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Castiglione V, Aimo A, Todiere G, Barison A, Fabiani I, Panichella G, Genovesi D, Bonino L, Clemente A, Cademartiri F, Giannoni A, Passino C, Emdin M, Vergaro G. Role of Imaging in Cardiomyopathies. Card Fail Rev 2023; 9:e08. [PMID: 37427006 PMCID: PMC10326670 DOI: 10.15420/cfr.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 07/11/2023] Open
Abstract
Imaging has a central role in the diagnosis, classification, and clinical management of cardiomyopathies. While echocardiography is the first-line technique, given its wide availability and safety, advanced imaging, including cardiovascular magnetic resonance (CMR), nuclear medicine and CT, is increasingly needed to refine the diagnosis or guide therapeutic decision-making. In selected cases, such as in transthyretin-related cardiac amyloidosis or in arrhythmogenic cardiomyopathy, the demonstration of histological features of the disease can be avoided when typical findings are observed at bone-tracer scintigraphy or CMR, respectively. Findings from imaging techniques should always be integrated with data from the clinical, electrocardiographic, biomarker, genetic and functional evaluation to pursue an individualised approach to patients with cardiomyopathy.
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Affiliation(s)
- Vincenzo Castiglione
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Alberto Aimo
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giancarlo Todiere
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Andrea Barison
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Iacopo Fabiani
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Giorgia Panichella
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Dario Genovesi
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Lucrezia Bonino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Clemente
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Filippo Cademartiri
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Giannoni
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Claudio Passino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Michele Emdin
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giuseppe Vergaro
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
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2
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Marston S, Pinto JR. Suppression of lusitropy as a disease mechanism in cardiomyopathies. Front Cardiovasc Med 2023; 9:1080965. [PMID: 36698941 PMCID: PMC9870330 DOI: 10.3389/fcvm.2022.1080965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
In cardiac muscle the action of adrenaline on β1 receptors of heart muscle cells is essential to adjust cardiac output to the body's needs. Adrenergic activation leads to enhanced contractility (inotropy), faster heart rate (chronotropy) and faster relaxation (lusitropy), mainly through activation of protein kinase A (PKA). Efficient enhancement of heart output under stress requires all of these responses to work together. Lusitropy is essential for shortening the heartbeat when heart rate increases. It therefore follows that, if the lusitropic response is not present, heart function under stress will be compromised. Current literature suggests that lusitropy is primarily achieved due to PKA phosphorylation of troponin I (TnI) and phospholamban (PLB). It has been well documented that PKA-induced phosphorylation of TnI releases Ca2+ from troponin C faster and increases the rate of cardiac muscle relaxation, while phosphorylation of PLB increases SERCA activity, speeding up Ca2+ removal from the cytoplasm. In this review we consider the current scientific evidences for the connection between suppression of lusitropy and cardiac dysfunction in the context of mutations in phospholamban and thin filament proteins that are associated with cardiomyopathies. We will discuss what advances have been made into understanding the physiological mechanism of lusitropy due to TnI and PLB phosphorylation and its suppression by mutations and we will evaluate the evidence whether lack of lusitropy is sufficient to cause cardiomyopathy, and under what circumstances, and consider the range of pathologies associated with loss of lusitropy. Finally, we will discuss whether suppressed lusitropy due to mutations in thin filament proteins can be therapeutically restored.
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Affiliation(s)
- Steven Marston
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jose Renato Pinto
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, United States
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3
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Port Z, Ammari Z, Babapoor-Farrokhran S, Bozorgnia B. Assessing the future risks of subsequent pregnancies in peripartum cardiomyopathy. Heart Fail Rev 2021; 27:779-784. [PMID: 33433773 DOI: 10.1007/s10741-021-10075-z] [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: 01/04/2021] [Indexed: 11/28/2022]
Abstract
Peripartum cardiomyopathy is a myocardial disease process which occurs in young women either in late pregnancy or the early postpartum period. Due to the young age of women effected by this disease, many of these patients elect to pursue a subsequent pregnancy after their initial diagnosis. Currently, echocardiography is used to better elucidate the cardiovascular risks these young patients face when undergoing a subsequent pregnancy; however, the most accurate modality to determine these risks is debatable. In this review, we explore the current literature regarding the use and accuracy of resting transthoracic echocardiography, exercise stress echocardiography, and dobutamine stress echocardiography in risk stratification of a subsequent pregnancy in a patient with peripartum cardiomyopathy.
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Affiliation(s)
- Zachary Port
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA.
| | - Zaid Ammari
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Behnam Bozorgnia
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
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4
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Donal E, Delgado V, Bucciarelli-Ducci C, Galli E, Haugaa KH, Charron P, Voigt JU, Cardim N, Masci PG, Galderisi M, Gaemperli O, Gimelli A, Pinto YM, Lancellotti P, Habib G, Elliott P, Edvardsen T, Cosyns B, Popescu BA. Multimodality imaging in the diagnosis, risk stratification, and management of patients with dilated cardiomyopathies: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2020; 20:1075-1093. [PMID: 31504368 DOI: 10.1093/ehjci/jez178] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is defined by the presence of left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease sufficient to explain these changes. This is a heterogeneous disease frequently having a genetic background. Imaging is important for the diagnosis, the prognostic assessment and for guiding therapy. A multimodality imaging approach provides a comprehensive evaluation of all the issues related to this disease. The present document aims to provide recommendations for the use of multimodality imaging according to the clinical question. Selection of one or another imaging technique should be based on the clinical condition and context. Techniques are presented with the aim to underscore what is 'clinically relevant' and what are the tools that 'can be used'. There remain some gaps in evidence on the impact of multimodality imaging on the management and the treatment of DCM patients where ongoing research is important.
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Affiliation(s)
- Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, 2 rue Henri Le Guilloux, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden RC, The Netherlands
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University of Bristol, University Hospitals Bristol NHS Foundation Trust, Malborough St, Bristol, UK
| | - Elena Galli
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, 2 rue Henri Le Guilloux, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
| | - Philippe Charron
- Centre de Référence pour les Maladies Cardiaques Héréditaires, APHP, ICAN, Hôpital de la Pitié Salpêtrière, Paris, France.,Université Versailles Saint Quentin & AP-HP, CESP, INSERM U1018, Service de Génétique, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal
| | - P G Masci
- HeartClinic, Hirslanden Hospital Zurich, Witellikerstrasse 32, CH Zurich, Switzerland
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Oliver Gaemperli
- HeartClinic, Hirslanden Hospital Zurich, Witellikerstrasse 32, CH Zurich, Switzerland
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, Pisa, Italy
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, B Liège, Belgium
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Boulevard Jean Moulin, Marseille, France
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten (CHVZ), Unversitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussel, Belgium
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"- Euroecolab, Emergency Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, Sector 2, Bucharest, Romania
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5
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Millar LM, Fanton Z, Finocchiaro G, Sanchez-Fernandez G, Dhutia H, Malhotra A, Merghani A, Papadakis M, Behr ER, Bunce N, Oxborough D, Reed M, O'Driscoll J, Tome Esteban MT, D'Silva A, Carr-White G, Webb J, Sharma R, Sharma S. Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals. Heart 2020; 106:1059-1065. [DOI: 10.1136/heartjnl-2019-316147] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 12/30/2022] Open
Abstract
ObjectiveDistinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction <55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities.MethodsThirty-five asymptomatic active males with DCM, 25 male athletes in the ‘grey zone’ and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring.ResultsLarger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p<0.0001). Peak LV ejection fraction was >63% in 92% grey-zone athletes compared with 17% patients with DCM (p<0.0001). Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM.ConclusionComprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.
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Tayal U, Wage R, Newsome S, Manivarmane R, Izgi C, Muthumala A, Dungu JN, Assomull R, Hatipoglu S, Halliday BP, Lota AS, Ware JS, Gregson J, Frenneaux M, Cook SA, Pennell DJ, Scott AD, Cleland JG, Prasad SK. Predictors of left ventricular remodelling in patients with dilated cardiomyopathy – a cardiovascular magnetic resonance study. Eur J Heart Fail 2020; 22:1160-1170. [DOI: 10.1002/ejhf.1734] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/05/2019] [Accepted: 11/29/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Upasana Tayal
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Ricardo Wage
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Simon Newsome
- Department of Medical Statistics London School of Hygiene and Tropical Medicine London UK
| | | | - Cemil Izgi
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Amal Muthumala
- North Middlesex University Hospital and St Bartholomew's Hospital London UK
| | | | | | - Suzan Hatipoglu
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Brian P. Halliday
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Amrit S. Lota
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - James S. Ware
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
- MRC London Institute of Medical Sciences London UK
| | - John Gregson
- Department of Medical Statistics London School of Hygiene and Tropical Medicine London UK
| | - Michael Frenneaux
- National Heart Lung Institute Imperial College London UK
- University of East Anglia Norwich UK
| | | | - Dudley J. Pennell
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Andrew D. Scott
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - John G.F. Cleland
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Sanjay K. Prasad
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
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7
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De Luca A, Stolfo D, Caiffa T, Korcova R, Barbati G, Vitrella G, Rakar S, Perkan A, Secoli G, Pinamonti B, Merlo M, Sinagra G. Prognostic Value of Global Longitudinal Strain-Based Left Ventricular Contractile Reserve in Candidates for Percutaneous Correction of Functional Mitral Regurgitation: Implications for Patient Selection. J Am Soc Echocardiogr 2019; 32:1436-1443. [PMID: 31551186 DOI: 10.1016/j.echo.2019.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/03/2019] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Patients with symptomatic heart failure (HF), reduced left ventricular ejection fraction (LVEF), and high-grade functional mitral regurgitation (MR) may benefit from percutaneous edge-to-edge mitral valve repair (PMVR). However, patient selection still remains a central issue. We sought to investigate the potential role of the global longitudinal strain- (GLS-) based left ventricular contractile reserve (LVCR) at dobutamine stress echocardiography (DSE) in this setting. METHODS Thirty-three stable HF patients (MR grade ≥ 3+; median LVEF, 29%; median GLS, -8.3%) who were candidates for PMVR were prospectively enrolled. All patients underwent DSE to assess LVCR (LVEF increase ≥ 5%; GLS increase ≥ 2%; stroke volume [SV] increase ≥ 20% of the measured SV value). RESULTS After DSE, a positive LVCRLVEF was detected in 21 patients (64%), positive LVCRGLS in 12 patients (36%), and positive LVCRSV in 14 patients (42%). LVCRGLS was associated with better symptom relief, MR improvement, and LV reverse remodeling in a short-term follow-up. A significant improvement of GLS during DSE (hazard ratio [HR], 0.549; 95% CI, 0.395-0.765; P < .001), along with history of HF hospitalization (HR, 1.48; 95% CI, 1.119-1.967; P = .006) and beta-blocker therapy (HR, 0.146; 95% CI, 0.046-0.462; P = .001), were independently associated with risk of death/heart transplantation/HF-related hospitalizations. CONCLUSIONS LVCR, assessed by speckle-tracking DSE, is associated with better results after PMVR in the setting of advanced HF. Improvement of longitudinal function emerged, beyond the ejection fraction, as an independent predictor of outcomes and could improve the selection of best candidates for the percutaneous correction of functional MR.
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Affiliation(s)
- Antonio De Luca
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
| | - Davide Stolfo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Thomas Caiffa
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Renata Korcova
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Serena Rakar
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Andrea Perkan
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gabriele Secoli
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Bruno Pinamonti
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Marco Merlo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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8
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Usefulness of Addition of Magnetic Resonance Imaging to Echocardiographic Imaging to Predict Left Ventricular Reverse Remodeling in Patients With Nonischemic Cardiomyopathy. Am J Cardiol 2018; 122:490-497. [PMID: 29958711 DOI: 10.1016/j.amjcard.2018.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/16/2022]
Abstract
Defining short-term prognosis in nonischemic cardiomyopathy (NICM) is challenging in clinical practice. Although left ventricular reverse remodeling (LVRR) is a key prognostic marker in NICM there are few parameters able to predict it. We investigated whether a complete structural and functional cardiac magnetic resonance imaging (cMRI) evaluation was incremental to the classic clinical-echocardiographic approach in predicting LVRR in a large cohort of NICM patients receiving evidence-based treatment. Patients with a recent diagnosis of NICM (<3 months) who underwent complete clinical, echocardiographic and cMRI assessment were consecutively enrolled from 2008 to 2016. LVRR was defined as an increase in ≥10 points or normalization of left ventricular ejection fraction, associated with a ≥10% reduction or normalization of left ventricular end-diastolic diameter at midterm (median time 20 months) echocardiographic follow-up. Among 80 NICM patients included in the study, LVRR was observed in 43 (54%). At multivariate analysis, the clinical-echocardiographic evaluation failed to identify independent predictors of LVRR. However, absence of late gadolinium enhancement (odds ratio [OR] 9.07; confidence interval [CI] 2.7 to 13.1; p value 0.0003), left ventricular mass (OR 1.018; CI 1.001 to 1.036; p value 0.045) and peak circumferential strain (OR 1.213; CI 1.011 to 1.470; p value 0.049) assessed by cMRI were independently associated with LVRR. A model for LVRR prediction based on cMRI and clinical-echocardiographic parameters performed significantly better than the clinical-echocardiographic model alone (area under curve 0.84 vs 0.72; p value 0.023). In conclusion, an integrated imaging approach with the addition of a structural and functional cMRI study to the standard-of-care evaluation improves the prediction of LVRR in a large cohort of patients with recently diagnosed NICM receiving evidence-based treatment.
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9
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Unnithan VB, Rowland TW, George K, Lord R, Oxborough D. Left ventricular function during exercise in trained pre-adolescent soccer players. Scand J Med Sci Sports 2018; 28:2330-2338. [PMID: 29968944 DOI: 10.1111/sms.13258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023]
Abstract
It is unclear, what the underlying cardiovascular mechanisms are that give rise to the high level of aerobic fitness seen in youth soccer players. The aim of the study was to evaluate global and regional markers of systolic and diastolic function in a group of pre-adolescent soccer players during an incremental exercise test. Twenty-two, male soccer players (SP) from two professional soccer clubs (age: 12.0 ± 0.3 years) volunteered for the study. Fifteen recreationally active boys (CON), of similar age (age: 11.7 ± 0.2 years) were also recruited. All boys underwent a cycle ergometer test to exhaustion. Cardiac dimensions were determined using M-mode echocardiography. During submaximal and maximal exercise, continuous-wave Doppler ultrasound techniques were used to derive stroke volume (SVIndex). Tissue-Doppler imaging was used to quantify systolic (S'adj) and diastolic function (E; E'adj and E/E') at rest and both submaximal and maximal exercise intensities. Speckle tracking echocardiography was used to determine peak longitudinal ε at submaximal exercise intensities. SP demonstrated significantly (P ≤ 0.05) greater peak VO2 values than CON (SP: 48.0 ± 5.0 vs CON: 40.1 ± 7.5 mL/kg/min). Allometrically scaled to body surface area left ventricular end-diastolic volume (LVEDV) was larger (P ≤ 0.05) in the SP (51.3 ± 9.0) compared to CON (44.6 ± 5.8 mL·BSA1.5 ). At the same relative, submaximal exercise intensities, the SP demonstrated greater SVIndex, cardiac output (QIndex), and E. No differences were noted for peak longitudinal ε during submaximal exercise. Factors that augment pre-load and LV volume appear to determine the superior aerobic fitness seen in the soccer players.
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Affiliation(s)
- Viswanath B Unnithan
- Institute of Clinical Exercise and Health Science, School of Health Sciences, University of the West of Scotland, Hamilton, Scotland
| | - Thomas W Rowland
- Institute of Clinical Exercise and Health Science, School of Health Sciences, University of the West of Scotland, Hamilton, Scotland
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Rachel Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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10
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Claessen G, Schnell F, Bogaert J, Claeys M, Pattyn N, De Buck F, Dymarkowski S, Claus P, Carré F, Van Cleemput J, La Gerche A, Heidbuchel H. Exercise cardiac magnetic resonance to differentiate athlete’s heart from structural heart disease. Eur Heart J Cardiovasc Imaging 2018; 19:1062-1070. [DOI: 10.1093/ehjci/jey050] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/11/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Schnell
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- Department of Physiology, Rennes 1 University, Rennes, France
| | - Jan Bogaert
- University Hospitals Leuven, Leuven, Belgium
- Department of Imaging & Pathology, University of Leuven, Leuven, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Frederik De Buck
- University Hospitals Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Dymarkowski
- University Hospitals Leuven, Leuven, Belgium
- Department of Imaging & Pathology, University of Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Francois Carré
- Department of Physiology, Rennes 1 University, Rennes, France
| | - Johan Van Cleemput
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Andre La Gerche
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Al Bannay R, Husain A, AlJufairi Z. Peripartum cardiomyopathy, what if your patient plans to reconceive? Clin Case Rep 2017; 5:753-756. [PMID: 28588804 PMCID: PMC5458024 DOI: 10.1002/ccr3.935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/20/2017] [Accepted: 01/29/2017] [Indexed: 01/06/2023] Open
Abstract
Patients with peripartum cardiomyopathy (PPCM) often express a desire to conceive again, and the risk of relapse in future pregnancies should be disclosed. No consensus is available that can determine that risk. Adequate contractile reserve, evidenced by a stress echocardiogram (exercise or dobutamine), can identify those with lower relapse risk.
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Affiliation(s)
| | - Aysha Husain
- Cardiology unit Salmaniya Medical Complex Kingdom of Bahrain
| | - Zainab AlJufairi
- Obstetrics and Gynecology Salmaniya Medical Complex Kingdom of Bahrain
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12
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Morimoto R, Okumura T, Hirashiki A, Ishii H, Ichii T, Aoki S, Furusawa K, Hiraiwa H, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Takeshita K, Bando YK, Murohara T. Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy. J Cardiol 2017; 70:303-309. [PMID: 28325519 DOI: 10.1016/j.jjcc.2017.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/17/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events. METHODS There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmax from the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n=15) and who did not receive follow-up echocardiography (n=2), 83 patients were enrolled (52.5±12.3 years). RESULTS During the follow-up period (4.7±2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax (hazard ratio: 1.024, p=0.007) and the symptom duration (hazard ratio: 0.977, p=0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmax cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax≥75.1% group (p=0.045). CONCLUSIONS ΔLVdP/dtmax estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.
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Affiliation(s)
- Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirashiki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeo Ichii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soichiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyosuke Takeshita
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuko K Bando
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Toyama M, Usui A, Abe T, Oshima H, Akita T, Ueda Y. Mitral Valve Surgery for Dilated Cardiomyopathy with Mitral Regurgitation. Asian Cardiovasc Thorac Ann 2016; 14:371-6. [PMID: 17005882 DOI: 10.1177/021849230601400505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Outcomes of surgery for non-ischemic non-valvular dilated cardiomyopathy with associated mitral regurgitation were assessed in 8 consecutive patients who underwent 9 mitral valve operations between 2001 and 2004. Mitral valve replacement was performed when the coaptation depth exceeded 10 mm. Two patients initially underwent mitral valvuloplasty, and 6 underwent valve replacement. One patient had valve replacement soon after valvuloplasty. Transthoracic echocardiography was performed immediately before surgery, before discharge, and during follow-up. Transesophageal echocardiography was carried out intraoperatively to assess valvular and ventricular function. Postoperative mean functional class was significantly better than the preoperative value (2.4 ± 0.7 vs. 3.3 ± 0.7), and the improvement was sustained during follow-up (2.0 ± 0.7). The ejection fraction and left ventricular end-diastolic dimension did not improve. One patient died without leaving hospital and two died during follow-up. The 2- and 4-year survival rates were 75.0% and 37.5%. Mitral valve surgery improved functional class without obvious changes in ejection fraction or left ventricular end-diastolic dimension.
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Affiliation(s)
- Masashi Toyama
- Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
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Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy. Rev Port Cardiol 2016; 35:253-60. [DOI: 10.1016/j.repc.2015.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/21/2015] [Indexed: 11/20/2022] Open
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16
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Houston BA, Tedford RJ. Stressing the stepchild: assessing right ventricular contractile reserve in pulmonary arterial hypertension. Eur Respir J 2015; 45:604-7. [PMID: 25726537 DOI: 10.1183/09031936.00233614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Brian A Houston
- Division of Cardiology, Dept of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- Division of Cardiology, Dept of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Pieles GE, Gowing L, Forsey J, Ramanujam P, Miller F, Stuart AG, Williams CA. The relationship between biventricular myocardial performance and metabolic parameters during incremental exercise and recovery in healthy adolescents. Am J Physiol Heart Circ Physiol 2015; 309:H2067-76. [PMID: 26475589 DOI: 10.1152/ajpheart.00627.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/08/2015] [Indexed: 12/18/2022]
Abstract
Background left ventricular (LV) and right ventricular (RV) myocardial reserve during exercise in adolescents has not been directly characterized. The aim of this study was to quantify myocardial performance response to exercise by using two-dimensional (2-D) speckle tracking echocardiography and describe the relationship between myocardial reserve, respiratory, and metabolic exercise parameters. A total of 23 healthy boys and girls (mean age 13.2 ± 2.7 yr; stature 159.1 ± 16.4 cm; body mass 49.5 ± 16.6 kg; BSA 1.47 ± 0.33 m(2)) completed an incremental cardiopulmonary exercise test (25 W · 3 min increments) with simultaneous acquisition of 2-D transthoracic echocardiography at rest, each exercise stage up to 100 W, and in recovery at 2 min and 10 min. Two-dimensional LV (LV Sl) and RV (RV Sl) longitudinal strain and LV circumferential strain (LV Sc) were analyzed to define the relationship between myocardial performance reserve and metabolic exercise parameters. Participants achieved a peak oxygen uptake (V̇o 2peak) of 40.6 ± 8.9 ml · kg(-1) · min(-1) and a work rate of 154 ± 42 W. LV Sl and LV Sc and RV Sl increased significantly across work rates (P < 0.05). LV Sl during exercise was significantly correlated to resting strain, V̇o 2peak, oxygen pulse, and work rate (0.530 ≤ r ≤ 0.784, P < 0.05). This study identifies a positive and moderate relationship between LV and RV myocardial performance and metabolic parameters during exercise by using a novel methodology. Relationships detected present novel data directly describing myocardial adaptation at different stages of exercise and recovery that in the future can help directly assess cardiac reserve in patients with cardiac pathology.
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Affiliation(s)
- Guido E Pieles
- Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals, Bristol NHS Foundation Trust, and National Institute for Health Research Cardiovascular Biomedical, Research Unit, Bristol Heart Institute, Bristol, United Kingdom
| | - Lucy Gowing
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Jonathan Forsey
- Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals, Bristol NHS Foundation Trust, and
| | - Paramanantham Ramanujam
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Felicity Miller
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - A Graham Stuart
- Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals, Bristol NHS Foundation Trust, and
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
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Houston BA, Tedford RJ. Putting "at-rest" evaluations of the right ventricle to rest: insights gained from evaluation of the right ventricle during exercise in CTEPH patients with and without pulmonary endarterectomy. J Am Heart Assoc 2015; 4:e001895. [PMID: 25801758 PMCID: PMC4392453 DOI: 10.1161/jaha.115.001895] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian A Houston
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD (B.A.H., R.J.T.)
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD (B.A.H., R.J.T.)
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Sharma T, Lau EM, Choudhary P, Torzillo PJ, Munoz PA, Simmons LR, Naeije R, Celermajer DS. Dobutamine stress for evaluation of right ventricular reserve in pulmonary arterial hypertension. Eur Respir J 2014; 45:700-8. [DOI: 10.1183/09031936.00089914] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right ventricular contractile response to pharmacological stress in pulmonary arterial hypertension (PAH) has not been characterised. We evaluated right ventricular contractile reserve in adults with PAH using dobutamine stress echocardiography.16 PAH patients and 18 age-matched controls underwent low-dose dobutamine stress echocardiography. Contractile reserve was assessed by the change (Δ; peak stress minus rest value) in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S′). A subgroup of 13 PAH patients underwent treadmill cardiopulmonary exercise testing for peak oxygen uptake (V′O2peak).At rest, TAPSE and S′ were reduced in the PAH group compared with controls (1.7±0.4 versus 2.4±0.2 cm and 9.7±2.6 versus 12.5±1.2 cm·s−1, respectively; p<0.05). Contractile reserve was markedly attenuated in PAH compared to controls (ΔTAPSE 0.1±0.2 versus 0.6±0.3 cm and ΔS′ 4.6±2.8 versus 11.2±3.6 cm·s−1; p<0.0001). In the sub-group of PAH patients with preserved right ventricular systolic function at rest, contractile reserve remained depressed compared to controls. V′O2peak was significantly correlated with ΔS′ (r=0.87, p=0.0003) and change in stroke volume (r=0.59, p=0.03).Dobutamine stress can reveal sub-clinical reduction in right ventricular contractile reserve in patients with PAH. A correlation with exercise capacity suggests potential clinical value beyond resting measurements.
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20
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Gupta A, Goyal P, Bahl A. Frequency of recovery and relapse in patients with nonischemic dilated cardiomyopathy on guideline-directed medical therapy. Am J Cardiol 2014; 114:883-9. [PMID: 25084692 DOI: 10.1016/j.amjcard.2014.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/16/2022]
Abstract
Several key clinical questions, such as which patients with dilated cardiomyopathy (DC) will recover, how many will relapse, when will they relapse, and predictors of relapse, have sparse data. The present study examines the frequency and predictors of recovery and relapse in patients with DC. One hundred eighty-eight patients of a nonischemic DC cohort having baseline left ventricular ejection fraction (LVEF) ≤ 40% were divided into 3 groups: improved group with sustained recovery of LVEF to >40% with a net increase in LVEF of ≥ 10% from baseline, not-improved group without change or decrease in LVEF compared with that in baseline including patients with an increase in LVEF <10%, and relapsed group with decrease in LVEF ≥ 10% after initial improvement. Follow-up duration was 50 ± 31 months. One hundred ten patients (59%) did not improve. Of the 78 patients (41%) who improved, 50 (64%) had sustained improvement. Remaining 28 (36%) of the 78 improved patients relapsed on further follow-up of 36 ± 25 months. Baseline LVEF was similar in the 3 groups. Mean LVEF increased from 29 ± 8% to 50 ± 7% (p <0.001) in the improved group, changed from 27 ± 9% to 25 ± 9% (p = 0.95) in the not-improved group, and, after increasing from 30 ± 7% to 52 ± 6%, it decreased to 34 ± 9% (p <0.001) in the relapsed group. Multivariate analysis showed that the only variable associated with recovery of LVEF was shorter QRS duration (odds ratio 0.31, 95% confidence interval 0.15 to 0.67, p = 0.003). Recurrence of left ventricular systolic dysfunction was associated with long QRS duration (odds ratio 3.52, 95% confidence interval 1.27 to 9.76, p = 0.01). In conclusion, with currently recommended medical therapy, 1/4 of patients with nonischemic DC have sustained improvement, and >1/3 of those who improve relapse. QRS duration predicted both recovery and relapse. The survival rate of patients in the improved group was significantly better than that in the other 2 groups (p = 0.03, log-rank).
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Affiliation(s)
- Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Puneet Goyal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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21
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Messer AE, Marston SB. Investigating the role of uncoupling of troponin I phosphorylation from changes in myofibrillar Ca(2+)-sensitivity in the pathogenesis of cardiomyopathy. Front Physiol 2014; 5:315. [PMID: 25202278 PMCID: PMC4142463 DOI: 10.3389/fphys.2014.00315] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/02/2014] [Indexed: 12/12/2022] Open
Abstract
Contraction in the mammalian heart is controlled by the intracellular Ca(2+) concentration as it is in all striated muscle, but the heart has an additional signaling system that comes into play to increase heart rate and cardiac output during exercise or stress. β-adrenergic stimulation of heart muscle cells leads to release of cyclic-AMP and the activation of protein kinase A which phosphorylates key proteins in the sarcolemma, sarcoplasmic reticulum and contractile apparatus. Troponin I (TnI) and Myosin Binding Protein C (MyBP-C) are the prime targets in the myofilaments. TnI phosphorylation lowers myofibrillar Ca(2+)-sensitivity and increases the speed of Ca(2+)-dissociation and relaxation (lusitropic effect). Recent studies have shown that this relationship between Ca(2+)-sensitivity and TnI phosphorylation may be unstable. In familial cardiomyopathies, both dilated and hypertrophic (DCM and HCM), a mutation in one of the proteins of the thin filament often results in the loss of the relationship (uncoupling) and blunting of the lusitropic response. For familial dilated cardiomyopathy in thin filament proteins it has been proposed that this uncoupling is causative of the phenotype. Uncoupling has also been found in human heart tissue from patients with hypertrophic obstructive cardiomyopathy as a secondary effect. Recently, it has been found that Ca(2+)-sensitizing drugs can promote uncoupling, whilst one Ca(2+)-desensitizing drug Epigallocatechin 3-Gallate (EGCG) can reverse uncoupling. We will discuss recent findings about the role of uncoupling in the development of cardiomyopathies and the molecular mechanism of the process.
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Affiliation(s)
- Andrew E. Messer
- National Heart & Lung Institute, Imperial College LondonLondon, UK
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22
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Parthenakis FI, Patrianakos AP, Haritakis CN, Zacharis EA, Nyktari EG, Vardas PE. NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. Eur J Heart Fail 2014; 10:475-81. [DOI: 10.1016/j.ejheart.2008.03.003] [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] [Received: 09/07/2007] [Revised: 01/28/2008] [Accepted: 03/06/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | | | - Eva G. Nyktari
- Department of Cardiology; Heraklion University Hospital; Crete Greece
| | - Panos E. Vardas
- Department of Cardiology; Heraklion University Hospital; Crete Greece
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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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24
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Okumura T, Hirashiki A, Yamada S, Funahashi H, Ohshima S, Kono Y, Cheng XW, Takeshita K, Murohara T. Association between cardiopulmonary exercise and dobutamine stress testing in ambulatory patients with idiopathic dilated cardiomyopathy: a comparison with peak VO₂ and VE/VCO₂ slope. Int J Cardiol 2013; 162:234-9. [PMID: 21641058 DOI: 10.1016/j.ijcard.2011.05.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/18/2011] [Accepted: 05/13/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both peak VO(2) and VE/VCO(2) slope are considered to be useful predictors of cardiovascular events. The left ventricular (LV) response to dobutamine stress testing (DST) also provides useful prognostic information. However, the relationship between these variables has not been fully investigated. Therefore, the aim of this study is to investigate the association between myocardial contractile reserve measured by DST and cardiopulmonary exercise testing (CPX) variables in patients with idiopathic dilated cardiomyopathy (IDCM). METHODS Thirty-eight patients were subjected to CPX as well as cardiac catheterization for measurement of LV pressure. The maximum first derivative of LV pressure (LV dP/dt(max)) was measured at baseline and during dobutamine infusion at incremental doses of 5, 10, and 15 μg kg(-1)min(-1). LV dP/dt(max) at baseline and the percentage increase in LV dP/dt(max) (ΔLV dP/dt(max)) induced by DST served as indices of LV contractility and myocardial contractile reserve, respectively. RESULTS Peak VO(2), and VE/VCO(2) slope were 18.6 mL kg(-1)min(-1) and 32.3, respectively. Peak VO(2) was not correlated with LV dP/dt(max) at baseline. However, peak VO(2) was significantly correlated with ΔLV dP/dt(max), and the correlation became more pronounced as the dose of dobutamine was increased. There was no correlation between VE/VCO(2) slope and ΔLV dP/dt(max). Multivariate regression analysis revealed that ΔLV dP/dt(max) was independently correlated with peak VO(2) (p=0.011). CONCLUSIONS Peak VO(2), but not VE/VCO(2) slope, may reflect myocardial contractile reserve in ambulatory patients with IDCM. This study population is small, and therefore large confirmatory studies are needed.
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Affiliation(s)
- Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Lee JH, Yang DH, Choi WS, Kim KH, Park SH, Bae MH, Lee JH, Park HS, Cho Y, Chae SC, Jun JE. Prediction of improvement in cardiac function by high dose dobutamine stress echocardiography in patients with recent onset idiopathic dilated cardiomyopathy. Int J Cardiol 2013; 167:1649-50. [DOI: 10.1016/j.ijcard.2012.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 11/01/2012] [Indexed: 11/25/2022]
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26
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Diagnostik und Therapie der chronischen Myokardischämie. Herz 2013; 38:334-43. [DOI: 10.1007/s00059-013-3813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Pingitore A, Aquaro GD, Lorenzoni V, Gallotta M, De Marchi D, Molinaro S, Cospite V, Passino C, Emdin M, Lombardi M, Lionetti V, L'Abbate A. Influence of preload and afterload on stroke volume response to low-dose dobutamine stress in patients with non-ischemic heart failure: A cardiac MR study. Int J Cardiol 2013; 166:475-81. [DOI: 10.1016/j.ijcard.2011.11.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 11/01/2011] [Accepted: 11/24/2011] [Indexed: 01/25/2023]
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Grimm W, Timmesfeld N, Efimova E. Left ventricular function improvement after prophylactic implantable cardioverter-defibrillator implantation in patients with non-ischaemic dilated cardiomyopathy. Europace 2013; 15:1594-600. [DOI: 10.1093/europace/eut097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Cadeddu C, Nocco S, Piano D, Deidda M, Cossu E, Baroni MG, Mercuro G. Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects. Cardiovasc Diabetol 2013; 12:66. [PMID: 23590337 PMCID: PMC3637195 DOI: 10.1186/1475-2840-12-66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/29/2013] [Indexed: 11/23/2022] Open
Abstract
Background Insulin resistance (IR) is currently considered a crucial cardiovascular (CV) risk factor, which seems to play a dominant role in the evolution toward cardiac and vascular impairment. Early IR-induced cardiac dysfunction can be assessed by Doppler-derived myocardial systolic strain rate (SR) index, measured at baseline and after dobutamine stress echocardiography (DSE). Methods Thirty IR patients (HOMA-IR = 7 ± 5.2, age 52.6 ± 2.1 years), and 20 healthy, age and sex matched controls were studied. IR had been diagnosed in all patients in the 3 months preceding the study. Dobutamine echocardiography was performed in all subjects to exclude ischemic heart disease, and left ventricular contractile reserve (LVCR) was then assessed. LVCR was evaluated as an increase in the peak of an average longitudinal SR, measured in the basal and mid segments of 2 and 4 chamber ventricular walls. Results No significant differences between the 2 groups were revealed by baseline echocardiography. In contrast, after DSE a significant decrease of Delta SR was found in the IR group in comparison to the controls (0.54 ± 0.31 s−1vs 1.14 ± 0.45 s−1; p < 0.0001). Conclusions Our results show that IR, even if isolated and arising within a short time period, not only represents the initial phase of future diabetes, but may adversely affect heart function, as evidenced by the depressed LVCR. Our data strengthen the need for attention to be paid to IR state and for an early therapeutic approach.
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Verna E, Ghiringhelli S, Scotti S, Caravati F. Evaluation of baseline contractile reserve vs dyssynchrony as a predictor of functional improvement and long term outcome after resynchronization pacing therapy: a radionuclide stress study. J Nucl Cardiol 2012; 19:53-62. [PMID: 21769704 DOI: 10.1007/s12350-011-9421-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
Abstract
AIM To assess the predictive value of baseline ventricular dyssynchrony and myocardial contractile reserve (mCR) in identifying responders to cardiac resynchronization therapy (CRT). METHODS We prospectively studied 57 patients selected for CRT according to current recommendations. Regional dyssynchrony was evaluated by parametric phase imaging of ecg-gated equilibrium radionuclide angiography (ERNA). The mean inter-ventricular phase delay and the standard deviation to mean left ventricular (LV) phase angle were used as a measure of inter- and intra-ventricular dyssynchrony, respectively. Change in LV ejection fraction (LVEF) during low-dose dobutamine (LDD) was measured to assess mCR. ERNA was repeated at 6 months to evaluate changes in LVEF after CRT. Combined end-points of re-hospitalization for heart failure, heart transplantation, and cardiac death were assessed over a period of 76 months (mean 43 ± 31). RESULTS Baseline dyssynchrony was present in most patients (85%). After CRT only one half of patients showed a reduction in intra-ventricular dyssynchrony and 33% an increase in LVEF by >5%. Improvement of LVEF was not predicted by baseline LVEF, clinical presentation, dyssynchrony parameters or QRS duration. There was a significant relationship between changes in LVEF during LDD testing and after CRT (r = 0.65; P < .0001). Logistic regression analysis identified mCR as independent predictor of improvement in LVEF (P = .039; OR = 3.84; CI 95% = 1.06-13.9), resynchronization (P = .046; OR = 4.20; CI 95% = 1.03-17.2), and event-free survival (P = .002; OR = 0.10; CI 95% = 0.02-0.43). CONCLUSIONS In patients with left ventricular dysfunction and baseline dyssynchrony as assessed by ERNA, evaluation of mCR during LDD may help predicting functional improvement and selecting potential responders to CRT.
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Affiliation(s)
- Edoardo Verna
- Department of Cardiology, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Viale Borri 56, 21100 Varese, Italy.
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Wever-Pinzon O, Bangalore S, Romero J, Enciso JS, Chaudhry FA. Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy: a dobutamine stress echocardiography study. JACC Cardiovasc Imaging 2011; 4:1231-8. [PMID: 22172778 PMCID: PMC3595113 DOI: 10.1016/j.jcmg.2011.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 09/07/2011] [Accepted: 09/09/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether inotropic contractile reserve (ICR) during dobutamine stress echocardiography (DSE) could risk-stratify patients with human immunodeficiency virus (HIV) cardiomyopathy and predict improvement of left ventricular ejection fraction (LVEF). BACKGROUND HIV cardiomyopathy is an important cause of heart failure and death. ICR is associated with better survival and improvement of LVEF in patients with ischemic and nonischemic cardiomyopathies. However, the prognostic value of ICR in patients with HIV cardiomyopathy is unknown. METHODS Patients with HIV cardiomyopathy and a LVEF <45% who were referred for DSE were enrolled. ICR was evaluated by the delta wall motion score index (ΔWMSI), calculated as the difference between rest and peak WMSI. Patients were followed for cardiac death and change in LVEF on follow-up. RESULTS Sixty patients (75% men; age, 54 ± 9 years) with HIV cardiomyopathy (mean LVEF, 28 ± 11%) formed the study group. After 2.4 ± 2.1 years, 11 cardiac deaths occurred (event rate of 7.6%/year). A receiver-operating characteristic curve identified a ΔWMSI of 0.38 as an optimal cut point for the presence of ICR, with a specificity of 88% and a sensitivity of 73% for the prediction of cardiac death. On univariable analysis, the absence of ICR (hazard ratio: 6.6; 95% confidence interval: 1.93 to 22.62; p = 0.003) and New York Heart Association functional class IV (hazard ratio: 7.2; 95% confidence interval: 2.20 to 23.65; p = 0.001) were the only predictors of cardiac death. After 2.1 ± 1.8 years, 41 patients had a follow-up echocardiogram. LVEF improvement from baseline occurred in 23 patients (56%), more so in patients with ICR than without ICR. A ΔWMSI of 0.59 predicted improvement in the LVEF with a specificity of 78% and a sensitivity of 74%. CONCLUSIONS The presence of ICR during DSE can risk-stratify and predict subsequent improvement in LVEF in patients with HIV cardiomyopathy.
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Affiliation(s)
- Omar Wever-Pinzon
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Jorge Romero
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
| | - Jorge Silva Enciso
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
| | - Farooq A. Chaudhry
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
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The concept of ventricular reserve in heart failure and pulmonary hypertension: an old metric that brings us one step closer in our quest for prediction. Curr Opin Cardiol 2011; 26:123-31. [PMID: 21297465 DOI: 10.1097/hco.0b013e3283437485] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ventricular reserve is emerging a strong predictor of outcome in heart failure and cardiovascular disease. Ventricular reserve is the term used to describe the extent of increase or change in ventricular function that occurs during exercise or pharmacological stress (typically with dobutamine). RECENT FINDINGS The interest in ventricular reserve lies in its ability to assess viability in coronary artery disease, to predict clinical outcome and response to therapy in patients with heart failure and to screen patients for early cardiovascular disease. SUMMARY In this paper, we will review the emerging role of ventricular reserve in heart failure and pulmonary hypertension. We will also explore the mechanisms involved in the pathophysiology of impaired ventricular reserve and discuss future directions of research in the field.
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Altered microRNA expression associated with reduced catecholamine sensitivity in patients with chronic heart failure. J Cardiol 2011; 57:338-44. [DOI: 10.1016/j.jjcc.2011.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/05/2011] [Accepted: 01/12/2011] [Indexed: 12/18/2022]
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Dini FL. Assessment of cardiac dynamics during stress echocardiography by the peak power output-to-left ventricular mass ratio. Future Cardiol 2011; 7:347-56. [DOI: 10.2217/fca.11.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Peak cardiac power-to-mass and peak mass-to-power are variables that couple cardiac power output with left ventricular (LV) mass at peak exercise or during maximal inotropic stimulation. Quantitative stress echocardiography enables the calculation of power output according to the formula: 133 × 10–6 × stroke volume per second (ml) × mean blood pressure (BP; mmHg) × heart rate. Power-to-mass may be calculated as LV power output per 100 g of LV mass: 100 g × LV power output divided by LV mass (W/100 g). Conversely, mass-to-power may be estimated by dividing LV mass index by LV power output (g/m2/W). With a little rearrangement of the formulas we can write: power-to-mass (W/100 g) = 0.222 × cardiac output (l/min) × mean BP (mmHg)/LV mass (g) and mass-to-power (g/m2/W) = LV mass index/0.00222 × cardiac output (l/min) × mean BP (mmHg). These parameters reflect the energy delivery of ventricular myocardium with respect to potential energy that is stored in LV mass. The assessment of peak power-to-mass and peak mass-to-power indices may be useful to distinguish compensatory versus maladaptive remodeling in patients with LV dysfunction. When the integrity of myocardial structure is compromised, a disproportion becomes apparent between maximal cardiac power output and LV mass and this leads to either a reduction of peak power-to-mass or an increase of peak mass-to-power. Preliminary reports have demonstrated the usefulness and the prognostic value of peak power-to-mass and peak mass-to-power in patients with LV systolic dysfunction and coronary artery disease.
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Affiliation(s)
- Frank L Dini
- Cardiac, Thoracic & Vascular Department, Unità Operativa Cardiologia Universitaria 1, Dipartimento Cardio, Toracico e Vascolare, Azienda Ospedaliera-Universitaria Pisana, Via Paradisa, 2, 56124 – Pisa, Italy
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Chaudhry FA, Shah A, Bangalore S, DeRose J, Steinberg JS. Inotropic Contractile Reserve and Response to Cardiac Resynchronization Therapy in Patients with Markedly Remodeled Left Ventricle. J Am Soc Echocardiogr 2011; 24:91-7. [DOI: 10.1016/j.echo.2010.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Indexed: 01/24/2023]
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Favorable outcome of pediatric fulminant myocarditis supported by extracorporeal membranous oxygenation. Pediatr Cardiol 2010; 31:1059-63. [PMID: 20734191 DOI: 10.1007/s00246-010-9765-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
Abstract
Myocarditis among pediatric patients varies in severity from mild disease to a fulminant course with overwhelming refractory shock and a high risk of death. Because the disease is potentially reversible, it is reasonable to deploy extracorporeal membranous oxygenation (ECMO) to bridge patients until recovery or transplantation. This study aimed to review the course and outcome of children with acute fulminant myocarditis diagnosed by clinical and echocardiographic data only who were managed by ECMO because of refractory circulatory collapse. A chart review of a single center identified 12 children hospitalized over an 8-year period who met the study criteria. Data were collected on demographics, diagnosis, disease course, and outcome. The patients ranged in age from 20 days to 8 years (25.5 ± 29.6 months). Echocardiography showed a severe global biventricular decrease in myocardial function, with a shortening fraction of 12% or less. Ten children (83.3%) were weaned off extracorporeal support after 100-408 h (mean, 209.9 ± 82.4 h) and discharged home. Two patients died: one due to multiorgan failure and one due to sustained refractory heart failure. During a long-term follow-up period, all survivors showed normal function in daily activities and normal myocardial function. The study showed that ECMO can be safely and successfully used for children with acute fulminant myocarditis diagnosed solely on clinical and radiographic grounds who need mechanical support. These patients usually have a favorable outcome, regaining normal or near normal heart function without a need for heart transplantation.
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Stipac AV, Otasević P, Popović ZB, Cvorović V, Putniković B, Stanković I, Nesković AN. Prognostic significance of contractile reserve assessed by dobutamine-induced changes of Tei index in patients with idiopathic dilated cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:264-70. [PMID: 19995800 DOI: 10.1093/ejechocard/jep208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alja Vlahović Stipac
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, 11080 Belgrade, Serbia.
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Kobayashi M, Izawa H, Cheng XW, Asano H, Hirashiki A, Unno K, Ohshima S, Yamada T, Murase Y, Kato TS, Obata K, Noda A, Nishizawa T, Isobe S, Nagata K, Matsubara T, Murohara T, Yokota M. Dobutamine stress testing as a diagnostic tool for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy. JACC Cardiovasc Imaging 2009; 1:718-26. [PMID: 19356507 DOI: 10.1016/j.jcmg.2008.04.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 03/27/2008] [Accepted: 04/17/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We performed dobutamine stress testing for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy (DCM). BACKGROUND Catecholamine sensitivity is reduced in failing hearts as a result of myocardial abnormalities in the beta-adrenergic receptor signaling pathway. However, little is known about adrenergic myocardial contractile reserve in asymptomatic or mildly symptomatic patients with DCM. METHODS The maximal first derivative of left ventricular pressure (LV dP/dt(max)) was determined during infusion of dobutamine (10 microg kg(-1) min(-1)) in 46 asymptomatic or mildly symptomatic (New York Heart Association functional class I or II) patients with DCM. The expression of messenger ribonucleic acid (mRNA) for contractile regulatory proteins in endomyocardial biopsy specimens was quantified by reverse transcription and real-time polymerase chain reaction analysis. Plasma norepinephrine levels were measured in all patients and [(123)I]metaiodobenzylguanidine (MIBG) scintigraphy performed. RESULTS Patients were classified into 3 groups based on the percentage increase in LV dP/dt(max) induced by dobutamine (DeltaLV dP/dt(max)) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): DeltaLV dP/dt(max) >100% and LVEF >25%; group IIa (n = 17): DeltaLV dP/dt(max) <or=100% and LVEF > 25%; and group IIb (n = 11): DeltaLV dP/dt(max) <or=100% and LVEF <or=25%. The amounts of beta(1)-adrenergic receptor, sarcoplasmic reticulum Ca(2+)-adenosine triphosphatase, and phospholamban mRNA were significantly smaller in groups IIa and IIb than in group I. The plasma norepinephrine level was increased and the delayed heart/mediastinum count ratio in MIBG scintigraphy was decreased in both groups IIa and IIb. CONCLUSIONS Dobutamine stress testing is a useful diagnostic tool for identifying reduced adrenergic myocardial contractile reserve related to altered myocardial expression of beta(1)-adrenergic receptor, sarcoplasmic reticulum Ca(2+)-adenosine triphosphatase, and phospholamban genes even in asymptomatic or mildly symptomatic patients with DCM.
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Affiliation(s)
- Masakazu Kobayashi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Francis GS, Desai MY. Contractile Reserve: Are We Beginning to Understand It? JACC Cardiovasc Imaging 2008; 1:727-8. [DOI: 10.1016/j.jcmg.2008.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 07/11/2008] [Accepted: 09/03/2008] [Indexed: 01/08/2023]
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Marwick TH, Schwaiger M. The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 1. Circ Cardiovasc Imaging 2008; 1:58-69. [DOI: 10.1161/circimaging.108.792408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas H. Marwick
- From the University of Queensland (T.H.M.), Brisbane, Australia, and Technische Universität of Munich (M.S.), Munich, Germany
| | - Markus Schwaiger
- From the University of Queensland (T.H.M.), Brisbane, Australia, and Technische Universität of Munich (M.S.), Munich, Germany
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41
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Ciampi Q, Bianchi S, Porta MD, Petruzziello B, Caputo S, Pezza B, Villari B. Role of dobutamine stress echocardiography in resynchronization therapy in a patient with heart failure secondary to radiotherapy for Hodgkin's disease and ventilatory and inotropic dependence. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2008; 14:149-152. [PMID: 18550926 DOI: 10.1111/j.1751-7133.2008.08015.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Fatebenefratelli Hospital, Benevento, Italy.
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Täng MS, Råmunddal T, Lindbom M, Omerovic E. Native cardiac reserve predicts survival in acute post infarction heart failure in mice. Cardiovasc Ultrasound 2007; 5:46. [PMID: 18053159 PMCID: PMC2217517 DOI: 10.1186/1476-7120-5-46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 12/02/2007] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Cardiac reserve can be used to predict survival and outcome in patients with heart failure. The aim of this study was to investigate if native cardiac reserve could predict survival after myocardial infarction (MI) in mice. METHOD We investigated 27 healthy C57Bl6 mice (male symbol10-12 weeks old) with echocardiography using a high-frequency 15-MHz linear transducer. Investigations were performed both at rest and after pharmacological stress induced by dobutamine (1 mug/g body weight i.p.). The day after the echocardiography examination, a large MI was induced by ligation of the left anterior descending (LAD) coronary artery for evaluation of mortality rate. RESULTS Two weeks after induction of MI, 7 mice were alive (26%). Evaluation of the difference between the surviving and deceased animals showed that the survivors had a better native ability to increase systolic performance (DeltaLVESd -1.86 vs -1.28mm p = 0.02) upon dobutamine challenge, resulting in a better cardiac reserve (DeltaFS 37 vs 25% p = 0.02 and DeltaCO 0.27 vs -0.10 ml/min p = 0.02) and a better chronotropic reserve (DeltaR-R interval -68 vs -19 ms p < 0.01). A positive relationship was found between ability to survive and both cardiac (p < 0.05) and chronotropic reserve (p < 0.05) when the mice were divided into three groups: survivors, surviving < 7 days, and surviving < 1 day. CONCLUSION We conclude that before MI induction the surviving animals had a better cardiac function compared with the deceased. This indicates that native cardiac and chronotropic reserve may be an important determinant and predictor of survival in the setting of large MI and post-infarction heart failure.
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Affiliation(s)
- Margareta Scharin Täng
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Pratali L, Otasevic P, Neskovic A, Molinaro S, Picano E. Prognostic Value of Pharmacologic Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy: A Prospective, Head-to-Head Comparison Between Dipyridamole and Dobutamine Test. J Card Fail 2007; 13:836-42. [DOI: 10.1016/j.cardfail.2007.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/06/2007] [Accepted: 07/30/2007] [Indexed: 11/26/2022]
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Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007; 20:1021-41. [PMID: 17765820 DOI: 10.1016/j.echo.2007.07.003] [Citation(s) in RCA: 510] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia A Pellikka
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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45
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Rigo F, Gherardi S, Galderisi M, Sicari R, Picano E. The independent prognostic value of contractile and coronary flow reserve determined by dipyridamole stress echocardiography in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2007; 99:1154-8. [PMID: 17437747 DOI: 10.1016/j.amjcard.2006.11.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 11/24/2006] [Accepted: 11/24/2006] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in assessing inotropic response in patients with idiopathic dilated cardiomyopathy (IDC). One hundred thirty-two patients with IDC (90 men; mean age 62 +/- 11 years) were evaluated by transthoracic dipyridamole (0.84 mg/kg in 10 minutes) stress echocardiography. All patients had ejection fractions <40% (mean 33 +/- 7%) and angiographically normal coronary arteries, with New York Heart Association class <or=III. CFR was assessed in the left anterior descending coronary artery by pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. Inotropic reserve was identified as rest-stress variation in wall motion score index >0.25. All patients were followed for a median of 24 months. Mean CFR was 2.0 +/- 0.5. On individual patient analysis, 48 patients had normal CFR (>2), and 84 had abnormal CFR. The mean wall motion score index at rest was 2.0 +/- 0.33 and decreased to 1.8 +/- 0.4 at peak dipyridamole dose (p <0.000). Forty-two patients (32%) had inotropic reserve. During follow-up, 19 patients died, and 34 showed worsening of New York Heart Association class. The worst outcomes were observed in those patients with abnormal CFR and no inotropic reserve with high-dose dipyridamole. In a Cox model, mitral insufficiency (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.1 to 2.8), New York Heart Association class (HR 2.0, 95% CI 1.1 to 3.7), abnormal CFR (HR 2.8, 95% CI 1.0 to 8.5), wall motion score index at rest (HR 3.5, 95% CI 1.3 to 9.8), and the absence of inotropic reserve with high-dose dipyridamole (HR 2.3, 95% CI 1.06 to 5.1) were independent predictors of survival. In conclusion, in patients with IDC, CFR is often impaired. Reduced CFR and the absence of an inotropic response during vasodilator stress are additive in predicting a worse prognosis.
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Affiliation(s)
- Fausto Rigo
- Cardiology Division, Umberto I Hospital, Mestre-Venice, Cesena, Italy
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Skouri HN, Dec GW, Friedrich MG, Cooper LT. Noninvasive imaging in myocarditis. J Am Coll Cardiol 2006; 48:2085-93. [PMID: 17112998 DOI: 10.1016/j.jacc.2006.08.017] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 07/05/2006] [Accepted: 07/05/2006] [Indexed: 11/22/2022]
Abstract
Increased recognition of the role of inflammation in acute and chronic dilated cardiomyopathy has revived an interest in noninvasive imaging for detection of myocarditis. Diagnostic strategies that are based on molecular imaging promise to further advance our understanding and improve diagnostic precision. This article reviews the strengths and limitations of common clinical tests used for the diagnosis of myocarditis, with a focus on the emerging role of cardiovascular magnetic resonance imaging. Novel imaging modalities that are currently in preclinical development are discussed with recommendations for future clinical research.
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Affiliation(s)
- Hadi N Skouri
- Cardiovascular Department, Mayo Clinic, Rochester, Minnesota 55905, USA
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Yu CM, Zhang Q, Yip GWK, Chan YS, Lee PW, Wu LW, Lam YY, Kum LCC, Chan HCK, Chan S, Fung JWH. Are left ventricular diastolic function and diastolic asynchrony important determinants of response to cardiac resynchronization therapy? Am J Cardiol 2006; 98:1083-7. [PMID: 17027576 DOI: 10.1016/j.amjcard.2006.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 05/09/2006] [Accepted: 05/09/2006] [Indexed: 11/16/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been shown to reduce symptoms and reverse left ventricular (LV) remodeling. It is not known, however, whether diastolic function will improve after CRT and diastolic asynchrony will predict LV reverse remodeling. Seventy-six patients (mean age 65 +/- 12 years, 74% men) who received CRT were studied at baseline and after 3 months. Diastolic function was assessed by transmitral Doppler and tissue Doppler imaging. LV systolic and diastolic asynchrony were assessed by the time to peak myocardial contraction (Ts) and early diastolic relaxation (Te) using the 6 basal, 6 mid-segmental model. There were 42 responders (55%) with LV reverse remodeling (defined as a reduction of LV end-systolic volume >or=15%). Parameters of systolic function were significantly improved only in the responders. For diastolic function, there were reductions of transmitral E velocity in the 2 groups, without any change in atrial velocity or the E/A ratio. Tissue Doppler imaging revealed that myocardial early diastolic velocity was unchanged in responders but was significantly worsened in nonresponders. The systolic asynchrony index (the SD of Ts of 12 LV segments) correlated significantly with LV reverse remodeling (r = -0.64, p <0.001) but not the diastolic asynchrony index (the SD of Te of 12 LV segments) (r = -0.10, p = NS). The systolic asynchrony index was the only independent predictor of reverse remodeling (beta = -0.99, 95% confidence interval -1.41 to -0.58, p <0.001). In conclusion, CRT improves systolic function and systolic asynchrony but has a neutral effect on diastolic function and diastolic asynchrony. LV reverse remodeling response is determined by the severity of prepacing systolic asynchrony but not diastolic asynchrony or the diastolic filling pattern.
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Affiliation(s)
- Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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Marchlinski FE, Jessup M. Timing the implantation of implantable cardioverter-defibrillators in patients with nonischemic cardiomyopathy. J Am Coll Cardiol 2006; 47:2483-5. [PMID: 16781377 DOI: 10.1016/j.jacc.2006.01.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 01/24/2006] [Accepted: 01/24/2006] [Indexed: 12/15/2022]
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50
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Civelli M, Cardinale D, Martinoni A, Lamantia G, Colombo N, Colombo A, Gandini S, Martinelli G, Fiorentini C, Cipolla CM. Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity. Int J Cardiol 2006; 111:120-6. [PMID: 16242796 DOI: 10.1016/j.ijcard.2005.07.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 07/29/2005] [Accepted: 07/30/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDC) is utilized in high-risk cancer patients. This type of treatment may induce cardiac toxicity which becomes clinically evident weeks or months after HDC. Hence, the possibility of early identification of patients who will develop cardiac impairment is strategic for its clinical implications. The aim of this study was to identify possible early changes of left ventricular contractile reserve (LVCR) in cancer patients undergoing HDC, as well as to evaluate the relevance of such changes as predictors of chemotherapy-induced cardiotoxicity. METHODS In forty-nine female patients scheduled for HDC, due to poor-prognosis breast cancer, dobutamine stress echocardiography (DSE) was performed, before each of the three HDC cycles (C1, C2, C3), and 1, 4, and 7 months after the end of chemotherapy. According to rest left ventricular ejection fraction (LVEF) evaluated within 18 months after HDC (f-LVEF), patients were allocated to Group A (LVEF < 50% and >10 absolute units reduction) and to Group B (LVEF > or = 50%). RESULTS Rest LVEF didn't show any significant difference between the two groups except at f-LVEF. Peak LVEF and LVCR significantly decreased in Group A only, starting from C3. At C3, a > or = 5 units fall in LVCR was found to be predictive for f-LVEF drop below 50%. CONCLUSIONS In patients undergoing HDC, low-dose DSE allows the early identification of patients at a high risk of developing cardiac dysfunction.
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Affiliation(s)
- Maurizio Civelli
- Cardiology Unit, European Institute of Oncology, University of Milan, Italy
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