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Alhakak AS, Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Espersen C, Abildgaard U, Jensen GB, Schnohr P, Marott JL, Søgaard P, Møgelvang R, Biering-Sørensen T. Changes in cardiac time intervals over a decade and the risk of incident heart failure: The Copenhagen City heart study. Int J Cardiol 2023:S0167-5273(23)00709-X. [PMID: 37178800 DOI: 10.1016/j.ijcard.2023.05.018] [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: 01/01/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The cardiac time intervals include the isovolumic contraction time (IVCT), the left ventricular ejection time (LVET), the isovolumic relaxation time (IVRT) and the combination of all the cardiac time intervals in the myocardial performance index (MPI) (defined as [(IVCT+IVRT)/LVET)]. Whether the cardiac time intervals change over time and which clinical factors that accelerate these changes is not well-established. Additionally, whether these changes are associated with subsequent heart failure (HF), remains unknown. METHODS We investigated participants from the general population (n = 1064) who had an echocardiographic examination including color tissue Doppler imaging performed in both the 4th and 5th Copenhagen City Heart Study. The examinations were performed 10.5 years apart. RESULTS The IVCT, LVET, IVRT and MPI increased significantly over time. None of the investigated clinical factors were associated with increase in IVCT. Systolic blood pressure (standardized β= - 0.09) and male sex (standardized β= - 0.08) were associated with an accelerated decrease in LVET. Age (standardized β=0.26), male sex (standardized β=0.06), diastolic blood pressure (standardized β=0.08), and smoking (standardized β=0.08) were associated with an increase in IVRT, while HbA1c (standardized β= - 0.06) was associated with a decrease in IVRT. Increasing IVRT over a decade was associated with an increased risk of subsequent HF in participants aged <65 years (per 10 ms increase: HR 1.33; 95%CI (1.02-1.72), p = 0.034). CONCLUSION The cardiac time increased significantly over time. Several clinical factors accelerated these changes. An increase in IVRT was associated with an increased risk of subsequent HF in participants aged <65 years.
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Affiliation(s)
- Alia Saed Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Niklas Dyrby Johansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Espersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Whalley GA, Wasywich CA, Walsh H, Doughty RN. Role of echocardiography in the contemporary management of chronic heart failure. Expert Rev Cardiovasc Ther 2014; 3:51-70. [PMID: 15723575 DOI: 10.1586/14779072.3.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Echocardiography is an excellent noninvasive tool for the assessment of ventricular size and both systolic and diastolic function, and it is routinely used in patients with heart failure. This review will discuss the role of echocardiography in heart failure diagnosis, prognostic assessment and in the management of heart failure patients.
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Affiliation(s)
- Gillian A Whalley
- University of Auckland, Department of Medicine, Private Bag 92019, Auckland, New Zealand.
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3
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Kaminski G, Michalkiewicz D, Makowski K, Podgajny Z, Szalus N, Ruchala M, Szczepanek E, Gielerak G. Prospective echocardiographic evaluation of patients with endogenous subclinical hyperthyroidism and after restoring euthyroidism. Clin Endocrinol (Oxf) 2011; 74:501-7. [PMID: 21158893 DOI: 10.1111/j.1365-2265.2010.03957.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Clinical significance of, and the need for, treatment in subclinical hyperthyroidism (sHT) is still a matter of debate. The aim of the study was to assess the impact of sHT on echocardiographic parameters. DESIGN Patients with endogenous sHT of nonautoimmune origin underwent full echocardiographic assessment at diagnosis and after restoring euthyroidism with radioiodine treatment. PATIENTS Studied group consisted of 44 patients (37 women, 7 men), aged 22-65 years (mean 45·9±11·0). MEASUREMENTS Full echocardiographic assessment included estimation of cardiac chamber diameters and volume as well as cardiac contractility, according to the guidelines of the American Society of Echocardiography. Left ventricular mass was calculated according to Penn's convention. For estimation of left ventricle diastolic function, the following echocardiographic parameters were obtained: maximal early filling wave velocity (E), maximal late filling wave velocity (A), E/A ratio, isovolumetric relaxation time and early filling wave deceleration time. RESULTS In the studied group, phase of sHT was associated with increased volume of heart chambers, increased diameter of ascending aorta, increased left ventricle mass and disturbed left ventricle relaxation (P<0·05). The systolic function of the left ventricle was unaffected; however, the ejection time was shortened. The changes were reversible with restoring biochemical euthyroidism (P<0·05). Moreover, a significant correlation between some of the parameters and thyroid hormones concentration was demonstrated. CONCLUSIONS sHT was associated with significant changes in echocardiographic parameters, which may contribute to increased cardiovascular risk in these patients. The alterations were reversible with restoring biochemical euthyroidism, what supports the necessity of treatment introduction in sHT.
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Affiliation(s)
- Grzegorz Kaminski
- Departments of Endocrinology and Isotope Therapy Internal Medicine and Cardiology Nuclear Medicine, Military Institute of Medicine, Szaserów St. 128, Warsaw, Poland.
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Strobl I, Windbichler G, Strasak A, Weiskopf-Schwendinger V, Schweigmann U, Ramoni A, Scheier M. Left ventricular function many years after recovery from pre-eclampsia. BJOG 2010; 118:76-83. [PMID: 21083867 DOI: 10.1111/j.1471-0528.2010.02780.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epidemiological observations have shown that women with pre-eclampsia are at increased risk for subsequent development of cardiovascular disease. We evaluated maternal haemodynamics in asymptomatic women many years after pre-eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. DESIGN Case-control study. SETTING University-based department of obstetrics. POPULATION Forty-eight women, 13-18 years after the affected pregnancy: 17 women with a history of HELLP syndrome, 14 women with a history of pre-eclampsia and 17 women following normal pregnancy (control group). METHODS Echocardiographic examination was performed in all groups, recording the isovolumetric contraction time and isovolumetric relaxation time (ICT + IVRT), ejection time (ET), myocardial performance index (MPI), transmitral early to atrial filling velocity ratio (MV-E/MV-A), stroke volume (SV) and cardiac output (CO). MAIN OUTCOME MEASURES Cardiac function. RESULTS Women with previous HELLP syndrome showed a significantly increased MPI (0.34 versus 0.26; P = 0.008) and ICT + IVRT (442.16 versus 415.03; P = 0.01); MV-E/A, SV, ET and CO were not significantly different. Women with a history of pre-eclampsia showed a significantly increased MPI (0.36 versus 0.26; P = 0.006) and decreased ET (317.3 versus 328.93; P = 0.04); ICT + IVRT, MV-E/A, SV and CO were not significantly different. CONCLUSION This study confirms epidemiological observations that women with pre-eclampsia are at increased risk for subsequent development of cardiovascular disease. Many years after HELLP syndrome or pre-eclampsia, asymptomatic women have an increased risk for impaired cardiac function as shown by an increased MPI.
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Affiliation(s)
- I Strobl
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria.
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Lindqvist P, Bajraktari G, Molle R, Palmerini E, Holmgren A, Mondillo S, Henein MY. Valve replacement for aortic stenosis normalizes subendocardial function in patients with normal ejection fraction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY : THE JOURNAL OF THE WORKING GROUP ON ECHOCARDIOGRAPHY OF THE EUROPEAN SOCIETY OF CARDIOLOGY 2010; 11:608-13. [PMID: 20219771 DOI: 10.1093/ejechocard/jeq026] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Long-standing aortic stenosis (AS) causes various degrees of left ventricular (LV) dysfunction, which may improve after valve replacement. The aim of this study was to assess the nature of LV subendocardial abnormalities in AS and their response to valve replacement (AVR). METHODS AND RESULTS We studied 41 consecutive symptomatic patients (age 64 +/- 13 years) with severe AS, normal LV ejection fraction (EF), but no obstructive coronary artery disease before, a week after AVR, and 6 months after AVR. LV subendocardial function was studied from recordings of long-axis M-mode (amplitude), tissue-Doppler (myocardial velocities) and speckle tracking (myocardial strain) echocardiographic techniques. Results were compared with those from 20 age- and gender-matched controls. In patients, LV dimensions and markers of asynchrony, total isovolumic time (t-IVT), and Tei index were not different from controls before AVR and remained unchanged afterwards. LV lateral long-axis amplitude, as well as lateral and septal systolic velocities and strain, were reduced (P < 0.001 for all) and E/E' was modestly raised. Lateral long-axis amplitude, systolic and diastolic velocities normalized within a week of AVR but strain lagged behind until 6 months later. The reduced septal long-axis amplitude remained permanently unchanged (NS) despite the early normalization of its systolic velocities (P < 0.001) and strain (P < 0.001). LV mass normalized at 6 months after AVR (P < 0.005). CONCLUSIONS In patients with severe AS and maintained LV ejection fraction, subendocardial function is globally abnormal showing reduced amplitude of motion, velocities, and strain. The different response of its components suggests an evidence for differential reverse remodelling, irrespective of myocardial mass regression.
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Nishioka SAD, Martinelli Filho M, Brandão SCS, Giorgi MC, Vieira MLC, Costa R, Mathias W, Meneghetti JC. Cardiac sympathetic activity pre and post resynchronization therapy evaluated by 123I-MIBG myocardial scintigraphy. J Nucl Cardiol 2007; 14:852-9. [PMID: 18022112 DOI: 10.1016/j.nuclcard.2007.08.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Imaging with (123)I-metaiodobenzylguanidine (MIBG) is used for the assessment of cardiac sympathetic activity (CSA). We analyzed CSA before and after cardiac resynchronization therapy (CRT), and correlated these data with CRT response. METHODS AND RESULTS Thirty patients with chronic heart failure and classic indications for CRT were prospectively studied before and at least 3 months after CRT. The variables analyzed were: QRS width, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic diameter (LVEDD), heart/mediastinum MIBG uptake ratio (H/M), and washout rate (WR). After CRT, patients were divided into two groups: group 1 (21 patients), responders improving to functional class (FC) I or II; and group 2 (9 patients), nonresponders remaining in FC III or IV. After CRT, only group 1 showed favorable changes in QRS width (P =.003), LVEF (P =.01), LVEDD (P =.04), and H/M ratio (P =.003). The H/M ratio and WR were associated with CRT response (P =.005 and P =.04, respectively). The H/M ratio was the only independent predictor of CRT response (P =.01). Receiver operating characteristic curves showed that the optimal H/M ratio cutoff point was 1.36 (sensitivity, 75%; specificity, 71%). CONCLUSIONS Improvement in CSA correlated with a positive CRT response. Lower MIBG uptake before therapy was associated with CRT nonresponse. The H/M ratio could be helpful in selecting patients for CRT.
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Affiliation(s)
- Silvana A D'Orio Nishioka
- Department of Arrhythmia and Cardiac Stimulation, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
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Kirkpatrick JN, Vannan MA, Narula J, Lang RM. Echocardiography in Heart Failure. J Am Coll Cardiol 2007; 50:381-96. [PMID: 17662389 DOI: 10.1016/j.jacc.2007.03.048] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 03/27/2007] [Accepted: 03/29/2007] [Indexed: 11/21/2022]
Abstract
Echocardiography is well qualified to meet the growing need for noninvasive imaging in the expanding heart failure (HF) population. The recently-released American College of Cardiology/American Heart Association guidelines for the diagnosis and management of HF labeled echocardiography "the single most useful diagnostic test in the evaluation of patients with HF...," because of its ability to accurately and noninvasively provide measures of ventricular function and assess causes of structural heart disease. It can also detect and define the hemodynamic and morphologic changes in HF over time and might be equivalent to invasive measures in guiding therapy. In this article we will discuss: 1) the clinical uses of echocardiography in HF and their prognostic value; 2) the use of echocardiography to guide treatment in HF patients; and 3) promising future techniques for echocardiographic-based imaging in HF. In addition, we will highlight some of the limitations of echocardiography.
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Affiliation(s)
- James N Kirkpatrick
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Abstract
Despite advances in the therapy of cardiovascular disorders, heart failure remains a challenging disease with a dismal prognosis. A plethora of variables have been shown to be related to survival in patients with heart failure. These include heart failure etiology, clinical presentation, ventricular performance, exercise capacity, neurohormones and, more recently, inflammatory and necrosis markers. In this review we briefly list established predictive markers and discuss whether survival can accurately be predicted in this condition.
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Affiliation(s)
- Viorel G Florea
- Heart Failure Program, VA Medical Center, One Veterans Drive, 111-C, Minneapolis, MN 55417, USA
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Kosiborod M, Soto GE, Jones PG, Krumholz HM, Weintraub WS, Deedwania P, Spertus JA. Identifying heart failure patients at high risk for near-term cardiovascular events with serial health status assessments. Circulation 2007; 115:1975-81. [PMID: 17420346 DOI: 10.1161/circulationaha.106.670901] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Identification of heart failure outpatients at increased risk for clinical deterioration remains a critical challenge, with few tools currently available to assist clinicians. We tested whether serial health status assessments with the Kansas City Cardiomyopathy Questionnaire (KCCQ) can identify patients at increased risk for mortality and hospitalization. METHODS AND RESULTS We evaluated 1358 patients with heart failure after an acute myocardial infarction in the Eplerenone's Neurohormonal Efficacy and Survival Study, a multicenter randomized trial that included serial KCCQ assessments. Cox proportional-hazards models were used to examine whether changes in KCCQ scores during successive outpatient visits were independently associated with all-cause mortality and cardiovascular mortality or hospitalization. Change in KCCQ (deltaKCCQ) was linearly associated with all-cause mortality (hazard ratio [HR], for each 5-point decrease in deltaKCCQ, 1.11; 95% CI, 1.04 to 1.19) and the combined outcome of cardiovascular mortality or hospitalization (HR for each 5-point decrease in deltaKCCQ, 1.12; 95% CI 1.07 to 1.18). In Kaplan-Meier survival analysis, all-cause mortality among patients with deltaKCCQ of < or = -10, > -10 to < 10, and > 10 points was 26%, 16%, and 13%, respectively (P=0.008). After multivariable adjustment, the linear relationship between deltaKCCQ and both all-cause mortality and combined cardiovascular death and hospitalization persisted (HR, 1.09; 95% CI, 1.00 to 1.18; and HR, 1.11; 95% CI, 1.05 to 1.17 for each 5-point decrease in deltaKCCQ, respectively). CONCLUSIONS In heart failure outpatients, serial health status assessments with the KCCQ can identify high-risk patients and may prove useful in directing the frequency of follow-up and the intensity of treatment.
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Affiliation(s)
- Mikhail Kosiborod
- Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO 64111, USA
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Whalley GA, Gamble GD, Doughty RN. The prognostic significance of restrictive diastolic filling associated with heart failure: A meta-analysis. Int J Cardiol 2007; 116:70-7. [PMID: 16901562 DOI: 10.1016/j.ijcard.2006.03.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 03/12/2006] [Accepted: 03/25/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have reported that the presence of a restrictive filling pattern (RFP) is associated with poor outcome in patients with heart failure (HF). These studies, of variable sample size, have involved different HF patient groups with variable associated mortality rates and follow-up times, and while powered for effects on combined end-points such as death or hospital admission, many were underpowered to reliably determine the overall effect of the RFP on total mortality. Consequently, we performed a meta-analysis to determine the mortality associated with RFP in patients with HF. METHODS We searched several online medical databases for prospective studies of patients with HF. All authors were requested to confirm their data. All-cause mortality was compared between RFP and non-restrictive filling patterns (Non-RFP). Review Manager version 4.2.7 software was used for the analysis. RESULTS 3024 patients in 27 studies were identified (379 idiopathic cardiomyopathy, 2645 mixed aetiology HF). Average follow-up was between 3 months and 5 years. 1284 (42%) patients had RFP at baseline. 688 deaths occurred and the overall odds ratio for death was 4.36 (CI 3.60, 5.04); idiopathic group: 6.65 (CI 3.86, 11.47); mixed aetiology group: 4.10 (CI 3.34, 5.04). The overall odds ratio for death/transplantation was 4.87 (CI 4.04, 5.86); idiopathic group: 7.62 (CI 4.50, 12.92); mixed aetiology group: 4.56 (CI 3.74, 5.56). CONCLUSIONS Restrictive filling pattern is associated with a four-fold increase in mortality in patients with HF and thus should be an important part of the echocardiographic assessment of such patients.
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Affiliation(s)
- Gillian A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Private Bag 92 019, Auckland, New Zealand.
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De Winter O, Van de Veire N, Gemmel F, Goethals I, De Sutter J. Myocardial perfusion imaging in the elderly: a review. Nucl Med Commun 2006; 27:529-34. [PMID: 16710108 DOI: 10.1097/00006231-200606000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Coronary artery disease is a major cause of morbidity and mortality in the elderly population. As a result of ageing of the population and better medical, interventional and surgical treatment of patients with coronary artery disease, more and more elderly patients are referred to the cardiology department for diagnostic work-up. Stress testing, in combination with myocardial perfusion imaging, is routinely used in elderly patients, a population in which the diagnosis of significant coronary artery disease is often challenging because of atypical symptomatology. Since the introduction of technetium-99m ligands for myocardial perfusion imaging, it is possible to perform electrocardiogram-gated perfusion imaging. This not only improves the specificity of the test for coronary artery disease detection, but also enables the simultaneous assessment of left ventricular functional parameters. This article briefly overviews the possible stress modalities, diagnostic accuracy and prognostic value of myocardial perfusion imaging in elderly patients.
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Freitas HFG, Chizzola PR, Paes AT, Lima ACP, Mansur AJ. Risk stratification in a Brazilian hospital-based cohort of 1220 outpatients with heart failure: role of Chagas' heart disease. Int J Cardiol 2005; 102:239-47. [PMID: 15982491 DOI: 10.1016/j.ijcard.2004.05.025] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Revised: 05/04/2004] [Accepted: 05/05/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few studies evaluated prognostic factors of outpatients with heart failure of different etiologies including Chagas' heart disease. METHODS We studied 1220 outpatients with heart failure in functional classes III and IV (NYHA) to evaluate prognostic factors. Patients aged 13-72 years (mean 45.5, standard deviation 11); 952 men (78%) and 268 women (22%) were followed up for 25.6+/-26 months from 1991 to 2000. Heart failure was attributed to idiopathic dilated cardiomyopathy in 454 (37%) patients. Etiologies were Chagas' heart disease in 242 (20%) patients, ischemic cardiomyopathy in 212 (17%), hypertensive cardiomyopathy in 170 (14%) and others in 142 (12%). Statistical analyses were performed with Kaplan-Meier and Cox proportional hazards methods, following a strategy of noninvasive model as well as in an invasive model to identify the risk of death. RESULTS Four hundred fifteen (34%) patients died in the follow-up period, 71 (6%) patients underwent heart transplantation and 28 (2%) underwent other surgical interventions. In the noninvasive model, Chagas' heart disease (relative risk compared with other etiologies 2.26 to 2.97), left ventricular end diastolic diameter on echocardiography (relative risk 1.13) and left ventricular ejection fraction on radionuclide angiography (relative risk 0.96) were associated with higher mortality. In the invasive model, Chagas' heart disease (relative risk compared with other etiologies 2.66 to 9.13) was the most important determinant of mortality in association with the cardiac index (relative risk 0.40). CONCLUSIONS In this cohort of patients with heart failure of different etiologies, Chagas' heart disease was the main prognostic factor for mortality.
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Affiliation(s)
- Humberto F G Freitas
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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Arnlöv J, Lind L, Andrén B, Risérus U, Berglund L, Lithell H. A Doppler-derived index of combined left ventricular systolic and diastolic function is an independent predictor of cardiovascular mortality in elderly men. Am Heart J 2005; 149:902-7. [PMID: 15894975 DOI: 10.1016/j.ahj.2004.07.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies on echocardiographic and Doppler indices of cardiac function as predictors for cardiovascular mortality have been performed in the general population. The novel myocardial performance index (MPI, also denoted as Tei-Doppler index) has been suggested to reflect both left ventricular (LV) systolic and diastolic function. METHODS We investigated whether 10 different echocardiographic and Doppler indices of cardiac function predicted cardiovascular mortality by using a population-based cohort of 583 seventy-year-old men with a mean follow-up time of 6.8 years. RESULTS In a multivariate Cox proportional hazard analysis for a 1-SD increase including LV ejection fraction, E/A ratio, MPI, and traditional cardiovascular risk factors (previous myocardial infarction, hyperlipidemia, hypertension, diabetes, smoking status, and LV hypertrophy), both ejection fraction (hazard ratio [HR] = 0.59, 95% CI 0.38-0.90, P < .05) and MPI (HR = 2.92, 95% CI 1.71-4.97, P < .0001) were found to be independent predictors for cardiovascular mortality. After excluding subjects with coronary heart disease, only MPI remained a significant predictor (HR = 2.18, 95% CI 1.11-4.27, P < .03, for 1-SD increase), and neither ejection fraction, E/A ratio, nor any of the cardiovascular risk factors remained significant predictors. CONCLUSION Myocardial performance index is a predictor for cardiovascular mortality, independent of other measurements of cardiac function and of traditional cardiovascular risk factors in elderly men free from coronary heart disease.
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Affiliation(s)
- Johan Arnlöv
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Cabell CH, Trichon BH, Velazquez EJ, Dumesnil JG, Anstrom KJ, Ryan T, Miller AB, Belkin RN, Cropp AB, O'Connor CM, Jollis JG. Importance of echocardiography in patients with severe nonischemic heart failure: the second Prospective Randomized Amlodipine Survival Evaluation (PRAISE-2) echocardiographic study. Am Heart J 2004; 147:151-7. [PMID: 14691434 DOI: 10.1016/j.ahj.2003.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Echocardiography is used commonly in clinical practice when caring for patients with heart failure. It is unknown whether the presence of certain findings provides an incremental ability to predict survival beyond the use of baseline clinical findings alone. The second PRAISE-2 echocardiographic study was prospectively designed to identify echocardiographic predictors of survival among patients with nonischemic cardiomyopathy and heart failure and to determine if components of the echocardiographic examination add prognostic information to baseline demographic and clinical information. METHODS One hundred patients participated in the second Prospective Randomized Amlodipine Survival Evaluation Study (PRAISE-2) echocardiographic study; of these, 93 had full and interpretable echocardiographic examinations. Cox proportional hazards modeling was used to assess the relation between various characteristics and survival as well as to assess the incremental prognostic information gained by echocardiography beyond the clinical examination. RESULTS Seven of 10 routine echocardiographic measures were significantly associated with death. These included mitral regurgitation (hazard ratio [HR], 2.31; 95% CI, 1.02, 5.27), left ventricular ejection fraction <20% (HR, 2.59; 95% CI, 1.14, 5.88), restrictive left ventricular filling pattern (HR, 2.37; 95% CI, 1.05, 5.32), and peak D velocity (HR, 1.62; 95% CI, 0.38, 0.87). The only statistically significant clinical predictor of survival was dyspnea at rest. The addition any of several echocardiographic parameters to baseline clinical information significantly improved the ability to predict survival. CONCLUSIONS Several readily available echocardiographic parameters are predictive of death and when added to clinical examination findings significantly improve the ability to determine prognosis among patients with nonischemic cardiomyopathy and heart failure.
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Faris R, Coats AJS, Henein MY. Echocardiography-derived variables predict outcome in patients with nonischemic dilated cardiomyopathy with or without a restrictive filling pattern. Am Heart J 2002; 144:343-50. [PMID: 12177655 DOI: 10.1067/mhj.2002.123844] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite recent therapeutic advances, patients with heart failure caused by dilated cardiomyopathy (DCM) still have high morbidity and mortality rates. In this study, we sought to assess the prognostic value of echocardiographic variables in patients with DCM and to assess the impact of a restrictive left ventricle filling pattern. DESIGN We conducted a retrospective cohort study of 337 patients with DCM, using the Royal Brompton Hospital Echocardiography database for the years 1994 to 1998. METHODS AND RESULTS There were 337 patients with a mean age of 53 +/- 15 years. One hundred ninety-five patients (58%) had a restrictive left ventricle filling pattern (RFP). There was a total of 74 deaths (22%) during the follow-up period (43 +/- 25 months). RFP more than tripled the risk of death (adjusted hazard ratio 3.2, 95% CI 1.8-5.7, P =.003). RFP is correlated with isovolumic relaxation time, incoordinate wall-motion, amplitude of right ventricular long axis excursion on M-mode echocardiography, and mitral regurgitation. CONCLUSION RFP is a powerful independent predictor of mortality in patients with nonischemic DCM. The risk associated with RFP is greatest among patients who had short isovolumic relaxation time, mitral regurgitation, incoordinate wall-motion, and depressed amplitude of right ventricular long axis excursion. Thus, echocardiography-derived variables may stratify patients with heart failure with DCM who are at high risk, for whom aggressive medical treatment or heart transplantation should be considered early.
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Affiliation(s)
- Rajaa Faris
- Department of Clinical Cardiology, National Heart and Lung Institute, The Royal Brompton Hospital, Imperial College School of Science, Technology, and Medicine, London, United Kingdom.
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Ogita H, Shimonagata T, Fukunami M, Kumagai K, Yamada T, Asano Y, Hirata A, Asai M, Kusuoka H, Hori M, Hoki N. Prognostic significance of cardiac (123)I metaiodobenzylguanidine imaging for mortality and morbidity in patients with chronic heart failure: a prospective study. Heart 2001; 86:656-60. [PMID: 11711461 PMCID: PMC1730035 DOI: 10.1136/heart.86.6.656] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine whether cardiac iodine-123 metaiodobenzylguanidine ((123)I MIBG) imaging is useful in predicting the prognosis of patients with chronic heart failure. DESIGN Cardiac (123)I MIBG imaging was done on entry to the study. The cardiac MIBG washout rate was calculated from anterior chest view images obtained 20 and 200 minutes after injection of the isotope. Study patients were divided into two groups with washout rates above and below 27% (the mean value + 2 SD obtained in 20 normal subjects), and were then followed up. SETTING Tertiary referral centre. PATIENTS 79 patients with chronic heart failure in whom the left ventricular ejection fraction was less than 40%. RESULTS There were 37 patients in group 1 (washout rate of >/= 27%) and 42 in group 2 (< 27%). During a follow up period of between 1 and 52 months, eight patients died suddenly and five died of worsening heart failure in group 1, while none died in group 2; 13 patients in group 1 and four in group 2 were admitted to hospital for progressive heart failure. Kaplan-Meier analysis showed that group 1 had a significantly higher mortality and morbidity (p = 0.001 and p < 0.001, respectively) than group 2. CONCLUSIONS Cardiac (123)I MIBG washout rate seems to be a good predictor of prognosis in patients with chronic heart failure.
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Affiliation(s)
- H Ogita
- Division of Cardiology, Osaka Prefectural General Hospital, 3-1-56 Mandai-Higashi Sumiyoshi-ku, Osaka 558-8558, Japan.
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