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Lisi M, Luisi GA, Pastore MC, Mandoli GE, Benfari G, Ilardi F, Malagoli A, Sperlongano S, Henein MY, Cameli M, D'Andrea A. New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure. Heart Fail Rev 2024:10.1007/s10741-024-10398-7. [PMID: 38507022 DOI: 10.1007/s10741-024-10398-7] [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] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
International Guidelines consider left ventricular ejection fraction (LVEF) as an important parameter to categorize patients with heart failure (HF) and to define recommended treatments in clinical practice. However, LVEF has some technical and clinical limitations, being derived from geometric assumptions and is unable to evaluate intrinsic myocardial function and LV filling pressure (LVFP). Moreover, it has been shown to fail to predict clinical outcome in patients with end-stage HF. The analysis of LV antegrade flow derived from pulsed-wave Doppler (stroke volume index, stroke distance, cardiac output, and cardiac index) and non-invasive evaluation of LVFP have demonstrated some advantages and prognostic implications in HF patients. Speckle tracking echocardiography (STE) is able to unmask intrinsic myocardial systolic dysfunction in HF patients, particularly in those with LV preserved EF, hence allowing analysis of LV, right ventricular and left atrial (LA) intrinsic myocardial function (global peak atrial LS, (PALS)). Global PALS has been proven a reliable index of LVFP which could fill the gaps "gray zone" in the previous Guidelines algorithm for the assessment of LV diastolic dysfunction and LVFP, being added to the latest European Association of Cardiovascular Imaging Consensus document for the use of multimodality imaging in evaluating HFpEF. The aim of this review is to highlight the importance of the hemodynamics multiparametric approach of assessing myocardial function (from LVFP to stroke volume) in patients with HF, thus overcoming the limitations of LVEF.
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Affiliation(s)
- Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
| | - Giovanni Andrea Luisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
- Mediterranea Cardiocentro, 80122, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Baggiovara, Italy
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Matteo Cameli
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014, Nocera Inferiore, SA, Italy
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Hemmerich C, Heep M, Gärtner U, Taghiyev ZT, Schneider M, Böning A. Myocardial Recovery, Metabolism, and Structure after Cardiac Arrest with Cardioplexol. Thorac Cardiovasc Surg 2023. [PMID: 37562431 DOI: 10.1055/s-0043-1772210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Clinical studies indicate encouraging cardioprotective potential for Cardioplexol. Its cardioprotective capacities during 45 minutes of ischemia compared with pure no-flow ischemia or during 90 minutes of ischemia compared with Calafiore cardioplegia were investigated experimentally. METHODS Forty-four rat hearts were isolated and inserted into a blood-perfused pressure-controlled Langendorff apparatus. In a first step, cardiac arrest was induced by Cardioplexol or pure no-flow ischemia lasting 45 minutes. In a second step, cardiac arrest was induced by Cardioplexol or Calafiore cardioplegia lasting 90 minutes. For both experimental steps, cardiac function, metabolic parameters, and troponin I levels were evaluated during 90 minutes of reperfusion. At the end of reperfusion, hearts were fixed, and ultrastructural integrity was examined by electron microscopy. RESULTS Step 1: after 90 minutes of reperfusion, hearts exposed to Cardioplexol had significantly higher left ventricular developed pressure (CP-45': 74%BL vs. no-flow-45': 45%BL; p = 0.046) and significantly better maximal left ventricular relaxation (CP-45': 84%BL vs. no-flow-45': 51%BL; p = 0.012). Oxygen consumption, lactate production, and troponin levels were similar in both groups. Step 2: left ventricular developed pressure was lower (22 vs. 48% of BL; p = 0.001) and coronary flow was lower (24 vs. 53% of BL; p = 0.002) when Cardioplexol was used compared with Calafiore cardioplegia. Troponin I levels were significantly higher under Cardioplexol (358.9 vs. 106.1 ng/mL; p = 0.016). CONCLUSION Cardioplexol significantly improves functional recovery after 45 minutes of ischemia compared with pure ischemia. However, Cardioplexol protects the myocardium from ischemia/reperfusion-related damage after 90 minutes of ischemia worse than Calafiore cardioplegia.
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Affiliation(s)
- Carina Hemmerich
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Martina Heep
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Ulrich Gärtner
- Institute of Anatomy and Cell Biology, German Center for Lung Research, Justus Liebig University Giessen, Giessen, Germany
| | - Zulfugar Timur Taghiyev
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Matthias Schneider
- Medical and Forensic Veterinary Clinic, Department of Small Animal Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Giessen, Germany
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Effect of Left Ventricular geometric remodeling on restrictive filling pattern and survival in ischemic cardiomyopathy. Indian Heart J 2022; 74:206-211. [PMID: 35513044 PMCID: PMC9244999 DOI: 10.1016/j.ihj.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background To evaluate the effects of Left ventricular remodeling patterns in patients with left ventricular restrictive filling pattern (RFP; E/A>2) in ischemic cardiomyopathy (ICM) on prognosis. Methods Patient data was retrospectively analyzed over a period of 4.5 years to determine the effect of LV geometry by Echocardiographic parameterson survival and re-admission for heart failure. All patients with previous history of transmural myocardial infarction were studied and all were on guideline directed medical therapy. None underwent device therapy or surgery. The stored 2D Echocardiograms were studied. Left ventricular dimensions were noted, including the relative wall thickness (RWT). The patients were grouped based on RWT<0.34 and ≥ 0.34 and were compared for clinical outcomes of mortality and re-admissions for heart failure, over a period of 54 months. Results There were 102 ICM patients who had baseline RFP. We identified two sub-groups based on geometric phenotypes of left ventricular eccentric remodeling and dilated remodeling based on the relative wall thickness (RWT >0.34 or <0.34). The patients with preserved RWT had significantly more dilated ventricles (LVIDd and LVIDs), greater pulmonary artery systolic pressures (PASP), greater diatolic dysfunction (E/A) and less left ventricular ejection fraction (LVEF); p < 0.001. The number of deaths was higher in the reduced RWT patients, as were the number of re-admissions, although the time to survival and time to re-admission was not significant. Conclusions In this pilot study on ICM patients in advanced heart failure with baseline RFP, the presence of preserved RWT indicative of eccentric remodelling demonstrated a better clinical outcome.
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Surgical Ventricular Restoration for Ischemic Heart Failure: A Glance at a Real-World Population. J Pers Med 2022; 12:jpm12040567. [PMID: 35455682 PMCID: PMC9030669 DOI: 10.3390/jpm12040567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From July 2001 to June 2017, 648 patients (111 females) underwent SVR; coronary surgery was performed in 582 patients. Data were analyzed by dividing the population into two groups: Group I (371 patients operated between July 2001 and December 2007) and Group II (277 patients operated between January 2008 and June 2017). At baseline, Group I patients were more symptomatic for angina (47.4% versus 19.4%, p < 0.0001) and less symptomatic for HF (NYHA class III/IV, 46.3% versus 57%, p = 0.0071). The end-diastolic volume (106 mL/m2 versus 118.3 mL/m2, p < 0.0001) and the end-systolic volume (70.5 mL/m2 versus 81.5 mL/m2, p < 0.0001) were lower in Group I. The presence of 3-vessel coronary artery disease (CAD) was higher in Group I (73.3% versus 59.2%, p < 0.0001). Thirty-day mortality (6.64%) was similar in the two groups (p = 0.4475). The Kaplan−Meier estimate for all-cause mortality for the entire population was 13% at 2 years, 19.2% at 4 years and 36.6% at 8 years, and the probability was not different between groups (Log-rank = 0.11). In a real-world ischemic HF population, SVR may be carried out with favorable results; in patients with worse LV remodeling and less extensive CAD, SVR showed a trend toward a better outcome.
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Milwidsky A, Greidinger D, Frydman S, Hochstadt A, Ifrach-Kashtan N, Mizrachi M, Topilsky Y. Echocardiographic Killip Classification. J Am Soc Echocardiogr 2021; 35:287-294. [PMID: 34767929 DOI: 10.1016/j.echo.2021.10.012] [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: 08/08/2021] [Revised: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although routine echocardiographic parameters such as ejection fraction are used to risk-stratify for death in patients referred for echocardiography, they have limited predictive value. The authors speculated that noninvasive hemodynamic echocardiographic data, assessing left ventricular filling pressure and output, stratified on the basis of the clinical Killip score, might have additive prognostic value on top of routine echocardiographic parameters. The authors created an echocardiographic correlate of this classification, using diastolic grade and stroke volume index (SVI) as indicators of pulmonary congestion and systemic perfusion, respectively, and evaluated the prognostic value of this correlate. METHODS A retrospective study of consecutive patients (hospitalized or not) referred for echocardiography for a range of cardiac diagnoses in a tertiary medical center. A total of 556 patients in sinus rhythm who were evaluated by two sonographers, and reviewed by a single cardiologist, were included. Normal filling pressure and normal SVI (>35 mL/m2) defined echocardiographic Killip (eKillip) class 1. Patients with pseudonormal or restrictive diastolic patterns and normal SVI were ascribed to eKillip class 2 or 3, respectively. A pseudonormal or restrictive diastolic pattern and a subnormal SVI defined eKillip class 4. RESULTS eKillip class 1 was present in 382 patients (68%); 115 (20%), 26 (5%), and 42 (7%) patients were in eKillip classes 2 to 4, respectively. Median follow-up time was 1,056 days (interquartile range, 729-1,390 days). A total of 105 deaths occurred. Univariate Cox regression analysis showed that eKillip class was associated with all-cause mortality; hazard ratios (HR) -2.73 (95% CI, 1.67-4.48), 3.19 (95% CI, 1.42-7.17), and 4.79 (95% CI, 2.58-8.89) for each eKillip class above 1 (P < .001). In a multivariate analysis adjusted for the Charlson comorbidity index, eKillip class remained independently associated with all-cause mortality (P = .04). CONCLUSIONS eKillip class was associated with all-cause mortality among all patients undergoing echocardiography at a tertiary hospital.
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Affiliation(s)
- Assi Milwidsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dahlia Greidinger
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Ifrach-Kashtan
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Mizrachi
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Adhyapak SM, Parachuri VR, Thomas T, Varghese K. Left ventricular function and survival in ischemic cardiomyopathy: Implications for surgical ventricular restoration. JTCVS OPEN 2021; 7:211-218. [PMID: 36003693 PMCID: PMC9390468 DOI: 10.1016/j.xjon.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/04/2022]
Abstract
Objectives This pilot study evaluates the association of relative wall thickness (RWT) on survival in patients with ischemic cardiomyopathy (ICM). We hypothesized that patients with preserved RWT may be better candidates for surgical ventricular restoration than those with thinner RWT. Methods Echocardiography was performed in 165 consecutive patients (aged 58.2 ± 14.7 years) divided into 2 groups based on RWT values. Group 1 had patients with preserved RWT and group 2 had patients with reduced RWT. Results There were 120 (72.7%) patients with hypertension and 112 (67.8%) patients had diabetes mellitus. The patients with preserved RWT (group 1) had significantly more hypertension and diabetes. The patients with decreased RWT (group 2) were in a higher New York Heart Association functional class and had significantly greater incidence of anterior wall myocardial infarction. The entire cohort was followed over 24 months (group 1: n = 117 and group 2: n = 48). The overall all-cause mortality in group 1 (preserved RWT) was 7 (5.9%) and in group 2 (reduced RWT) was 35 (72.9%) (P < .0001). When readmission for congestive heart failure was analyzed, group 2 patients with lower RWT (P < .0001) had an increased rate of readmissions for heart failure. Conclusions In patients with ischemic cardiomyopathy, a lower RWT indicative of dilated LV remodeling was associated with increased mortality and readmission for heart failure. The RWT may be a simple benchmark of viable or contractile myocardium in ICM. It can be hypothesized that patients with preserved RWT may benefit from surgical ventricular restoration.
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Meng X, Wang Y, Tang X, Gu J, Fu Y. Self-management on heart failure: A meta-analysis. Diabetes Metab Syndr 2021; 15:102176. [PMID: 34186372 DOI: 10.1016/j.dsx.2021.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated. METHODS The research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis. RESULTS Eight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I2 = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I2 = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I2 = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results. CONCLUSION Self-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).
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Affiliation(s)
- Xianghong Meng
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yuping Wang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Xiaowen Tang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Jianfang Gu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yonghua Fu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China.
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Restrictive filling pattern in ischemic cardiomyopathy: Insights after surgical ventricular restoration. J Thorac Cardiovasc Surg 2021; 161:651-660. [DOI: 10.1016/j.jtcvs.2019.09.173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/28/2023]
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Ghio S, Carluccio E, Scardovi AB, Dini FL, Rossi A, Falletta C, Scelsi L, Greco A, Temporelli PL. Prognostic relevance of Doppler echocardiographic re-assessment in HFrEF patients. Int J Cardiol 2020; 327:111-116. [PMID: 33220364 DOI: 10.1016/j.ijcard.2020.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current guidelines do not recommend periodically repeating echocardiograms in the follow-up of stable heart failure patients with reduced ejection fraction (HFrEF). The objective of the study was to verify the additional prognostic information provided by a comprehensive re-assessment of their cardiac function and hemodynamic profile at Doppler echocardiography in HFrEF patients. METHODS Retrospective analysis of 769 stable HFrEF outpatients who underwent two complete echocardiograms, at baseline and at re-assessment. Main candidate predictors of prognosis were: left ventricular (LV) filling pattern, pulmonary artery systolic pressure (PASP) and right ventricular function (TAPSE). Age, LV ejection fraction, mitral regurgitation severity, NYHA class, brain natriuretic peptide plasma levels at baseline, and their changes at 12 months, were used as covariates. Median follow-up was 30 months. All-cause death was the study end-point. RESULTS At baseline, restrictive filling pattern and low TAPSE were significant predictors of poor prognosis. At re-evaluation, persistently restrictive/worsened filling pattern, persistently-low/worsened TAPSE and worsened PASP, were associated with poorer survival. A significant interaction between changes in TAPSE, PASP and LV filling pattern was observed: in the restrictive pattern subgroup, survival was poorer in worsened/persistently low TAPSE (p < 0.01); in non-restrictive pattern subgroup, survival was poorer in worsened/persistently elevated PASP (p = 0.01). The re-assessment model improved the C-index from 0.69 to 0.74 (P < 0.01) compared to baseline model. CONCLUSIONS Doppler echocardiographic re-assessment of LV filling pattern, PASP and TAPSE allows a better prognostic stratification of HFrEF outpatients than baseline evaluation and is additional to changes in BNP and NYHA class.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S.Maria della Misericordia", Perugia, Italy
| | | | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, I.R.C.C.S. - ISMETT, Palermo, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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Ghio S, Mercurio V, Fortuni F, Forfia PR, Gall H, Ghofrani A, Mathai SC, Mazurek JA, Mukherjee M, Richter M, Scelsi L, Hassoun PM, Tello K. A comprehensive echocardiographic method for risk stratification in pulmonary arterial hypertension. Eur Respir J 2020; 56:13993003.00513-2020. [PMID: 32430422 DOI: 10.1183/13993003.00513-2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/07/2020] [Indexed: 02/01/2023]
Abstract
QUESTION ADDRESSED Echocardiography is not currently considered as providing sufficient prognostic information to serve as an integral part of treatment goals in pulmonary arterial hypertension (PAH). We tested the hypothesis that incorporation of multiple parameters reflecting right heart function would improve the prognostic value of this imaging modality. METHODS AND MAIN RESULTS We pooled individual patient data from a total of 517 patients (mean age 52±15 years, 64.8% females) included in seven observational studies conducted at five European and United States academic centres. Patients were subdivided into three groups representing progressive degrees of right ventricular dysfunction based on a combination of echocardiographic measurements, as follows. Group 1 (low risk): normal tricuspid annular plane systolic excursion (TAPSE) and nonsignificant tricuspid regurgitation (TR) (n=129); group 2 (intermediate risk): normal TAPSE and significant TR or impaired TAPSE and nondilated inferior vena cava (IVC) (n=256); group 3 (high risk): impaired TAPSE and dilated IVC (n=132). The 5-year cumulative survival rate was 82% in group 1, 63% in group 2 and 43% in group 3. Low-risk patients had better survival rates than intermediate-risk patients (log-rank Chi-squared 12.25; p<0.001) and intermediate-risk patients had better survival rates than high-risk patients (log-rank Chi-squared 26.25; p<0.001). Inclusion of other parameters such as right atrial area and pericardial effusion did not provide added prognostic value. ANSWER TO THE QUESTION The proposed echocardiographic approach integrating the evaluation of TAPSE, TR grade and IVC is effective in stratifying the risk for all-cause mortality in PAH patients, outperforming the prognostic parameters suggested by current guidelines.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy .,These authors contributed equally as co-first authors
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Dept of Translational Medical Sciences, Federico II University, Naples, Italy.,These authors contributed equally as co-first authors
| | - Federico Fortuni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Dept of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy.,These authors contributed equally as co-first authors
| | - Paul R Forfia
- Pulmonary Hypertension, Right Heart Failure and Pulmonary Thromboendarterectomy Program, Temple University Hospital, Philadelphia, PA, USA
| | - Henning Gall
- University Hospital Giessen und Marburg GmbH, Pulmonary Hypertension Division, Medical Clinic II, Giessen, Germany
| | - Ardeschir Ghofrani
- University Hospital Giessen und Marburg GmbH, Pulmonary Hypertension Division, Medical Clinic II, Giessen, Germany
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy A Mazurek
- Dept of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manuel Richter
- University Hospital Giessen und Marburg GmbH, Pulmonary Hypertension Division, Medical Clinic II, Giessen, Germany
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,These authors contributed equally as co-last authors
| | - Khodr Tello
- University Hospital Giessen und Marburg GmbH, Pulmonary Hypertension Division, Medical Clinic II, Giessen, Germany.,These authors contributed equally as co-last authors
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Bragança B, Trêpa M, Santos R, Silveira I, Fontes-Oliveira M, Sousa MJ, Reis H, Torres S, Santos M. Echocardiographic Assessment of Right Ventriculo-arterial Coupling: Clinical Correlates and Prognostic Impact in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Cardiovasc Imaging 2020; 28:109-120. [PMID: 32052609 PMCID: PMC7114448 DOI: 10.4250/jcvi.2019.0094] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Right ventriculo-arterial coupling (RV-PA) can be estimated by echocardiography using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) and it has prognostic value in the general heart failure (HF) population. We aimed to study the clinical correlates and prognostic value of RV-PA in HF patients undergoing cardiac resynchronization therapy (CRT). METHODS We retrospectively studied 70 HF patients undergoing CRT implantation. RESULTS RV-PA coupling was estimated by TAPSE/PASP ratio using baseline echocardiography. Non-response to CRT was defined as improvement of left ventricular ejection fraction < 5% in a follow-up echo 6-12 months after CRT. Those with lower TAPSE/PASP ratios (worse RV-PA coupling) had higher NT-proBNP concentrations and increased E/e' ratio. TAPSE/PASP ratio and PASP, but not TAPSE, predicted nonresponse to CRT with TAPSE/PASP ratio showing the best discriminative ability with a sensitivity of 76% and specificity of 71%. Among these parameters, PASP independently predicted all-cause mortality. CONCLUSIONS RV-PA coupling estimated by TAPSE/PASP ratio was associated with established prognostic markers in HF. It numerically outperformed PASP and TAPSE in predicting the response to CRT. Our data suggest that this simple and widely available echocardiographic parameter conveys significant pathophysiological and prognostic meaning in HF patients undergoing CRT.
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Affiliation(s)
- Bruno Bragança
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Maria Trêpa
- Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Raquel Santos
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Silveira
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | - Hipólito Reis
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Severo Torres
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mário Santos
- Centro Hospitalar Universitário do Porto, Porto, Portugal
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12
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Additive Value of Biomarkers and Echocardiography to Stratify the Risk of Death in Heart Failure Patients with Reduced Ejection Fraction. Cardiol Res Pract 2019; 2019:1824816. [PMID: 31192003 PMCID: PMC6525851 DOI: 10.1155/2019/1824816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 01/20/2023] Open
Abstract
Background Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.
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13
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Saijo Y, Yamada H, Kusunose K, Bando M, Nishio S, Torii Y, Hirata Y, Seno H, Matsuura T, Ise T, Tobiume T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M. A clinical application of preload stress echocardiography for predicting future hemodynamic worsening in patients with early-stage heart failure. Echocardiography 2018; 35:1587-1595. [PMID: 30005132 DOI: 10.1111/echo.14098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM To improve the prognosis of patients with heart failure, risk stratification in their early stage is important. We assessed whether the change in transmitral flow (TMF) velocity pattern during preload augmentation can predict future hemodynamic worsening in early-stage heart failure patients with impaired relaxation TMF pattern. METHODS We designed a prospective cohort study that included 155 consecutive patients with impaired relaxation (IR) pattern at rest. Preload stress echocardiography was achieved using leg-positive pressure (LPP), and changes in TMF pattern during the LPP was observed during baseline echocardiographic examination. The patients whose TMF pattern developed to pseudonormal (PN) pattern throughout the study period were classified into the change to PN group, and patients whose TMF pattern stayed in IR pattern were classified into the stay in IR group. RESULTS The median follow-up period was 17 months. The average age was 68 ± 11 years old, and 97 patients (63%) were male. Among 155 patients, 27 were classified into the change to PN group. A Cox proportional hazard analysis confirmed that the change in the peak atrial systolic TMF velocity during the LPP (ΔA, hazard ratio = 0.58 per 1SD; 95% CI = 0.39-0.88, P = 0.010) was the powerful independent predictor of change into PN pattern. Kaplan-Meier analysis revealed that the patients with ΔA ≤ -7 cm/s had more likely to develop into PN pattern than patients with ΔA > -7 cm/s (P = 0.001). CONCLUSIONS Evaluation of a response in TMF during the LPP might provide an incremental diagnostic value to detect future overt heart failure in patients with early-stage heart failure.
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Affiliation(s)
- Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Mika Bando
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Susumu Nishio
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Yuta Torii
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Hiromitsu Seno
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Tomomi Matsuura
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Takeshi Tobiume
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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14
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Kitkungvan D, Yusuf SW, Moudgil R, Palaskas N, Guindani M, Juhee S, Hassan S, Sanchez L, Banchs J. Echocardiographic measures associated with the presence of left ventricular thrombus in patients with chemotherapy-related cardiac dysfunction. Echocardiography 2018; 35:1512-1518. [PMID: 30005128 DOI: 10.1111/echo.14087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies have not evaluated the prevalence and specific risk factors for the development of left ventricular (LV) thrombus in patients with severely reduced left ventricular dysfunction due to chemotherapy-related cardiomyopathy. We sought to evaluate the prevalence and potential markers of LV thrombus in this patient population. METHODS From January 2009 to December 2013, patients with chemotherapy-related severe LV dysfunction (LV ejection fraction [LVEF] ≤ 30%) identified from MD Anderson Cancer Center database were reviewed. Patient characteristics and echocardiographic parameters were analyzed to determine potential risk factors for LV thrombus. RESULTS A total of 121 patients met inclusion criteria (age 54.8 ± 15.2 years; female 63.6%; LVEF 26.3 ± 4%). LV thrombus was present in 9 patients (7.4%). Patients with LV thrombus have significantly lower LVEF compared to those without (18.7 ± 3.8% vs 26.9 ± 3.4%, P < .0001). Prevalence of LV thrombus increased as LVEF decreased and was the highest in patients with LVEF < 20%. By univariate analysis, decreased LVEF, particularly LVEF < 20% (OR 36.30, 95% CI 7.35-179.25, P < .0001) and restrictive LV filling pattern (OR 18.13, 95% CI 4.17-78.89, P = .0001) were associated with presence of LV thrombus. CONCLUSION In patients with severely reduced LV systolic function due to chemotherapy-induced cardiomyopathy, LV thrombus was found in 7.4% of subjects. Severely decreased LVEF (<20%) and restrictive LV filling pattern were associated with the presence of LV thrombus.
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Affiliation(s)
- Danai Kitkungvan
- Division of Cardiovascular Medicine, The University of Texas Health and Science Center at Houston, Houston, TX, USA
| | - Syed W Yusuf
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rohit Moudgil
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michele Guindani
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Song Juhee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liza Sanchez
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose Banchs
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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15
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Dini FL, Bajraktari G, Zara C, Mumoli N, Rosa GM. Optimizing Management of Heart Failure by Using Echo and Natriuretic Peptides in the Outpatient Unit. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1067:145-159. [PMID: 29374825 DOI: 10.1007/5584_2017_137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic heart failure (HF) is an important public health problem and is associated with high morbidity, high mortality, and considerable healthcare costs. More than 90% of hospitalizations due to worsening HF result from elevations of left ventricular (LV) filling pressures and fluid overload, which are often accompanied by the increased synthesis and secretion of natriuretic peptides (NPs). Furthermore, persistently abnormal LV filling pressures and a rise in NP circulating levels are well known indicators of poor prognosis. Frequent office visits with the resulting evaluation and management are most often needed. The growing pressure from hospital readmissions in HF patients is shifting the focus of interest from traditionally symptom-guided care to a more specific patient-centered follow-up care based on clinical findings, BNP and echo. Recent studies supported the value of serial NP measurements and Doppler echocardiographic biomarkers of elevated LV filling pressures as tools to scrutinize patients with impending clinically overt HF. Therefore, combination of echo and pulsed-wave blood-flow and tissue Doppler with NPs appears valuable in guiding ambulatory HF management, since they are potentially useful to distinguish stable patients from those at high risk of decompensation.
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Affiliation(s)
- Frank Lloyd Dini
- Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy. .,Unità Operativa Malattie Cardiovascolari 1, Dipartimento Cardio, Toracico e Vascolare, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.,Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Cornelia Zara
- Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - Gian Marco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy
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16
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Norum HM, Broch K, Michelsen AE, Lunde IG, Lekva T, Abraityte A, Dahl CP, Fiane AE, Andreassen AK, Christensen G, Aakhus S, Aukrust P, Gullestad L, Ueland T. The Notch Ligands DLL1 and Periostin Are Associated with Symptom Severity and Diastolic Function in Dilated Cardiomyopathy. J Cardiovasc Transl Res 2017; 10:401-410. [PMID: 28474304 DOI: 10.1007/s12265-017-9748-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/25/2017] [Indexed: 02/08/2023]
Abstract
In dilated cardiomyopathy (DCM), adverse myocardial remodeling is essential, potentially involving Notch signaling. We hypothesized that secreted Notch ligands would be dysregulated in DCM. We measured plasma levels of the canonical Delta-like Notch ligand 1 (DLL1) and non-canonical Notch ligands Delta-like 1 homologue (DLK1) and periostin (POSN) in 102 DCM patients and 32 matched controls. Myocardial mRNA and protein levels of DLL1, DLK1, and POSN were measured in 25 explanted hearts. Our main findings were: (i) Circulating levels of DLL1 and POSN were higher in patients with severe DCM and correlated with the degree of diastolic dysfunction and (ii) right ventricular tissue expressions of DLL1, DLK1, and POSN were oppositely associated with cardiac function indices, as high DLL1 and DLK1 expression corresponded to more preserved and high POSN expression to more deteriorated cardiac function. DLL1, DLK1, and POSN are dysregulated in end-stage DCM, possibly mediating different effects on cardiac function.
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Affiliation(s)
- Hilde M Norum
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida G Lunde
- Center for Heart Failure Research, University of Oslo, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Tove Lekva
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Aurelija Abraityte
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Christen P Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Arnt E Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Geir Christensen
- Center for Heart Failure Research, University of Oslo, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
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17
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Bakalli A, Georgievska-Ismail L, Musliu N, Koçinaj D. Lower Body Weight in Men, an Epidemiological Predictor of Enlarged Left Atrium in Sinus Rhythm Patients with Dilated Heart. J Cardiovasc Echogr 2017; 26:83-88. [PMID: 28465968 PMCID: PMC5224671 DOI: 10.4103/2211-4122.187956] [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: 11/04/2022] Open
Abstract
BACKGROUND/AIMS The source of thrombi in patients with dilated cardiomyopathy is not necessarily from the dilated left ventricle. Left atrium (LA) and left atrial appendage (LAA) might be in charge for relatively high rate of systemic embolizations in these patients. The main aim of our study was to identify epidemiological predictors in sinus rhythm patients with dilated heart for LA and LAA dilation and/or dysfunction. PATIENTS AND METHODS This was a prospective cross-sectional study conducted from 2009 to 2014 in 101 sinus rhythm patients with dilated heart. We excluded patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flutter, severe systolic dysfunction, mechanical valves, oral anticoagulation therapy, and/or patients with a history of stroke/systemic thromboembolic event. RESULTS Mean patient age was 58.13 ± 12.66 years and 69.3% were men. Hypertension was encountered in 51% of our patients, 56% of them had a history of coronary artery disease, 30% had diabetes, 25% had dyslipidemia, 30% were smokers, whereas 10% were alcoholics. Mean LA dimensions resulted higher than reference values, whereas 86% of our patients had LAA dysfunction. Male gender was an independent predictor for LA diameter dilation (95% confidence interval [CI]: 1.765-9.078, P = 0.005), while lower body weight was a predictor for enlargement of LA area (95% CI: 0.044-0.351, P = 0.014) and LA volume (95% CI: 0.160-2.067, P = 0.024). CONCLUSION Male patients with dilated cardiomyopathy at sinus rhythm with lower body weight tend to have larger LA and consequently might be at higher risk of developing atrial thrombus and its subsequent consequences.
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Affiliation(s)
- Aurora Bakalli
- University Clinical Center of Kosova and Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | | | - Nebi Musliu
- University Clinical Center of Kosova and Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Dardan Koçinaj
- University Clinical Center of Kosova and Medical Faculty, University of Prishtina, Prishtina, Kosovo
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18
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Left ventricular global longitudinal strain predicts major adverse cardiac events and all-cause mortality in heart transplant patients. J Heart Lung Transplant 2017; 36:567-576. [DOI: 10.1016/j.healun.2016.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
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19
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Obasare E, Bhalla V, Gajanana D, Rodriguez Ziccardi M, Codolosa JN, Figueredo VM, Morris DL, Pressman GS. Natural history of severe aortic stenosis: Diastolic wall strain as a novel prognostic marker. Echocardiography 2017; 34:484-490. [DOI: 10.1111/echo.13491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Edinrin Obasare
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
| | - Vikas Bhalla
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
| | - Deepakraj Gajanana
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
| | | | - Jose N. Codolosa
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
| | - Vincent M. Figueredo
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
| | - Dennis Lynn Morris
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
| | - Gregg S. Pressman
- Einstein Heart and Vascular Institute; Einstein Medical Center; Philadelphia PA USA
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20
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Simioniuc A, Carluccio E, Ghio S, Rossi A, Biagioli P, Reboldi G, Galeotti GG, Lu F, Zara C, Whalley G, Temporelli PL, Dini FL. Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients. Int J Cardiol 2016; 224:416-423. [DOI: 10.1016/j.ijcard.2016.09.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022]
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21
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Dini FL, Carluccio E, Simioniuc A, Biagioli P, Reboldi G, Galeotti GG, Raineri C, Gargani L, Scelsi L, Mandoli GE, Cannito A, Rossi A, Temporelli PL, Ghio S. Right ventricular recovery during follow-up is associated with improved survival in patients with chronic heart failure with reduced ejection fraction. Eur J Heart Fail 2016; 18:1462-1471. [DOI: 10.1002/ejhf.639] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/18/2016] [Accepted: 05/21/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - Erberto Carluccio
- Division of Cardiology, University of Perugia; School of Medicine; Perugia Italy
| | - Anca Simioniuc
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - Paolo Biagioli
- Division of Cardiology, University of Perugia; School of Medicine; Perugia Italy
| | - Gianpaolo Reboldi
- Department of Internal Medicine; University of Perugia; Perugia Italy
| | | | - Claudia Raineri
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
| | - Luna Gargani
- Institute of Clinical Physiology; National Research Council; Pisa Italy
| | - Laura Scelsi
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
| | | | - Antonia Cannito
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences; Cardiology Section, University of Verona; Verona Italy
| | | | - Stefano Ghio
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
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Assessment and impact of diastolic function by echocardiography in elderly patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:252-60. [PMID: 27103921 PMCID: PMC4826896 DOI: 10.11909/j.issn.1671-5411.2016.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Doppler echocardiography is the gold standard for assessment of diastolic dysfunction, which is increasingly recognised as a cause of heart failure, especially in the elderly. Using a combination of Doppler echocardiography techniques, it is possible to identify grades of diastolic dysfunction, estimate left ventricular filling pressures and establish the chronicity of diastolic dysfunction. These physiologically-derived measures have been widely validated against invasive measurements of left heart pressures and have been shown to be prognostically valuable in a wide range of clinical settings. This review explores the mechanisms, and approaches to the assessment of diastolic dysfunction in the elderly. The challenge for clinicians is to identify pathophysiological changes from those associated with normal ageing. When used in combination, and taking age into account, Doppler echocardiographic parameters are helpful in the assessment of dyspnoea in older patients and provide prognostic insights.
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23
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Right ventricular dysfunction in patients with idiopathic dilated cardiomyopathy: Prognostic value and predictive factors. Arch Cardiovasc Dis 2016; 109:231-41. [DOI: 10.1016/j.acvd.2015.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/03/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022]
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24
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Irizarry Pagán EE, Vargas PE, López-Candales A. The clinical dilemma of heart failure with preserved ejection fraction: an update on pathophysiology and management for physicians. Postgrad Med J 2016; 92:346-55. [DOI: 10.1136/postgradmedj-2015-133859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/11/2016] [Indexed: 12/20/2022]
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25
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26
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Rigolli M, Rossi A, Quintana M, Klein AL, Yu CM, Ghio S, Dini FL, Prior D, Troughton RW, Temporelli PL, Poppe KK, Doughty RN, Whalley GA. The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: Can age-stratified E/A ratio alone predict survival? Int J Cardiol 2014; 181:362-8. [PMID: 25555281 DOI: 10.1016/j.ijcard.2014.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/13/2014] [Accepted: 12/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction. METHODS AND RESULTS This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction. CONCLUSIONS Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.
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Affiliation(s)
- Marzia Rigolli
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; University of Verona, Verona, Italy
| | | | | | | | - Cheuk-Man Yu
- Chinese University of Hong Kong, Hong Kong, China
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Frank L Dini
- Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | | | - Richard W Troughton
- Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Katrina K Poppe
- Department of Medicine, University Of Auckland, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine, University Of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Unitec Institute of Technology, Auckland, New Zealand.
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27
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Sung MM, Das SK, Levasseur J, Byrne NJ, Fung D, Kim TT, Masson G, Boisvenue J, Soltys CL, Oudit GY, Dyck JRB. Resveratrol treatment of mice with pressure-overload-induced heart failure improves diastolic function and cardiac energy metabolism. Circ Heart Fail 2014; 8:128-37. [PMID: 25394648 DOI: 10.1161/circheartfailure.114.001677] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although resveratrol has multiple beneficial cardiovascular effects, whether resveratrol can be used for the treatment and management of heart failure (HF) remains unclear. In the current study, we determined whether resveratrol treatment of mice with established HF could lessen the detrimental phenotype associated with pressure-overload-induced HF and identified physiological and molecular mechanisms contributing to this. METHODS AND RESULTS C57Bl/6 mice were subjected to either sham or transverse aortic constriction surgery to induce HF. Three weeks post surgery, a cohort of mice with established HF (% ejection fraction <45) was administered resveratrol (≈320 mg/kg per day). Despite a lack of improvement in ejection fraction, resveratrol treatment significantly increased median survival of mice with HF, lessened cardiac fibrosis, reduced gene expression of several disease markers for hypertrophy and extracellular matrix remodeling that were upregulated in HF, promoted beneficial remodeling, and improved diastolic function. Resveratrol treatment of mice with established HF also restored the levels of mitochondrial oxidative phosphorylation complexes, restored cardiac AMP-activated protein kinase activation, and improved myocardial insulin sensitivity to promote glucose metabolism and significantly improved myocardial energetic status. Finally, noncardiac symptoms of HF, such as peripheral insulin sensitivity, vascular function, and physical activity, were improved with resveratrol treatment. CONCLUSIONS Resveratrol treatment of mice with established HF lessens the severity of the HF phenotype by lessening cardiac fibrosis, improving molecular and structural remodeling of the heart, and enhancing diastolic function, vascular function, and energy metabolism.
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Affiliation(s)
- Miranda M Sung
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Subhash K Das
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Jody Levasseur
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Nikole J Byrne
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - David Fung
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Ty T Kim
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Grant Masson
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Jamie Boisvenue
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Carrie-Lynn Soltys
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Gavin Y Oudit
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.)
| | - Jason R B Dyck
- From the Department of Pediatrics, Cardiovascular Research Centre (M.M.S., N.J.B., D.F., T.T.K., G.M., J.B., C.-L.S., J.R.B.D.) and Department of Medicine (S.K.D., G.Y.O.), Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and Alberta HEART, AHFMR Interdisciplinary Team Grant, Edmonton, Alberta, Canada (M.M.S., J.L., G.Y.O., J.R.B.D.).
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Pislaru C, Pellikka PA, Pislaru SV. Wave propagation of myocardial stretch: correlation with myocardial stiffness. Basic Res Cardiol 2014; 109:438. [PMID: 25193091 DOI: 10.1007/s00395-014-0438-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/27/2014] [Accepted: 09/01/2014] [Indexed: 02/06/2023]
Abstract
The mechanism of flow propagation during diastole in the left ventricle (LV) has been well described. Little is known about the associated waves propagating along the heart walls. These waves may have a mechanism similar to pulse wave propagation in arteries. The major goal of the study was to evaluate the effect of myocardial stiffness and preload on this wave transmission. Longitudinal late diastolic deformation and wave speed (Vp) of myocardial stretch in the anterior LV wall were measured using sonomicrometry in 16 pigs. Animals with normal and altered myocardial stiffness (acute myocardial infarction) were studied with and without preload alterations. Elastic modulus estimated from Vp (E VP; Moens-Korteweg equation) was compared to incremental elastic modulus obtained from exponential end-diastolic stress-strain relation (E SS). Myocardial distensibility and α- and β-coefficients of stress-strain relations were calculated. Vp was higher at reperfusion compared to baseline (2.6 ± 1.3 vs. 1.3 ± 0.4 m/s; p = 0.005) and best correlated with E SS (r2 = 0.80, p < 0.0001), β-coefficient (r2 = 0.78, p < 0.0001), distensibility (r2 = 0.47, p = 0.005), and wall thickness/diameter ratio (r2 = 0.42, p = 0.009). Elastic moduli (E VP and E SS) were strongly correlated (r2 = 0.83, p < 0.0001). Increasing preload increased Vp and E VP and decreased distensibility. At multivariate analysis, E SS, wall thickness, and end-diastolic and systolic LV pressures were independent predictors of Vp (r2 model = 0.83, p < 0.0001). In conclusion, the main determinants of wave propagation of longitudinal myocardial stretch were myocardial stiffness and LV geometry and pressure. This local wave speed could potentially be measured noninvasively by echocardiography.
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Affiliation(s)
- Cristina Pislaru
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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Bytyçi I, Bajraktari G, Ibrahimi P, Berisha G, Rexhepaj N, Henein MY. Left atrial emptying fraction predicts limited exercise performance in heart failure patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 4:203-207. [PMID: 29450190 PMCID: PMC5801443 DOI: 10.1016/j.ijchv.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/13/2014] [Indexed: 02/08/2023]
Abstract
AIM We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF). METHODS This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s', e' and a'), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination. RESULTS Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898-0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance. CONCLUSION In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.
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Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
| | - Gani Bajraktari
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Corresponding author at: Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, “Rrethi i Spitalit,” p.n., Prishtina, Kosovo. Tel.: + 377 45 800 808Corresponding author at: Clinic of Cardiology and AngiologyUniversity Clinical Centre of Kosova“Rrethi i Spitalit,” p.n.Tel.: + 377 45 800 808PrishtinaKosovo
| | - Pranvera Ibrahimi
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gëzim Berisha
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
| | - Nehat Rexhepaj
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
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Ghio S, Alessandrino G, Albertini R, Klersy C, Girardi B, Maggi G, Pazzano AS, Raineri C, Scelsi L, Visconti LO. Prognostic stratification of patients with chronic systolic heart failure using biomarkers and Doppler echocardiography. J Cardiovasc Med (Hagerstown) 2014; 15:470-5. [PMID: 24983266 DOI: 10.2459/jcm.0000000000000034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS To verify whether a combined assessment of left-ventricular filling pattern at Doppler echocardiography, plasma levels of brain natriuretic peptide (BNP) and high-sensitive troponin I (hsTnI) improves prognostic stratification in patients with chronic systolic heart failure. METHODS Three predictors of prognosis were evaluated in 200 consecutive outpatients with heart failure and left-ventricular ejection fraction 35% or less: left-ventricular filling pattern at Doppler echocardiography, BNP plasma levels and hsTnI plasma levels. RESULTS During a median follow-up period of 44 months, 15 deaths, two urgent cardiac transplantations, two episodes of ventricular fibrillation and 50 heart failure hospitalizations were observed. The end point of survival analysis was the composite of hard events and hospitalization for acute heart failure. At univariable analysis, the E-wave deceleration time at Doppler echocardiography and BNP plasma level on a continuous log-scale were significantly associated with event-free survival, whereas hsTnI plasma level was not statistically significant. A hierarchical multivariable analysis was performed including a restrictive left-ventricular filling pattern at Doppler as the first prognostic indicator; the subsequent addition of BNP plasma levels above 138 pg/ml (median value) and hsTnI above 0.018 ng/ml (median value) did not further improve prognostic stratification. CONCLUSION A restrictive left-ventricular filling pattern at Doppler echocardiography is the most important prognostic indicator in chronic heart failure patients. Plasma levels of BNP and hsTnI do not provide additional relevant information to identify patients at higher risk of cardiovascular outcomes.
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Affiliation(s)
- Stefano Ghio
- aDivisione di Cardiologia bServizio di Analisi Chimico Cliniche cDipartimento di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Gestational hypertension and the developmental origins of cardiac hypertrophy and diastolic dysfunction. Mol Cell Biochem 2014; 391:201-9. [DOI: 10.1007/s11010-014-2003-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/21/2014] [Indexed: 01/15/2023]
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Todaro MC, Khandheria BK, Paterick TE, Umland MM, Thohan V. The Practical Role of Echocardiography in Selection, Implantation, and Management of Patients Requiring LVAD Therapy. Curr Cardiol Rep 2014; 16:468. [DOI: 10.1007/s11886-014-0468-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Early diastolic strain rate predicts response to heart failure therapy in patients with dilated cardiomyopathy. Int J Cardiovasc Imaging 2014; 30:505-13. [DOI: 10.1007/s10554-014-0361-8] [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] [Received: 08/27/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
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Ghio S, Temporelli PL, Klersy C, Simioniuc A, Girardi B, Scelsi L, Rossi A, Cicoira M, Genta FT, Dini FL. Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure. Eur J Heart Fail 2014; 15:408-14. [DOI: 10.1093/eurjhf/hfs208] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefano Ghio
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS Policlinico San Matteo; Piazza Golgi 1 27100 Pavia Italy
| | | | - Catherine Klersy
- Service of Biometry & Statistics; Fondazione IRCCS, Policlinico San Matteo; Pavia Italy
| | - Anca Simioniuc
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - Bruna Girardi
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS Policlinico San Matteo; Piazza Golgi 1 27100 Pavia Italy
| | - Laura Scelsi
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS Policlinico San Matteo; Piazza Golgi 1 27100 Pavia Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences, Cardiology Section; University of Verona; Verona Italy
| | - Mariantonietta Cicoira
- Department of Biomedical and Surgical Sciences, Cardiology Section; University of Verona; Verona Italy
| | - Franco Tarro Genta
- Division of Cardiology; Fondazione Salvatore Maugeri, IRCCS; Torino Italy
| | - Frank L. Dini
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa Italy
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Schou M, Kjaergaard J, Torp-Pedersen C, Hassager C, Gustafsson F, Akkan D, Moller JE, Kober L. Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study. BMC Nephrol 2013; 14:267. [PMID: 24299462 PMCID: PMC3879040 DOI: 10.1186/1471-2369-14-267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 11/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction. Methods Using Cox Proportional Hazard Models on data (N = 669) from the EchoCardiography and Heart Outcome Study (ECHOS) study we evaluated whether estimated glomerular filtration rate (eGFR) was associated with mortality risk before and after adjustment for severe diastolic dysfunction. Severe diastolic dysfunction was defined by a restrictive left ventricular filling pattern (RF) (=deceleration time < 140 ms) by Doppler echocardiography. Results Median eGFR was 58 ml/min/1.73 m2, left ventricular ejection fraction was 33% and RF was observed in 48%. During the 7 year follow up period 432 patients died. Multivariable adjusted eGFR was associated with similar mortality risk before (Hazard Ratio(HR)eGFR 10 ml increase: 0.94 (95% CI: 0.89-0.99, P = 0.024) and after (HReGFR 10 ml increase: 0.93 (0.89-0.99), P = 0.012) adjustment for RF (HR: 1.57 (1.28-1.93), P < 0.001). Conclusions In patients admitted with HF RF does not contribute to the increased mortality risk observed in patients with a decreased eGFR. Factors other than severe diastolic dysfunction may explain the association between renal function and mortality risk in HF patients.
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Affiliation(s)
- Morten Schou
- Department of Cardiology, The Heart Centre and University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark.
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Abstract
Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is associated with significant morbidity, mortality, and costs. Prompt diagnosis may help decrease mortality, hospital stay, and costs related to treatment. A complete heart failure evaluation comprises a comprehensive history and physical examination, echocardiogram, and diagnostic tools that provide information regarding the etiology of heart failure, related complications, and prognosis in order to prescribe appropriate therapy, monitor response to therapy, and transition expeditiously to advanced therapies when needed. Emerging technologies and biomarkers may provide better risk stratification and more accurate determination of cause and progression.
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Affiliation(s)
- Maria Patarroyo-Aponte
- Division of Cardiovascular Medicine, University of Minnesota Medical Center, Lillehei Heart Institute, University of Minnesota, 420 Delaware Street Southeast, MMC 508, Minneapolis, MN 55455, USA
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Wang S, Fang F, Liu M, Lam YY, Wang J, Shang Q, Sun JP, Sanderson JE, Yu CM. Rapid bedside identification of high-risk population in heart failure with reduced ejection fraction by acoustic cardiography. Int J Cardiol 2013; 168:1881-6. [DOI: 10.1016/j.ijcard.2012.12.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/21/2012] [Accepted: 12/25/2012] [Indexed: 11/16/2022]
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Dini FL, Ghio S, Klersy C, Rossi A, Simioniuc A, Scelsi L, Genta FT, Cicoira M, Tavazzi L, Temporelli PL. Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity score analysis. Int J Clin Pract 2013; 67:656-64. [PMID: 23758444 DOI: 10.1111/ijcp.12144] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/25/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To ascertain whether increasing doses of orally administered furosemide are associated with impaired survival in outpatients with chronic heart failure (CHF) and left ventricular (LV) systolic dysfunction. METHODS Transthoracic echo-Doppler examination was carried out at baseline in 813 consecutive CHF outpatients with LV ejection fraction ≤ 45%. The total daily dose of furosemide was assessed for each patient. Chronic kidney disease (CKD) was defined by a glomerular filtration rate < 60 ml/min/1.73 m(2). The end-point was all-cause mortality. To control the prognostic effect of furosemide for the propensity of using high doses of the drug, the Cox model was stratified by the propensity score, itself computed from a multivariable logistic model. Mean follow up was 44 months. RESULTS After stratification for the propensity score, the risk of death increased linearly across quartiles of furosemide dose (HR 1.38, 95% CI 1.14-1.68, p < 0.001). A daily dose of 50 mg was identified as the best threshold value to predict a high risk of death within 3 years with an area under the ROC curve of 0.68 (95% CI 0.64-0.72). Increasing doses of furosemide were associated with an increased risk of death regardless of LV filling pattern, CKD and background therapy with ACE-inhibitors or beta-blockers. CONCLUSIONS In outpatients with CHF, after stratification for the propensity score, the risk of death increased linearly across quartiles of furosemide daily dose. A threshold furosemide dose of 50 mg was related with the worse outcome.
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Affiliation(s)
- F L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
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Fontanive P, Miccoli M, Simioniuc A, Angelillis M, Bello VD, Baggiani A, Bongiorni MG, Marzilli M, Dini FL. A Multiparametric Clinical and Echocardiographic Score to Risk Stratify Patients with Chronic Systolic Heart Failure: Derivation and Testing. Echocardiography 2013; 30:1172-9. [DOI: 10.1111/echo.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Paolo Fontanive
- Cardiovascular Diseases Unit 2; Cisanello Hospital; Pisa Italy
| | - Mario Miccoli
- Department of Experimental Pathology M.B.I.E.; Epidemiology Unit; University of Pisa; Pisa Italy
| | - Anca Simioniuc
- Cardiovascular Diseases Unit 1; University of Pisa; Pisa Italy
| | | | | | - Angelo Baggiani
- Department of Experimental Pathology M.B.I.E.; Epidemiology Unit; University of Pisa; Pisa Italy
| | | | - Mario Marzilli
- Cardiovascular Diseases Unit 1; University of Pisa; Pisa Italy
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Andrea R, Falces C, Sanchis L, Sitges M, Heras M, Brugada J. [Diagnosis of heart failure with preserved or reduced ejection fraction in a one-stop clinic]. Aten Primaria 2013; 45:184-92. [PMID: 23159793 PMCID: PMC6985517 DOI: 10.1016/j.aprim.2012.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/07/2012] [Accepted: 09/22/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES a) To assess the usefulness of a one-stop clinic for the diagnosis of outpatients with new onset heart failure; b) to characterize these patients comparing preserved (HF-PEF) versus reduced ejection fraction (HF-REF), and c) to determine brain natriuretic peptide (BNP) cut-off limit to identify HF in outpatients. DESIGN Observational descriptive study. SETTING Primary care. PARTICIPANTS AND MEASUREMENTS A total of 143 outpatients with new onset HF were assessed in a one-stop clinic. A cardiologist evaluation, electrocardiogram, chest X-ray, BNP, and echocardiography (diastolic and systolic study) were performed. RESULTS Almost two-thirds (65.7%) were diagnosed with HF: 67% with HF-PEF and 33% HF-REF. Women (71.4% versus 38.7%, P=.002), presence of swelling ankles (61.9% versus 35.5%, P=.016) and higher body mass index (29.8±5.1 versus 27.2±5.0 P=.021) were more frequent in the first group of patients. Echocardiographic signs of diastolic dysfunction and pulmonary hypertension were found in both groups, with higher values of BNP (153.3±123.1 versus 400.8±579.8 P=.025) and troponin I (0.024±0.019 versus 0.071±0.12, P=.037) in HF-REF patients. Female gender and swelling ankles were predictors of HF-PEF in the multivariate analysis, while Q waves and higher values of BNP and heart rate were predictors of HF-REF. A cut-off value of 60.12 pg/ml for BNP provided 83% sensitivity, 84% specificity (AUC=0.898; 95% CI; 0.848-0.948; P <.001). CONCLUSIONS The one-stop HF clinic has diagnosed and characterized outpatients with new onset HF and high prevalence of HF-PEF. The cut-off value of 60.12 pg/ml for BNP provides high sensitivity and specificity to identify HF in this population.
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Affiliation(s)
- Rut Andrea
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IBIDAPS), Universidad de Barcelona, Barcelona, España.
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Paterson I, Mielniczuk LM, O'Meara E, So A, White JA. Imaging Heart Failure: Current and Future Applications. Can J Cardiol 2013; 29:317-28. [DOI: 10.1016/j.cjca.2013.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 01/11/2023] Open
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Affiliation(s)
- Michael A. Rosenberg
- From the Departments of Medicine (Cardiovascular Division) (M.A.R., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Warren J. Manning
- From the Departments of Medicine (Cardiovascular Division) (M.A.R., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Akiyama E, Sugiyama S, Matsuzawa Y, Konishi M, Suzuki H, Nozaki T, Ohba K, Matsubara J, Maeda H, Horibata Y, Sakamoto K, Sugamura K, Yamamuro M, Sumida H, Kaikita K, Iwashita S, Matsui K, Kimura K, Umemura S, Ogawa H. Incremental prognostic significance of peripheral endothelial dysfunction in patients with heart failure with normal left ventricular ejection fraction. J Am Coll Cardiol 2012; 60:1778-86. [PMID: 23040568 DOI: 10.1016/j.jacc.2012.07.036] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/04/2012] [Accepted: 07/23/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate whether peripheral endothelial dysfunction could predict the occurrence of cardiovascular events in patients with heart failure (HF) with normal left ventricular ejection fraction (HFNEF). BACKGROUND Endothelial dysfunction plays an important role in HF, but the relation between peripheral endothelial dysfunction and prognosis in HFNEF remains unknown. METHODS We conducted a prospective cohort study of 321 patients with HFNEF. We evaluated cardiac function by echocardiography measuring the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e'), noninvasively assessed peripheral endothelial function by reactive hyperemia-peripheral arterial tonometry (RH-PAT) as the RH-PAT index (RHI), and followed cardiovascular events. RESULTS A total of 59 patients had a cardiovascular event. Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in the low RHI group than in the high RHI group (mean follow-up: 20 months; log-rank test: p < 0.001). Multivariate Cox hazard analysis identified RHI (per 0.1) (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.67 to 0.94; p = 0.007), E/e' (Ln[E/e'] [per 0.1]) (HR: 1.15; 95% CI: 1.04 to 1.26; p = 0.006), and B-type natriuretic peptide (BNP) (Ln[BNP] [per picogram/milliliter]) (HR: 1.81; 95% CI: 1.44 to 2.28; p < 0.001) as independent predictors of cardiovascular events. The C-statistics for cardiovascular events substantially increased when the RHI was added to the HFNEF prognostic 5 factors (PF5)-age, diabetes, New York Heart Association classification, HF hospitalization history, and left ventricular ejection fraction-which were identified in the I-PRESERVE (Irbesartan in Heart Failure with Preserved Ejection Fraction Study) (PF5 alone: 0.671; PF5 + RHI: 0.712). The net reclassification index was significant after addition of the RHI (19.0%, p = 0.01). CONCLUSIONS Peripheral endothelial dysfunction independently correlated with future cardiovascular events, adding incremental clinical significance for risk stratification in patients with HFNEF. (Endothelial Dysfunction Assessed by Reactive Hyperemia Peripheral Arterial Tonometry and Heart Failure with Preserved Left Ventricular Ejection Fraction; UMIN000002640).
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Affiliation(s)
- Eiichi Akiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Bajraktari G, Miccoli M, Buralli S, Fontanive P, Elezi S, Metelli MR, Baggiani A, Dini FL. Plasma metalloproteinase-9 and restrictive filling pattern as major predictors of outcome in patients with ischemic cardiomyopathy. Eur J Intern Med 2012; 23:616-20. [PMID: 22939806 DOI: 10.1016/j.ejim.2012.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Assessment of plasma matrix metalloproteinase-9 (MMP-9) and Doppler markers of increased left ventricular (LV) filling pressure may be added to risk stratify patients with ischemic cardiomyopathy (IC). Therefore, we aimed at investigating the value of plasma MMP-9 and restrictive filling pattern (RFP) in IC patients. METHODS Eighty-eight consecutive patients hospitalized for heart failure (LV ejection fraction ≤ 40%) due to IC were enrolled. A complete M-mode and two-dimensional echo-Doppler examination were performed. Patients were defined as having RFP if they had a mitral E wave deceleration time<150 ms. Plasma MMP-9 and N-terminal protype-B natriuretic peptide levels were assessed at the time of the index echocardiogram. The end point was all-cause mortality or hospitalization for worsening HF. Follow-up period was 25 ± 17 months. RESULTS Median value of MMP-9 was 714 ng/ml. On univariate analysis, a number of measurements predicted the composite end point: NYHA class>2, RFP, MMP-9>60.5 ng/ml, LV ejection fraction<27%, anemia, pulmonary pressure ≥ 35 mm Hg, N-terminal protype-B natriuretic peptide>1742 pg/ml, and glomerular filtration rate<60 ml/min/1.73 m(2). Independent variables of outcome were anemia (HR=1.9, p=0.031), and the combination of plasma MMP-9 and RFP (HR=3.2, p=0.004). On Kaplan-Meier survival curves, patients with elevated MMP-9 levels and RFP had the lowest event-free survival rate (log-rank: 29.0, p<0.0001). The net reclassification improvement showed a significant increase in the prediction model when elevated MMP-9 and RFP were added to the base model that included clinical, biochemical and echocardiographic parameters (p<0.0001). CONCLUSION MMP-9 levels and RFP have an incremental predictive value to risk classify IC patients.
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Affiliation(s)
- Gani Bajraktari
- Service of Cardiology, Internal Medicine Clinic, University Clinical Centre of Kosova, Prishtina, Kosovo
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Abstract
PURPOSE OF REVIEW Nearly half of patients presenting with heart failure have a preserved left ventricular ejection fraction (LVEF), previously known as diastolic heart failure. The diagnosis requires fulfillment of three criteria: signs or symptoms of heart failure, presence of a normal LVEF, and evidence of diastolic dysfunction. Two of the criteria can be evaluated by echocardiography. This article reviews the echocardiographic approach to the patient with suspected heart failure with a normal left ventricular ejection fraction (HFNEF). RECENT FINDINGS Echocardiography is the primary modality for evaluating left ventricular (LV) systolic and diastolic function in heart failure patients. Measurements of LVEF from two-dimensional echocardiography can have significant variability despite the use of quantitative methods. The use of contrast agents and three-dimensional echocardiography can improve the accuracy. Newer modalities of tissue Doppler imaging and deformation imaging are challenging the concept that systolic function is preserved in HFNEF. Evaluation of diastolic function with echocardiography requires a comprehensive approach using multiple modalities to quantitate transmitral flow, pulmonary venous flow, mitral annular motion, myocardial deformation, and cardiac structure. The clinical applicability of parameters used for evaluating diastolic function and filling pressures is dependent on the LVEF, necessitating a unique approach in patients with suspected HFNEF. SUMMARY A comprehensive examination with knowledge of the potential limitations of echocardiography is required to accurately interpret LV systolic and diastolic function in patients with suspected HFNEF.
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Abo-Zaid G, Sauerbrei W, Riley RD. Individual participant data meta-analysis of prognostic factor studies: state of the art? BMC Med Res Methodol 2012; 12:56. [PMID: 22530717 PMCID: PMC3413577 DOI: 10.1186/1471-2288-12-56] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 04/24/2012] [Indexed: 12/20/2022] Open
Abstract
Background Prognostic factors are associated with the risk of a subsequent outcome in people with a given disease or health condition. Meta-analysis using individual participant data (IPD), where the raw data are synthesised from multiple studies, has been championed as the gold-standard for synthesising prognostic factor studies. We assessed the feasibility and conduct of this approach. Methods A systematic review to identify published IPD meta-analyses of prognostic factors studies, followed by detailed assessment of a random sample of 20 articles published from 2006. Six of these 20 articles were from the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in traumatic brain injury) collaboration, for which additional information was also used from simultaneously published companion papers. Results Forty-eight published IPD meta-analyses of prognostic factors were identified up to March 2009. Only three were published before 2000 but thereafter a median of four articles exist per year, with traumatic brain injury the most active research field. Availability of IPD offered many advantages, such as checking modelling assumptions; analysing variables on their continuous scale with the possibility of assessing for non-linear relationships; and obtaining results adjusted for other variables. However, researchers also faced many challenges, such as large cost and time required to obtain and clean IPD; unavailable IPD for some studies; different sets of prognostic factors in each study; and variability in study methods of measurement. The IMPACT initiative is a leading example, and had generally strong design, methodological and statistical standards. Elsewhere, standards are not always as high and improvements in the conduct of IPD meta-analyses of prognostic factor studies are often needed; in particular, continuous variables are often categorised without reason; publication bias and availability bias are rarely examined; and important methodological details and summary results are often inadequately reported. Conclusions IPD meta-analyses of prognostic factors are achievable and offer many advantages, as displayed most expertly by the IMPACT initiative. However such projects face numerous logistical and methodological obstacles, and their conduct and reporting can often be substantially improved.
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Affiliation(s)
- Ghada Abo-Zaid
- European Centre for Environment and Human Health, Peninsula College of Medicine and Dentistry, University of Exeter Knowledge Spa Royal Cornwall Hospital Truro, Cornwall TR1 3HD UK
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Ghio S, Temporelli PL, Marsan NA, Poppe K, Giannuzzi P, Dini FL, Rossi A, Doughty RN, Whalley G. Prognostic Implications of Left Ventricular Dilation in Patients With Nonischemic Heart Failure: Interactions With Restrictive Filling Pattern and Mitral Regurgitation. ACTA ACUST UNITED AC 2012; 18:198-204. [DOI: 10.1111/j.1751-7133.2011.00281.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abouezzeddine OF, Redfield MM. Who has advanced heart failure?: definition and epidemiology. ACTA ACUST UNITED AC 2011; 17:160-8. [PMID: 21790965 DOI: 10.1111/j.1751-7133.2011.00246.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Summarizing current guidelines and advanced heart failure (AHF) clinical trials/registries, this review focuses on the current definition of AHF and emphasizes the secular trends in this definition over the last two decades. Further, clinical, imaging, hemodynamic, functional capacity and biomarker parameters that may aid clinicians to better recognize patients with AHF are reviewed. Finally, we review the limited data concerning the epidemiology of AHF which to date has been poorly characterized.
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Affiliation(s)
- Omar F Abouezzeddine
- Division of Cardiovascular Diseases and Internal Medicine Mayo Clinic, Rochester, MN, USA
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Bajraktari G, Dini FL, Fontanive P, Elezi S, Berisha V, Napoli AM, Ciuti M, Henein M. Independent and incremental prognostic value of Doppler-derived left ventricular total isovolumic time in patients with systolic heart failure. Int J Cardiol 2011; 148:271-5. [PMID: 19948365 DOI: 10.1016/j.ijcard.2009.09.567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 09/15/2009] [Accepted: 09/26/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND A prolonged total isovolumic time (T-IVT) has been shown to be associated with worsening survival in patients submitted to coronary artery surgery. However, it is not known whether it has prognostic significance in patients with chronic systolic heart failure (HF). AIM To determine the prognostic value of T-IVT in comparison with other clinical, biochemical and echocardiographic variables in patients with chronic systolic HF. METHODS Patients (n=107; age 68±12 years, 25% women) with chronic systolic HF, left ventricular ejection fraction (EF)<45%, and sinus rhythm, underwent a complete Doppler echocardiographic study, that included tissue Doppler long axis velocities and total isovolumic time (T-IVT), determined as [60-(total ejection time+total filling time)]. Plasma N-terminal pro-B natriuretic peptide (NT-pro-BNP) was also measured. The associations of dichotomous variables selected according to the Receiver Operator Characteristic analysis were assessed using the Cox proportional hazard model. RESULTS Follow-up period was 37±18 months. Multivariate predictors of events were T-IVT≥12.3% s/min, mean E/Em ratio≥10, log NT-pro-BNP levels≥2.47 pg/ml and LV EF≤32.5%. On Kaplan-Meier analysis, patients with prolonged T-IVT, high mean E/Em ratio, increased NT-pro-BNP levels and decreased LV EF had a worse outcome compared with those without. The addition of T-IVT and NT-pro-BNP to conventional clinical and echocardiographic variables significantly improved the chi-square for the prediction of the outcome from 33.1 to 38.0, (P<0.001). CONCLUSIONS Prolonged T-IVT added to the prognostic stratification of patients with systolic HF.
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Affiliation(s)
- Gani Bajraktari
- Service of Cardiology, Internal Medicine Clinic, University Clinical Centre of Kosova, Prishtina, Kosovo.
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Poppe KK, Doughty RN, Yu CM, Quintana M, Møller JE, Klein AL, Gamble GD, Dini FL, Whalley GA. Understanding differences in results from literature-based and individual patient meta-analyses: An example from meta-analyses of observational data. Int J Cardiol 2011; 148:209-13. [DOI: 10.1016/j.ijcard.2009.09.566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 08/23/2009] [Accepted: 09/01/2009] [Indexed: 10/20/2022]
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