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Affiliation(s)
- Abdulghani M Larghat
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK Department of Cardiology and Internal Medicine, Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | | | - Mark T Kearney
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
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