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Lee SH, Ahn HJ, Kim GM, Yang M, Kim JA, Lee SM, Heo BY, Choi JW, Lee JY, Jeong H, Kim J. Effect of Sevoflurane Anesthesia on Diastolic Function: A Prospective Observational Study. Anesth Analg 2024:00000539-990000000-00768. [PMID: 38412113 DOI: 10.1213/ane.0000000000006924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND The effect of sevoflurane on left ventricular diastolic function is not well understood. We hypothesized that parameters of diastolic function may improve under sevoflurane anesthesia in patients with preexisting diastolic dysfunction compared to patients with normal diastolic function. METHODS This observational study included 60 patients undergoing breast surgery or laparoscopic cholecystectomy. Patients were assigned to diastolic dysfunction (n = 34) or normal (n = 26) groups of septal e' < 8 or ≥ 8.0 cm/s on the first thoracic echocardiography (TTE) performed before anesthesia. During anesthesia, sevoflurane was maintained at 1 to 2 minimum alveolar concentration (MAC) to maintain the bispectral index at 40 to 50. At the end of surgery, the second TTE was performed under 0.8 to 1 MAC of sevoflurane with the patient breathing spontaneously without ventilator support. Primary end point was the percentage change (Δ) of e' on 2 TTEs (Δe'). Secondary end points were ΔE/e', Δleft atrial volume index (ΔLAVI), and Δtricuspid regurgitation maximum velocity (ΔTR Vmax). These percentage changes (Δ) were compared between diastolic dysfunction and normal groups. RESULTS e' (Δe': 30 [6, 64] vs 0 [-18, 11]%; P < .001), mitral inflow E wave velocity (E), mitral inflow E/A ratio (E/A), and mitral E velocity deceleration time (DT) improved significantly in diastolic dysfunction group compared to normal group. LAVI decreased in diastolic dysfunction group but did not reach statistical significance between the 2 groups (ΔLAVI:-15 [-31, -3] vs -4 [-20, 10]%, P = .091). ΔE/e' was not different between the 2 groups (11 [-16, 26] vs 12 [-9, 22]%, P = .853) (all: median [interquartile range, IQR]). TR was minimal in both groups. CONCLUSIONS In this study, echocardiographic parameters of diastolic function, including septal e', E, E/A, and DT, improved with sevoflurane anesthesia in patients with preexisting diastolic dysfunction, but remained unchanged in patients with normal diastolic function.
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Affiliation(s)
- Sang Hyun Lee
- From the Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chen J, Song D, Sun Z, Zhang Y, Zhang L. Effects of lung resection on heart structure and function: A tissue Doppler ultrasound survey of 43 cases. Biomed Rep 2024; 20:11. [PMID: 38124772 PMCID: PMC10731166 DOI: 10.3892/br.2023.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Changes in heart structure and function after lung resection in patients with lung cancer are challenging to manage. Therefore, a non-invasive and reliable measurement tool to gauge such changes is critical. The purpose of the present study was to compare cardiological changes before and after lung resection using tissue Doppler imaging (TDI). A total of 43 patients (19 men and 24 women) with primary non-small cell lung cancer (n=37) and metastatic cancer in the lungs (n=6) were enrolled in the study.nTDI was used to determine the thickness of the ascending aorta, the open size of the ascending valve, the anterior-oposterior diameters of the left atrium and left ventricle, and the thickness of the ventricular septum and right ventricle before and after lung resection. Left ventricular (LV) ejection fraction (EF), pulmonary valve flow rate, tricuspid annular or mitral leaflet tip early (E) peak/late (A) diastolic blood flow velocities, tricuspid regurgitation flow, the lateral mitral annulus early (e') diastolic velocity and mitral E/e' ratio were used to determine LV filling pressure. Results revealed no significant differences between male and female patients in terms of the open size of the ascending valve, the anterior-posterior diameter of the left ventricle and the mitral E/e' ratio. Significant differences were found in the width of the ascending aorta, anterior-posterior diameter of the left atrium, width of the LV septum and right ventricular (RV) diameter before and after lung resection. Finally, there were significantchanges in EF and tricuspid pressure. The results indicated that TDI was useful as a non-invasive method for assessing left and right heart function following lung resection. The LV and RV dimensions were affected, but LV filling pressure was preserved after lobectomy.
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Affiliation(s)
- Jinfeng Chen
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Dongdong Song
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Zhiying Sun
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Yunxiao Zhang
- Department of Anesthesia, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Lijian Zhang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
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Winsløw U, Sakthivel T, Zheng C, Philbert B, Vinther M, Frandsen E, Iversen K, Bundgaard H, Jøns C, Risum N. The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy. Int J Cardiovasc Imaging 2023; 39:2097-2106. [PMID: 37470856 PMCID: PMC10673982 DOI: 10.1007/s10554-023-02914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Plasma potassium (p-K) in the high-normal range has been suggested to reduce risk of cardiovascular arrythmias and mortality through electrophysiological and mechanical effects on the myocardium. In this study, it was to investigated if increasing p-K to high-normal levels improves systolic- and diastolic myocardial function in patients with low-normal to moderately reduced left ventricular ejection fraction (LVEF). The study included 50 patients (mean age 58 years (SD 14), 81% men), with a mean p-K 3.95 mmol/l (SD 0.19), mean LVEF 48% (SD 7), and mean Global Longitudinal Strain (GLS) -14.6% (SD 3.1) patients with LVEF 35-55% from "Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial" (POTCAST). Patients were given standard therapy and randomized (1:1) to an intervention that included guidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists targeting high-normal p-K levels (4.5-5.0 mmol/l). Echocardiography was done at baseline and after a mean follow-up of 44 days (SD 18) and the echocardiograms were analyzed for changes in GLS, mechanical dispersion, E/A, e', and E/e'. At follow-up, mean difference in changes in p-K was 0.52 mmol/l (95%CI 0.35;0.69), P<0.001 in the intervention group compared to controls. GLS was improved with a mean difference in changes of -1.0% (-2;-0.02), P<0.05 and e' and E/e' were improved with a mean difference in changes of 0.9 cm/s (0.02;1.7), P = 0.04 and ? 1.5 (-2.9;-0.14), P = 0.03, respectively. Thus, induced increase in p-K to the high-normal range improved indices of systolic and diastolic function in patients with low-normal to moderately reduced LVEF.
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Affiliation(s)
- Ulrik Winsløw
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Tharsika Sakthivel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Chaoqun Zheng
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Berit Philbert
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Michael Vinther
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Emil Frandsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Grigoriadis G, Sherman SR, Lima NS, Lefferts EC, Hibner BA, Ozemek HC, Danciu OC, Kanaloupitis D, Fernhall B, Baynard T. Breast cancer survivors with preserved or rescued cardiorespiratory fitness have similar cardiac, pulmonary and muscle function compared to controls. Eur J Appl Physiol 2022; 122:2189-2200. [PMID: 35796827 DOI: 10.1007/s00421-022-04992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Breast cancer survivors (BCS) have a high prevalence of cardiovascular disease and low cardiorespiratory fitness (CRF). CRF is an important predictor of survival in BCS. However, the physiological factors that contribute to low CRF in BCS have not been completely elucidated. To assess differences in physiological factors (cardiac, pulmonary, muscle function) related to CRF between BCS and controls. Twenty-three BCS and 23 age-body mass index (BMI) matched controls underwent a peak cycling exercise test to determine CRF, with physiological factors measured at resting and at peak exercise. Cardiac hemodynamics (stroke volume [SV], SVindex, heart rate [HR], cardiac output [Formula: see text], and [Formula: see text]index) were evaluated using ultrasonography. Pulmonary function was evaluated using the oxygen uptake efficiency slope (OUES), ventilation to carbon dioxide production slope [Formula: see text] and breathing reserve at peak exercise (BR). Muscle oxygenation variables (oxygenated [HbO2] deoxygenated [HHb] and total hemoglobin [Hb], and tissue oxygenation index [TSI]) were measured with near-infrared spectroscopy (NIRS). Both groups had similar CRF and similarly increased all hemodynamic variables (HR, SV, SVindex, [Formula: see text] and [Formula: see text]index) at peak exercise compared to resting (p < 0.001). BCS had higher overall HR and lower SVindex (group effect, p < 0.05). BCS had similar OUES, [Formula: see text] and BR compared to the controls. Both groups decreased TSI, and increased Hb and HHb similarly at peak exercise compared to resting (p < 0.001). Our data suggest BCS do not exhibit differences in cardiac, pulmonary, or muscle function at peak exercise compared to controls, when both groups have similar CRF and physical activity.
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Affiliation(s)
- Georgios Grigoriadis
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Sara R Sherman
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Natalia S Lima
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth C Lefferts
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Brooks A Hibner
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Hannah C Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Oana C Danciu
- Department of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Bo Fernhall
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Zhu D, Chen W, Pan Y, Li T, Cui M, Chen B. The correlation between maternal age, parity, cardiac diastolic function and occurrence rate of pre-eclampsia. Sci Rep 2021; 11:8842. [PMID: 33893350 PMCID: PMC8065037 DOI: 10.1038/s41598-021-87953-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/17/2021] [Indexed: 01/04/2023] Open
Abstract
To evaluate the effect of age and parity on maternal cardiac diastolic function in second trimester among pregnant women with normal left ventricular ejection fraction. To analyze the correlation between impaired diastolic function and pre-eclampsia. It had been suggested that maternal cardiac adaptations during pregnancy differed between nulliparous and primiparous women and also varied according to age. Impaired cardiac function may precede pre-eclampsia. Therefore, we examined the effects of parity and age on cardiac diastolic function during pregnancy and whether impaired diastolic function during the second trimester correlates with pre-eclampsia. Women with singleton pregnancies at 13 + 0 to 27 + 6 weeks’ gestation and left ventricular ejection fraction (LVEF) ≥ 50% were retrospectively identified. Diastolic function parameters were assessed using transthoracic echocardiography. Pre-eclampsia was identified from medical records. The effect of age and parity on maternal cardiac diastolic function as well as the correlation between impaired diastolic function and occurrence rate of pre-eclampsia were examined. 376 pregnant women were included (median age: 30 years; median gestational age: 14 weeks; 171 primiparous women). LVEF was 66%. Impaired cardiac diastolic function was seen in 7.8% of pregnant women < 35 years compared with 28.6% of those ≥ 35 years (p = 0.000). ROC curve showed women with maternal age over 32 began to have a higher rate of impaired cardiac diastolic function (AUC = 0.704, p = 0.000, sensitivity = 54.5%, specificity = 75.3%). There was no difference in diastolic function indices between maternal women grouped by parity. Higher maternal age was an independent risk factor of declining Em (p < 0.05). Em < 13 cm/s was significantly associated with pre-eclampsia occurrence (HR 8.56; 95% CI 3.40–21.57) after being adjusted for confounders. Maternal age is an independent risk factor for diastolic function decline. There is no difference in cardiac diastolic function between nulliparous women and primiparous women. Pre-eclampsia occurrence is significantly higher in patients with impaired diastolic function at mid-gestation. The application of risk grading using diastolic function at mid-gestation may improve the survival outcomes of pregnant women.
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Affiliation(s)
- Dan Zhu
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
| | - Weiyu Chen
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Yuchen Pan
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Tingcui Li
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Ming Cui
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Baoxia Chen
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
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Nalcacioglu H, Ozkaya O, Kafali HC, Tekcan D, Baysal K. Cardiac functions in children with steroid-sensitive nephrotic syndrome. Pediatr Int 2020; 62:1364-1368. [PMID: 32374081 DOI: 10.1111/ped.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid-sensitive nephrotic syndrome (NS). METHODS The study population consisted of 19 patients with debut-relapse of NS aged 1-18 years and 30 sex and age-matched healthy controls. Blood and urine samples, two M-mode conventional echocardiograms and tissue Doppler velocity imaging were evaluated in both attack and remission periods. RESULTS With regard to conventional pulse wave Doppler (cPWD), steroid-sensitive NS patients (both in debut / relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak), and patients in debut / relapse had a lower E/A ratio than the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging echocardiography results, patients in debut/relapse had a higher A' and a lower E'/A' ratio (overall P < 0.001 and P = 0.001, respectively). There was also a significant difference in the cPWD E/TDI E' ratio between the patients showing an increased cPWD E/TDI E' ratio in remission periods compared to in debut/relapse periods (P = 0.09). The albumin levels were positively correlated with E'/A' and E/ E' ratio (r = 0.609; P = 0.007, r = 0.472; P = 0.041 respectively). CONCLUSIONS Systolic cardiac functions are preserved but diastolic functions are affected in steroid-sensitive NS patients both in debut/relapse and in remission periods in a relatively short time. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.
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Affiliation(s)
- Hulya Nalcacioglu
- Pediatric Nephrology Department, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ozan Ozkaya
- Pediatric Nephrology Department, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hasan Candas Kafali
- Pediatric Cardiology Department, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Demet Tekcan
- Pediatric Nephrology Department, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Kemal Baysal
- Pediatric Cardiology Department, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Chetrit M, Cremer PC, Klein AL. Imaging of Diastolic Dysfunction in Community-Based Epidemiological Studies and Randomized Controlled Trials of HFpEF. JACC Cardiovasc Imaging 2020; 13:310-326. [DOI: 10.1016/j.jcmg.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
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Seko Y, Kato T, Shiba M, Morita Y, Yamaji Y, Haruna Y, Nakane E, Hayashi H, Haruna T, Inoko M. Association of the low e' and high E/e' with long-term outcomes in patients with normal ejection fraction: a hospital population-based observational cohort study. BMJ Open 2019; 9:e032663. [PMID: 31753896 PMCID: PMC6887062 DOI: 10.1136/bmjopen-2019-032663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the association of the severity of left ventricular (LV) diastolic dysfunction with long-term outcomes in patients with normal ejection fraction. DESIGN Retrospective study. SETTING A single centre in Japan. PARTICIPANTS We included 3576 patients who underwent both scheduled transthoracic echocardiography and ECG between 1 January and 31 December 2013, in a hospital-based population after excluding valvular diseases or low ejection fraction (<50%) or atrial fibrillation and categorised them into three groups: septal tissue Doppler early diastolic mitral annular velocity (e')≥7 (without relaxation disorder, n=1593), e'<7 and early mitral inflow velocity (E)/e'≤14 (with relaxation disorder and normal LV end-diastolic pressure, n=1337) and e'<7 and E/e'>14 (with relaxation disorder and high LV end-diastolic pressure, n=646). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was a composite of all-cause death and major adverse cardiac events (MACE). The secondary outcome measure were all-cause death and MACE, separately. RESULTS The cumulative 3-year incidences of the primary outcome measures were significantly higher in the e'<7 and E/e'≤14 (19.0%) and e'<7 and E/e'>14 group (23.4%) than those for the e'≥7 group (13.0%; p<0.001). After adjusting for confounders, the excess 3-year risk of primary outcome for the groups with e'<7 and E/e'≤14 related to e'≥7 (HR: 1.24; 95% CI 1.02 to 1.52) and e'<7 and E/e'>14 related to e'<7 (HR: 1.57; 95% CI 1.28 to 1.94) were significant. The severity of diastolic dysfunction was associated with incrementally higher risk for primary outcomes (p<0.001). CONCLUSION The severity of LV diastolic dysfunction using e'<7 and E/e'>14 was associated with the long-term prognosis in patients with normal ejection fraction in an incremental fashion.
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Affiliation(s)
- Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Yusuke Morita
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | - Yuhei Yamaji
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | | | - Eisaku Nakane
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | | | | | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
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Mendizábal B, Urbina EM, Becker R, Daniels SR, Falkner BE, Hamdani G, Hanevold CD, Hooper SR, Ingelfinger JR, Lande M, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels JA, Flynn JT. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth). Hypertension 2019; 72:625-631. [PMID: 29987102 DOI: 10.1161/hypertensionaha.118.11434] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although hypertension is identifiable in children and adolescents, there are many knowledge gaps on how to best define and manage high blood pressure in the young. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth) is being conducted to address these knowledge gaps. Five hundred adolescents will be recruited and will undergo ambulatory blood pressure monitoring, echocardiographic, vascular, and cognitive assessments, as well as epigenetic studies to identify mechanisms that underlie the development of hypertensive target organ damage. Details of the design and methods that will be utilized in SHIP-AHOY are presented here, as well as baseline characteristics of the first 264 study participants. The primary aim of the study is to develop a risk-based definition of hypertension in the young that will result in better understanding of the transition from blood pressure in youth to adult cardiovascular disease.
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Affiliation(s)
| | | | - Richard Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.B.)
| | - Stephen R Daniels
- Department of Pediatrics, Denver Children's Hospital, Aurora, CO (S.R.D.)
| | - Bonita E Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.E.F.)
| | | | - Coral D Hanevold
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.D.H., J.T.F.)
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill (S.R.H.)
| | - Julie R Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children at Massachusetts General Hospital (J.R.I.)
| | - Marc Lande
- Department of Pediatrics, University of Rochester Medical Center, NY (M.L.)
| | - Lisa J Martin
- Human Genetics (L.J.M.), Cincinnati Children's Hospital Medical Center, OH
| | - Kevin Meyers
- Pediatric Nephrology, Children's Hospital of Philadelphia, PA (K.M.)
| | - Mark Mitsnefes
- From the Divisions of Preventive Cardiology (B.M., E.M.U.)
| | - Bernard Rosner
- Department of Medicine, Harvard Medical School, Boston, MA (B.R.)
| | - Joshua A Samuels
- Pediatric Nephrology and Hypertension, University of Texas Health Science Center at Houston (J.A.S.)
| | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.D.H., J.T.F.)
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Del Rios M, Colla J, Kotini-Shah P, Briller J, Gerber B, Prendergast H. Emergency physician use of tissue Doppler bedside echocardiography in detecting diastolic dysfunction: an exploratory study. Crit Ultrasound J 2018; 10:4. [PMID: 29372430 PMCID: PMC5785451 DOI: 10.1186/s13089-018-0084-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/09/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (eʹA) and an independent cardiologist’s diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines. Methods This was a secondary analysis of 48 limited bedside echocardiograms (LBE) performed as a part of a research study of patients presenting to the Emergency Department (ED) with elevated blood pressure but without decompensated heart failure. EPs diagnosed DD based on eʹA < 9 cm/s alone. A blinded board-certified cardiologist reviewed LBEs to estimate LA filling pressures following ASE guidelines. An unweighted kappa measure was calculated to determine agreement between EP and cardiologist. Results Six LBEs were deemed indeterminate by the cardiologist and excluded from the analysis. Agreement was reached in 41 out of 48 cases (85.4%). The unweighted kappa coefficient was 0.74 (95% CI 0.57–0.92). EPs identified 18 out of 20 LBEs diagnosed with diastolic dysfunction by the cardiologist. Conclusion There is a good agreement between (eʹA) by EP and cardiologist interpretation of LBEs. Future studies should investigate this simplified approach as a one-step method of screening for LV diastolic dysfunction in the ED.
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Affiliation(s)
- Marina Del Rios
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Joseph Colla
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joan Briller
- Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ben Gerber
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Heather Prendergast
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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11
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Yalçin F, Muderrisoglu H, Korkmaz ME, Ozin B, Baltali M, Yigit F. The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy. Angiology 2016; 55:295-301. [PMID: 15156263 DOI: 10.1177/000331970405500309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Basal septal hypertrophy (BSH), a cause of left ventricular outflow tract (LVOT) obstruction, is thought to occur by increased ventricular dynamics. The aim of the study was to evaluate the effect of pharmacologic stress on LVOT gradients in a group of hypertensive patients with BSH. Dobutamine stress was used in 24 hypertensive patients (mean age 56 ±8 years; 11 women) with BSH and 20 normal controls (mean age 54 ±9 years; 7 women). Ejection fraction and myocardial mass, basal septal dimension, and LVOT diameter were measured with 2-dimensional echocardiography. LVOT velocities and transmitral velocities before and at peak dobutamine infusion were determined by continuous wave Doppler and pulsed Doppler, respectively. There were no differences in mean ejection fraction and myocardial mass between BSH patients (58 ±3%, 204 ±24 g) and normals (56 ±4%, 201 ±32 g). The basal septum was thicker in patients (1.55 ±0.2 cm) than in normals (1.03 ±0.1 cm, p<0.001). Maximum LVOT velocities were similar in BSH (1.2 ±0.4 m/sec) and normals (1.1 ±0.2 m/sec) at rest. At peak stress, maximum LVOT velocities were higher in BSH (3.3 ±0.6 m/sec) than normals (1.7 ±0.4 m/sec, p<0.001). LV rate-pressure product at peak stress was higher in BSH (23,326 ±4,388) than normals (17,592 ±2,409, p<0.001). LV isovolumetric relaxation time was prolonged, and the E/A ratio was decreased in the patients at rest (130 ±14 msec and 0.72 ±0.18, respectively, p<0.001). At peak stress, diastolic function did not significantly change in two groups. The correlations between LVOT velocity change by stress and mean LVOT diameter ( r =-0.668, p<0.001) and mean BS thickness ( r =0.610; p<0.001) were significant in the whole group. High velocities appeared on LVOT at peak pharmacologic stress in the hypertensive patients with BSH compared with control group. This suggests dynamic ventricular ejection by stress may contribute to hypertrophy of the basal segment, which is the closest part of septum to increased afterload.
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Affiliation(s)
- Fatih Yalçin
- Başkent University School of Medicine, Department of Cardiology, Medical and Research Center, Adana, Turkey.
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12
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. An Echocardiographic Study of Left Ventricular Size and Cardiac Function in Adolescent Females with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 24:26-33. [DOI: 10.1002/erv.2409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - James E. Potts
- Children's Heart Centre; British Columbia Children's Hospital; Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine and Provincial Specialized Eating Disorders Program; British Columbia Children's Hospital; Canada
| | | | - Gerald J. Mugford
- Faculty of Medicine and Discipline of Psychiatry; Memorial University of Newfoundland; Canada
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13
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Dogan CS, Akman S, Simsek A, Ozdem S, Comak E, Gokceoglu AU, Kardelen F, Koyun M. Assessment of left ventricular function by tissue Doppler echocardiography in pediatric chronic kidney disease. Ren Fail 2015; 37:1094-9. [DOI: 10.3109/0886022x.2015.1061301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Qian C, Gong L, Yang Z, Chen W, Chen Y, Xu Z, Wu B, Tang C, Gao F, Zeng W. Diastolic dysfunction in spontaneous type 2 diabetes rhesus monkeys: a study using echocardiography and magnetic resonance imaging. BMC Cardiovasc Disord 2015; 15:59. [PMID: 26113016 PMCID: PMC4480511 DOI: 10.1186/s12872-015-0046-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/01/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diastolic heart failure is a common and deadly complication of diabetes mellitus, with the development of diabetic cardiomyopathy as one of the key determinants of the disease's complex pathology. The cause of the association is unknown and has no approved therapy strategies as of yet. However significant advances in this area may come from studies on suitable animal models. METHODS A total of 25 male rhesus monkeys (12-16 years, 9-13 kg) were enrolled. Fifteen of them were diagnosed as spontaneous type 2 diabetes mellitus (T2DM, FPG ≥ 104 mg/dl, HbA1c: 4.7-5.5 %, diabetes duration: 1-4 years). The other 10 monkeys were non-diabetic (ND, FPG < 90 mg/dl). Echocardiography and cardiac magnetic resonance were used for evaluating the cardiac structure and function. One T2DM monkey with impaired diastolic function and another ND monkey were both sacrificed to gain the necessary pathology and protein expression studies displayed here. RESULTS Six out of 15 T2DM rhesus monkeys were diagnosed with diastolic dysfunction (DD) by echocardiography. Additionally, no abnormalities were found in the group which we determined as the ND monkeys. The six DD monkeys all showed low e' velocity and decreased e'/a' ratio, among which three of them showing decreased E/A ratio and the other 3 having elevated E/A ratio, this appears to be similar to the impaired relaxation pattern and pseudonormal pattern found in human patients respectively. The EF and FS of monkeys with pseudonormal pattern decreased significantly compared with ND subjects. A CMR study showed that LVID at end systole of 5 DD monkeys is significantly longer than that of 3 ND monkeys. Of great interest, myocardium lesions and mitochondria impairments and increased expression of AGEs and caspase-3 were found in a sacrificed DD subject. CONCLUSION The changes in the imaging and physiological markers of spontaneous T2DM rhesus monkeys are similar to those key markers found in human type 2 diabetes and diastolic dysfunction. This monkey model could help the medical community and us to understand the pathology of this debilitating disease and serve as a beginning to explore important measures to prevent and treat diabetic cardiomyopathy.
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Affiliation(s)
- Can Qian
- Sichuan Industrial Institute of Antibiotics, Chengdu, China. .,Sichuan PriMed Shines Bio-Tech Co., Ltd, Chengdu, China.
| | - Li Gong
- Sichuan PriMed Shines Bio-Tech Co., Ltd, Chengdu, China.
| | - Zunyuan Yang
- Sichuan PriMed Shines Bio-Tech Co., Ltd, Chengdu, China.
| | - Wei Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Yushu Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Bing Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Chungui Tang
- Department of Radiology, Yaan People's Hospital, Yaan, China.
| | - Fabao Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Wen Zeng
- Sichuan Industrial Institute of Antibiotics, Chengdu, China. .,Sichuan PriMed Shines Bio-Tech Co., Ltd, Chengdu, China.
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15
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The relationship between arterial stiffness and heart failure with preserved ejection fraction: a systemic meta-analysis. Heart Fail Rev 2015; 20:291-303. [DOI: 10.1007/s10741-015-9471-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Influence of age and gender on Doppler index of diastolic function in Chinese hypertensive patients. Ir J Med Sci 2014; 184:791-7. [DOI: 10.1007/s11845-014-1173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
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17
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Bilgi M, Yerdelen D, Çölkesen Y, Müderrisoğlu H. Evaluation of left ventricular diastolic function by tissue Doppler imaging in patients with newly diagnosed and untreated primary generalized epilepsy. Seizure 2013; 22:537-41. [DOI: 10.1016/j.seizure.2013.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 10/26/2022] Open
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Kibar AE, Pac FA, Ballı S, Oflaz MB, Ece I, Bas VN, Aycan Z. Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study. Pediatr Cardiol 2013; 34:1482-90. [PMID: 23503947 DOI: 10.1007/s00246-013-0674-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/13/2013] [Indexed: 11/24/2022]
Abstract
A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 ± 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI ≥ 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 ± 2 cm/s), peak early myocardial velocity (Am = 8.7 ± 1.3 cm/s), Em/Am ratio (1.8 ± 0.3), isovolumetric relaxation time (IVRT = 59.2 ± 8.2 ms), MPI (0.39 ± 0.03), and DI (25.5 ± 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 ± 1.2 cm/sn, 6.9 ± 0.6 cm/sn, 2.6 ± 0.2, 51.2 ± 9.6 ms, 0.34 ± 0.03, and 33.13 ± 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.
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Affiliation(s)
- Ayse Esin Kibar
- Department of Pediatric Cardiology, Mersin Women's and Children's Hospital, Güneykent, Mersin, Turkey.
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19
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Aggravation of left ventricular diastolic dysfunction in hypertensives with coronary artery disease. Hypertens Res 2013; 36:885-8. [DOI: 10.1038/hr.2013.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/17/2013] [Accepted: 03/18/2013] [Indexed: 01/08/2023]
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20
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Wang YC, Yu CC, Chiu FC, Tsai CT, Lai LP, Hwang JJ, Lin JL. Impacts of mitral E/e' on myocardial contractile motion and synchronicity in heart failure patients with reduced ejection fraction: An exercise-echocardiography study. Clin Cardiol 2013; 36:462-7. [PMID: 23670969 DOI: 10.1002/clc.22141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/15/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The association between diastolic abnormality and postexercise contractile decompensation is uncertain in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF). HYPOTHESIS The higher mitral E/annular early diastolic velocity (E/e') is relevant to postexercise regional myocardial contractile maladaptation. METHODS Seventy HF patients with LVEF <50 % (56 males, 58 ± 15 years) were studied pre- and postexercise using tissue Doppler echocardiography. We evaluated the mean and standard deviation of systolic myocardial velocity (Sm) and electromechanical delay (Ts) of 12 left ventricular segments, and further analyzed the corresponding changes of septal and posterolateral segments. RESULTS The higher mitral E/e' was associated with more blunted heterogeneity of Sm and greater ventricular dyssynchrony after exercise. This is due to the posterolateral wall not being able to increase Sm with exercise to the same degree as the septum (decreased posterolateral/septal Sm ratio). Furthermore, the postexercise aggravated difference of Ts between septum and posterolateral segments leads to more dyssynchronous contraction in the higher E/e' groups. An E/e' ≥10 predicted a postexercise posterolateral/septal Sm ≤ 1 (odds ratio [OR]: 5.8, 95% confidence interval [CI]: 1.5-22.6, P = 0.011), and a difference of Ts between septum and posterolateral segments >65 ms (OR: 64, 95% CI: = 6-651, P < 0.001) in HF patients with reduced LVEF in multivariate analysis. CONCLUSIONS The higher mitral E/e'-related postexercise maladaptation of myocardial contractile motion and synchronicity suggests the involvement of systolic abnormality in exercise pathophysiology in HF patients with reduced LVEF.
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Affiliation(s)
- Yi-Chih Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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21
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Yang Y, Wang Y, Shi ZW, Zhu DL, Gao PJ. Association of E/E' and NT-proBNP with renal function in patients with essential hypertension. PLoS One 2013; 8:e54513. [PMID: 23382907 PMCID: PMC3557266 DOI: 10.1371/journal.pone.0054513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate the association of left ventricular (LV) diastolic function and N-terminal pro-brain natriuretic peptide (NT-proBNP) with renal function in essential hypertension. Methods LV diastolic function was estimated by the ratio of early diastolic velocities (E) from transmitral inflow to early diastolic velocities (E′) of tissue Doppler at mitral annulus (septal corner); NT-proBNP was measured in 207 hypertensive patients (mean age 56±14 years). The subjects were classified into 3 groups: E/E′≤10 group (n = 48), 10<E/E′≤15 group (n = 109) and E/E′>15 group (n = 50). The renal function was estimated by glomerular filtration rate (GFR) with 99mTc-DTPA. GFR from 30 to 59 ml/min/1.73 m2 was defined as Stage 3 chronic kidney disease (CKD). GFR was also estimated using the modified MDRD equation. Albuminuria was defined by urinary albumin/creatinine ratio (UACR). Results GFR was lower and UACR was higher in E/E′ >15 group than in 10< E/E′ ≤15 group or E/E′ ≤10 group (p<0.0001), GFR was significantly negative and UACR was positive correlated with E/E′ and NT-proBNP (p<0.0001). In multivariate stepwise linear analysis, GFR had significant correlation with age (p = 0.001), gender (p = 0.003), E/E′ (p = 0.03), lgNT-proBNP (p = 0.001) and lgUACR (p = 0.01), while eGFR had no significant correlation with E/E′ or lgNT-proBNP. Multivariate logistic regression analysis, adjusted for potential confounding factors, showed that participants in E/E′>15 group were more likely to have Stage 3 CKD compared with those in E/E′≤10 group with an adjusted odds ratio of 8.31 (p = 0.0036). Conclusions LV diastolic function, assessed with E/E′ and NT-proBNP is associated with renal function in essential hypertension.
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Affiliation(s)
- Yan Yang
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Vascular Biology, Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Wang
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Vascular Biology, Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhong-wei Shi
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ding-liang Zhu
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Vascular Biology, Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Laboratory of Vascular Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Ping-jin Gao
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Vascular Biology, Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Laboratory of Vascular Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- * E-mail:
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22
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Mehlman E, Bright J, Jeckel K, Porsche C, Veeramachaneni D, Frye M. Echocardiographic Evidence of Left Ventricular Hypertrophy in Obese Dogs. J Vet Intern Med 2012. [DOI: 10.1111/jvim.12018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- E. Mehlman
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
| | - J.M. Bright
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
| | - K. Jeckel
- Department of Biomedical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
| | - C. Porsche
- Department of Biomedical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
| | - D.N.R. Veeramachaneni
- Department of Biomedical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
| | - M. Frye
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
- Department of Biomedical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins CO
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Ramazan K, Mustafa B, Yunus E, Halil M, Selcuk P, Mustafa A, Cihan C, Moe AS, Nihal Ö. Evaluation of Left Ventricular Function by Conventional Echocardiography and Tissue Doppler Imaging in Patients with Acute and Chronic Mitral Regurgitation. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Masugata H, Senda S, Murao K, Okuyama H, Inukai M, Hosomi N, Iwado Y, Noma T, Kohno M, Himoto T, Goda F. Aortic root dilatation as a marker of subclinical left ventricular diastolic dysfunction in patients with cardiovascular risk factors. J Int Med Res 2011; 39:64-70. [PMID: 21672308 DOI: 10.1177/147323001103900108] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Consensus is lacking about the clinical importance of aortic root dilatation in assessment of the risk of cardiovascular disease. In this study, correlations between aortic root diameter and echocardiographic features of left ventricular (LV) diastolic function were investigated in 333 patients with at least one cardiovascular risk factor (hypertension, diabetes or dyslipidaemia) and preserved LV systolic function. Aortic root diameter was measured by M-mode echocardiography, and LV diastolic function was evaluated by measuring the peak velocity of early (E) and late (A) diastolic transmitral blood flow and peak early diastolic mitral annular velocity (E') by Doppler echocardiography. Linear regression analysis showed that, in men, age was not related to aortic root diameter but hypertension and LV hypertrophy were, whereas the converse was true in women. The parameters E, E/A ratio and E', were related to aortic root diameter in both sexes. Stepwise multiple regression analysis confirmed that E in women and E' in men were independently associated with aortic root diameter. It is concluded that aortic root dilatation might be a useful marker of subclinical LV diastolic dysfunction. Patients with preserved systolic function showing aortic root dilatation should, therefore, be given preventative therapy against LV diastolic heart failure.
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Affiliation(s)
- H Masugata
- Department of Integrated Medicine, Kagawa University, 1750-1 Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
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Daskalov IR, Gotchev DT. A Quantitative Analysis of Left Ventricular Filling Pressures in Patients with a Reduced Ejection Fraction, with or without Concomitant Left Bundle Branch Block. Echocardiography 2011; 28:520-9. [DOI: 10.1111/j.1540-8175.2010.01381.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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SANAGALA THRIVENI, JOHNSTON SAMUELL, GROOT GLORIAD, RHINE DAVIDK, VARMA NIRAJ. Left Atrial Mechanical Responses to Right Ventricular Pacing in Heart Failure Patients: Implications for Atrial Fibrillation. J Cardiovasc Electrophysiol 2011; 22:866-74. [DOI: 10.1111/j.1540-8167.2011.02061.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Groban L, Lin M, Kassik KA, Ingram RL, Sonntag WE. Early-onset growth hormone deficiency results in diastolic dysfunction in adult-life and is prevented by growth hormone supplementation. Growth Horm IGF Res 2011; 21:81-88. [PMID: 21371927 PMCID: PMC3085723 DOI: 10.1016/j.ghir.2011.01.003] [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: 07/20/2010] [Revised: 01/27/2011] [Accepted: 01/29/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The primary goal of growth hormone (GH) replacement is to promote linear growth in children with growth hormone deficiency (GHD). GH and insulin-like growth factor-1 (IGF-1) are also known to have roles in cardiac development and as modulators of myocardial structure and function in the adult heart. However, little is known about cardiac diastolic function in young adults with childhood onset GH deficiency in which GH treatment was discontinued following puberty. The aim of the study was to evaluate the effects of long standing GHD and peri-pubertal or continuous GH replacement therapy on diastolic function in the adult dwarf rat. DESIGN The dwarf rat, which possesses a mutation in a transcription factor necessary for development of the somatotroph, does not exhibit the normal peri-pubertal rise in GH around day 28 and was used to model childhood or early-onset GHD (EOGHD). In another group of male dwarfs, GH replacement therapy was initiated at 4 weeks of age when GH pulsatility normally begins. Ten weeks after initiation of injections, GH-treated dwarf rats were divided into 2 groups; continued treatment with GH for 12 weeks (GH-replete) or treatment with saline for 12 weeks. This latter group models GH supplementation during adolescence with GHD beginning in adulthood (adult-onset GHD; AOGHD). Saline-treated heterozygous (HZ) rats were used as age-matched controls. At 26 weeks of age, cardiac function was assessed using invasive or noninvasive (conventional and tissue Doppler) indices of myocardial contractility and lusitropy. RESULTS Systolic function, as determined by echocardiography, was similar among groups. Compared with HZ rats and GH-replete dwarfs, the EOGHD group exhibited significant reductions in myocardial relaxation and increases in left ventricular filling pressure, indicative of moderate diastolic dysfunction. This was further associated with a decrease in the cardiac content of sarcoplasmic reticulum Ca(2+) ATPase (SERCA2), one of the important cardiac calcium regulatory proteins. Dwarfs supplemented with GH during the peri-adolescence stage, but not beyond (AOGHD), exhibited a subtle prolongation in the deceleration time to early filling. In contrast, continual GH replacement preserved diastolic function such that the cardiac phenotype of the GH-replete dwarfs resembled that of their age-matched HZ counterpart. DISCUSSION Our data indicate that GHD during adolescence leads to overt diastolic dysfunction in early adulthood and this is prevented by continual GH replacement therapy. Since discontinuation of GH replacement following adolescence only mitigated the lusitropic deficits that were observed in untreated dwarfs, GH treatment into adulthood could be beneficial.
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Affiliation(s)
- L Groban
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
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Dogan A, Yarlioglues M, Gul I, Kaya MG, Ozdogru I, Kalay N, Inanc MT, Ozdogru M, Ardic I, Dogdu O, Eryol NK, Ergin A, Oguzhan A. Acute Effects of Passive Smoking on Left Ventricular Systolic and Diastolic Function in Healthy Volunteers. J Am Soc Echocardiogr 2011; 24:185-91. [DOI: 10.1016/j.echo.2010.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Indexed: 11/27/2022]
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29
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Akgul E, Kutuk U, Ertek S, Cesur M, Cehreli S, Tore HF, Erdogan G. Cardiac Autonomic Function and Global Left Ventricular Performance in Autoimmune Eauthyroid Chronic Thyroiditis: Is Treatment Necessary at the Euthyroid Stage? Echocardiography 2011; 28:15-21. [DOI: 10.1111/j.1540-8175.2010.01240.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Myocardial dysfunction in fetuses exposed to intraamniotic infection: new insights from tissue Doppler and strain imaging. Am J Obstet Gynecol 2010; 203:459.e1-7. [PMID: 20691411 DOI: 10.1016/j.ajog.2010.06.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/02/2010] [Accepted: 06/15/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to assess myocardial function of fetuses who were exposed to intraamniotic infection compared with fetuses of uncomplicated pregnancies by the application of tissue Doppler and strain rate (SR) imaging. STUDY DESIGN We evaluated the right ventricular function of fetuses with preterm premature rupture of membranes and proven intraamniotic infection (n = 12 fetuses) and healthy fetuses (n = 27). Tissue Doppler velocities during early diastolic relaxation (E(m)) and atrial contraction (A(m)) and early diastolic SR were measured as indices of diastolic function, whereas the peak systolic strain and SR were used as parameters of systolic function. RESULTS Fetuses with intraamniotic infection exhibit impairment in both diastolic and systolic performance, which was characterized by increased diastolic compliance (increased E(m)/A(m) ratio, increased early diastolic SR compared with the control fetuses), decreased systolic contractile function (reduced systolic strain and SR), and longitudinal myocardial dyskinesia. CONCLUSION New echocardiographic tools suggest that fetal heart is a target organ in the context of intraamniotic infection.
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Schaefer A, Zwadlo C, Fuchs M, Meyer GP, Lippolt P, Wollert KC, Drexler H. Long-term effects of intracoronary bone marrow cell transfer on diastolic function in patients after acute myocardial infarction: 5-year results from the randomized-controlled BOOST trial--an echocardiographic study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:165-71. [DOI: 10.1093/ejechocard/jep191] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Echocardiographic assessment of left ventricular diastolic function: what we able to do in 2009. COR ET VASA 2009. [DOI: 10.33678/cor.2009.193] [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]
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Saccheri MC, Cianciulli TF, Lax JA, Guerra JE, Redruello HJ, Weich Glogier FL, Gagliardi JA, Dorelle AN, Prezioso HA, Vidal LA. Impaired myocardial function in hypertrophic cardiomyopathy. Echocardiography 2009; 26:657-64. [PMID: 19594814 DOI: 10.1111/j.1540-8175.2008.00871.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tissue Doppler imaging (TDI) parameters of peak myocardial velocities (S', E', and A') has been employed to assess the regional left ventricular myocardial function. The global function index (GFI) derived from TDI has been recently employed to distinguish the different etiologies of left ventricular hypertrophy. OBJECTIVE To analyze whether the GFI or individual TDI parameters of peak myocardial velocities (S', E', and A') allows detecting different degrees of regional myocardial dysfunction in the most frequent forms of hypertrophic cardiomyopathy (HCM). METHODS GFI = (E/E')/S' (where E is the peak transmitral flow velocity, E' is the early diastolic myocardial velocity, and S' is the peak systolic myocardial velocity) and TDI peak myocardial velocities was measured in the septal and lateral mitral annulus in 101 patients with HCM (mean age 47.5 +/- 14 years, 58 women) and in age-matched group of 30 healthy controls (mean age 46 +/- 6 years, 16 women). RESULTS Forty-five patients had nonobstructive asymmetric septal HCM, 20 patients had a subaortic gradient >or= 30 mm Hg, 21 p. had apical HCM, and 15 p. had other forms of HCM (midventricular, symmetric, and biventricular). All patients with HCM exhibited a decrease in early diastolic (E') and systolic (S') myocardial velocities, both in the lateral and septal-mitral annulus border, but more pronounced in septal-mitral annulus. Septal GFI was higher in HCM patients than in healthy subjects (1.8 (1.1-2.5) and (0.57 (0.31-0.92), respectively, P < 0.001), but no differences were seen when different forms of HCM were compared. CONCLUSIONS In a selected population of patients with HCM and a preserved left ventricular(LV) systolic function, GFI and individual TDI parameters of peak velocity (S', E', and A') and E/E' ratio were similar in different forms of HCM, indicating that in all patients with HCM there is regional systolic and diastolic myocardial dysfunction, regardless of the location of hypertrophy.
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Affiliation(s)
- María C Saccheri
- Division of Cardiology, Hospital of the Government of the City of Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina.
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Baykan M, Baykan EC, Turan S, Gedikli Ö, Kaplan Ş, Kırış A, Durmuş I, Çelik Ş. Assessment of Left Ventricular Function and Tei Index by Tissue Doppler Imaging in Patients with Slow Coronary Flow. Echocardiography 2009; 26:1167-72. [DOI: 10.1111/j.1540-8175.2009.00939.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Su HM, Lin TH, Lee CS, Lee HC, Chu CY, Hsu PC, Voon WC, Lai WT, Sheu SH. Myocardial performance index derived from brachial-ankle pulse wave velocity: a novel and feasible parameter in evaluation of cardiac performance. Am J Hypertens 2009; 22:871-6. [PMID: 19478795 DOI: 10.1038/ajh.2009.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Right brachial pre-ejection period (rbPEP), brachial-ankle pulse wave velocity (baPWV), and right brachial ejection time (rbET) can be automatically determined from an ABI-form device. The aims of this study are to test the applicability of baPWV-derived myocardial performance index (MPI) (defined as the ratio of rbPEP divided by its own s.d. + baPWV divided by its own s.d. to rbET divided by its own s.d.) as an indicator of combined left ventricular (LV) systolic and diastolic functions. METHODS A sum of 215 patients were consecutively included. The rbPEP, baPWV, and rbET were measured using an ABI-form device and LV function was determined by echocardiography. RESULTS After a multivariate analysis, diastolic blood pressure (beta = 0.220, P < 0.001), LV ejection fraction (LVEF) (beta = -0.291, P < 0.001), transmitral E wave velocity (E) (beta = -0.106, P = 0.032), early diastolic mitral annular velocity (Ea) (beta = -0.142, P = 0.009), and ET obtained by tissue Doppler echocardiography (beta = -0.397, P < 0.001) were the major determinants of baPWV-derived MPI. The area under the curve for rbPEP, baPWV, rbET, rbPEP/rbET, and baPWV-derived MPI in prediction of Ea <8 cm/s, E/Ea >10, or LVEF <50% were 0.69, 0.76, 0.67, 0.73, and 0.83, respectively. CONCLUSIONS BaPWV-derived MPI had a significant correlation with echocardiographic LV diastolic and systolic function. It may be a novel and feasible indicator in assessment of global LV function.
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Masugata H, Senda S, Hoshikawa J, Yamagami A, Okuyama H, Imai M, Yukiiri K, Kohno M, Goda F. Relationship of Cardiac Hypertrophy and Diastolic Dysfunction Assessed by Echocardiography with Atherosclerosis in Retinal Arteries in Hypertensive Patients. Clin Exp Hypertens 2009; 30:520-9. [DOI: 10.1080/10641960802251909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hisashi Masugata
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | - Shoichi Senda
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | | | - Ayumu Yamagami
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | - Hiroyuki Okuyama
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | | | - Kazushi Yukiiri
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - Masakazu Kohno
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - Fuminori Goda
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
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Eidem BW. Noninvasive evaluation of left ventricular noncompaction: what's new in 2009? Pediatr Cardiol 2009; 30:682-9. [PMID: 19184176 DOI: 10.1007/s00246-008-9372-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
Abstract
Significant interest in clinical practice as well as the medical literature exists regarding the presentation and outcome of children and adults with left-ventricular noncompaction (LVNC). The mainstay in the diagnosis of LVNC has been the anatomic definition of the ventricular myocardium by two-dimensional echocardiographic imaging. Although helpful, this approach lacks diagnostic precision and fails to evaluate the functional impact of this abnormal myocardial architecture on global and regional myocardial performance. This review will focus on the use of novel echocardiographic modalities of tissue Doppler, strain, and strain rate imaging to identify and characterize abnormalities of regional myocardial function in patients with LVNC.
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Affiliation(s)
- Benjamin W Eidem
- Divisions of Pediatric Cardiology and Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Shah KB, Kop WJ, Christenson RH, Diercks DB, Kuo D, Henderson S, Hanson K, Li SY, deFilippi CR. Natriuretic peptides and echocardiography in acute dyspnoea: implication of elevated levels with normal systolic function. Eur J Heart Fail 2009; 11:659-67. [PMID: 19515720 DOI: 10.1093/eurjhf/hfp075] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Previous evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea. METHODS AND RESULTS Prospective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37% of patients and 13% died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF <or= 40% was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF >or= 50%. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF >or= 50%. CONCLUSION In an acute dyspnoea population with 'all-comers' undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.
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Affiliation(s)
- Keyur B Shah
- Division of Cardiology, Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Diastolic Dysfunction of the Cardiac Allograft and Maximal Exercise Capacity. J Heart Lung Transplant 2009; 28:434-9. [DOI: 10.1016/j.healun.2008.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 09/12/2008] [Accepted: 12/01/2008] [Indexed: 11/20/2022] Open
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Somaratne JB, Whalley GA, Poppe KK, Gamble GD, Doughty RN. Pseudonormal Mitral Filling Is Associated with Similarly Poor Prognosis as Restrictive Filling in Patients with Heart Failure and Coronary Heart Disease: A Systematic Review and Meta-analysis of Prospective Studies. J Am Soc Echocardiogr 2009; 22:494-8. [DOI: 10.1016/j.echo.2009.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Indexed: 10/21/2022]
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41
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Impaired left ventricular synchronicity in patients with metabolic syndrome, regardless of hypertension. J Hypertens 2009; 27:869-75. [DOI: 10.1097/hjh.0b013e328325d845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hirono K, Konishi T, Origasa H, Ichida F, Miyawaki T. Echocardiographic and electrocardiographic analyses of patients with severe motor and intellectual disabilities. Heart Vessels 2009; 24:46-53. [DOI: 10.1007/s00380-008-1070-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
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Sürücü H, Tatli E, Değirmenci A, Okudan S, Aktoz M, Boz H. Clinical significance of positive isovolumetric relaxation velocity of pulsed-wave tissue Doppler imaging. Echocardiography 2009; 26:21-7. [PMID: 19125806 DOI: 10.1111/j.1540-8175.2008.00749.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Among the pulsed-wave tissue Doppler imaging (pw-TDI) parameters, there are two different pw-TDI velocities (IVRa and IVRb) after systolic velocity, but before Ea velocity. In our study, we investigated the clinical importance of these two velocities in left ventricular diastolic dysfunction (LVDDF) evaluation. METHODS One hundred and eighty cases without exclusion criteria were included in the study. Cases with a transmitral E to A flow (E/A) ratio below 1 were assigned to group 2. In cases with an E/A ratio between 1 and 2, the pw-TDI parameters were taken into consideration. Cases with an Ea/Aa ratio above 1 were assigned to group 1 and cases with an Ea/Aa ratio 1 or below than 1 were assigned to group 3. Group 1 (n: 68) represented normal diastolic left ventricular (LV) inflow while group 2 (n = 87) represented impaired relaxation and group 3 (n = 25) represented pseudonormal LV inflow. RESULTS In our study, we found that IVRa velocity was lower in group 1 compared to group 2 and group 3 (P < 0.001 and P = 0.038, respectively). Similarly, this velocity was significantly different in group 3 and group 2 such as it was higher in group 2 compared to group 3 (P = 0.022). There was no difference in IVRb velocity and IVRa/IVRb ratio among the groups. A negative correlation was found between IVRa velocity and Ea velocity (r = 44%, P < 0.001). Positive correlation was found between IVRa velocity and isovolumetric relaxation time (r = 18%, P = 0.014) and also between IVRa velocity and Aa velocity (r = 19%; P = 0.010). CONCLUSION Based on the results of our study, we concluded that IVRa velocity is an important pw-TDI parameter in the evaluation of LVDDF, especially in differentiating pseudonormal LVDDF type from normal LV inflow.
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Affiliation(s)
- Hüseyin Sürücü
- Department of Cardiology, Private Avcilar Anadolu Hospital, Istanbul, Turkey.
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Skubas N. Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists’ Armamentarium: A Core Review. Anesth Analg 2009; 108:48-66. [DOI: 10.1213/ane.0b013e31818a6c4c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Iles L, Pfluger H, Phrommintikul A, Cherayath J, Aksit P, Gupta SN, Kaye DM, Taylor AJ. Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol 2008; 52:1574-80. [PMID: 19007595 DOI: 10.1016/j.jacc.2008.06.049] [Citation(s) in RCA: 572] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 05/08/2008] [Accepted: 06/10/2008] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI). BACKGROUND Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis. METHODS We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T(1) mapping sequence was used to calculate the post-contrast myocardial T(1) time as an index of diffuse fibrosis; regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation. RESULTS Post-contrast myocardial T(1) times correlated histologically with fibrosis (R = -0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 +/- 17 ms vs. 564 +/- 23 ms, p < 0.0001). The T(1) time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 +/- 22 ms vs. 564 +/- 23 ms, p < 0.0001). The post-contrast myocardial T(1) time shortened as diastolic function worsened (562 +/- 24 ms in normal diastolic function vs. 423 +/- 33 ms in impaired diastolic function vs. 368 +/- 20 ms in restrictive function, p < 0.001). CONCLUSIONS Contrast-enhanced CMRI T(1) mapping identifies changes in myocardial T(1) times in heart failure, which appear to reflect diffuse fibrosis.
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Affiliation(s)
- Leah Iles
- Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Sürücü H, Tatlı E, Değirmenci A, Okudan S, Aktoz M, Boz H. A New Parameter of Pulsed-Wave Tissue Doppler Imaging: IVRa. Echocardiography 2008; 25:1079-85. [DOI: 10.1111/j.1540-8175.2008.00734.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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47
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Masugata H, Senda S, Goda F, Yamagami A, Okuyama H, Kohno T, Hosomi N, Imai M, Yukiiri K, Kohno M. Differences in left ventricular hypertrophy and dysfunction between patients with cerebral hemorrhage and those with cerebral infarction. TOHOKU J EXP MED 2008; 215:159-65. [PMID: 18577845 DOI: 10.1620/tjem.215.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left ventricular (LV) hypertrophy and dysfunction due to hypertension have been established as risk markers for stroke in hypertensive patients. The purpose of this study was to examine the differences in LV hypertrophy and dysfunction between patients with cerebral hemorrhage and those with cerebral infarction. The study enrolled 23 hypertensive patients with cerebral infarction, 25 hypertensive patients with cerebral hemorrhage, and 24 normotensive controls (controls). Standard echocardiography was performed; LV mass index was measured to evaluate LV hypertrophy, and conventional diastolic transmitral flow velocities were measured to assess LV diastolic function, which was also evaluated by measuring mitral annular velocities using tissue Doppler echocardiography. The Tei index, which reflects both the diastolic and systolic function of LV, was also calculated. The LV mass index and Tei index were significantly higher in cerebral hemorrhage (116 +/- 38 g/m(2) and 0.57 +/- 0.13) than those in controls (92 +/- 20 g/m(2) and 0.46 +/- 0.10) (p < 0.05). In contrast, the LV mass index and Tei index in cerebral infarction (100 +/- 27 g/m(2) and 0.46 +/- 0.12) were not different from those in controls. Thus, the Tei index was significantly worse in the patients with cerebral hemorrhage than in those with cerebral infarction (p < 0.05). On the other hand, the parameters, which reflect diastolic function, showed no significant differences between cerebral hemorrhage and cerebral infarction. These results indicate that LV hypertrophy and dysfunction due to hypertension are more apparent in patients with cerebral hemorrhage than in those with cerebral infarction.
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Affiliation(s)
- Hisashi Masugata
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan.
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Su HM, Lin TH, Lee CS, Yen HW, Huang CH, Cheng KH, Lee HC, Lai WT, Sheu SH, Voon WC. Differentiation of left ventricular diastolic function by mid-diastolic mitral annular motion patterns. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:753-759. [PMID: 18207309 DOI: 10.1016/j.ultrasmedbio.2007.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 10/14/2007] [Accepted: 11/12/2007] [Indexed: 05/25/2023]
Abstract
Mid-diastolic mitral annular motion may be driven by strain energy, an energy for myocardial recoil, stored during the previous systole. Hence, various patterns of mid-diastolic mitral annular motion may imply different left ventricular (LV) diastolic function. The purpose of this study is to compare LV diastolic properties among different types of mid-diastolic mitral annular motion. Two-hundred and three consecutive subjects underwent an echocardiographic examination at our outpatient clinic. Study subjects were classified into three groups according to mid-diastolic mitral annular motion patterns. Upward and downward La waves were defined, respectively, as a clear apically and atrially directed mid-diastolic annular motion on at least three consecutive beats with the average peak velocity > or =2 cm/s. Subjects with upward La wave, with downward but without upward La wave and without La wave were categorized as groups 1, 2 and 3, respectively. Early diastolic mitral annular velocity (Ea) was higher and the ratio of transmitral E wave velocity to Ea was lower in group 1 than in groups 2 and 3 (all p < 0.001). The diagnostic accuracy of upward La wave in prediction of normal diastolic function fell between 75% and 88%. In conclusion, patients with upward La wave had better LV diastolic function and lower LV filling pressure than patients without it. Upward La wave is useful in prediction of normal diastolic function. Therefore, analysis of mid-diastolic mitral annular motion may be complementary to other measures of LV diastolic function. (
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Affiliation(s)
- Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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[Diastolic dysfunction types in the prediction of viable myocardium functional recovery]. VOJNOSANIT PREGL 2008; 65:113-8. [PMID: 18365667 DOI: 10.2298/vsp0802113m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM It is well known that patients with coronary artery disease and viable tissue as a guarantee of contractile recovery (CR), despite of decreasing ejection fraction (EF) and systolic dysfunction, could have benefit from surgical revascularization. Therefore, relationship between diastolic filling type and early postoperative recovery and complications need to be established. The aim of this study was to investigate the relation between different left ventricular (LV) diastolic filling types and CR in patients after surgical revascularization with differently preserved systolic function. METHODS We investigated 60 patients. All of them had CR estimated by stress echocardiography regardless the extent of recovery of the heart systolic function. Echocardiographic evidence of diastolic dysfunction was estimated by Doppler examination of transmitral diastolic flow. According to the derived different diastolic filling types the patients were divided into three groups: I--patients with disorder of LV relaxation, II--with pseudovascularisation, and III--with restrictive filling type, and according to the value of systolic function into two subgroups: (1) relatively recovered systolic function--EF > 40% and (2) pronounced LV dysfunction--EF < 40%. Echocardiographic evaluation was performed before and two week after surgical revascularization. In the preoperative period the medication therapy was optimized. We estimated CR by echocardiografic pare meters but also by detection of cardiovascular events. RESULTS After CABG the mean value of WMISI LV tended to decrease in any groups: in the group I (n = 12) from 1.64 +/- 0.22 to 1.34 +/- 0.22; in the group II (n = 22) from 1.85 +/- 0.16 to 1.53 +/- 0.42, and in the group III (n=26) from 1.92 +/- 0.29 to 1.81 +/- 0.52. The lowest improvement of systolic function according to EF value expressed by the number of patients was found in the group of patients with restrictive LV filling type (12; 53.8%) as contrasting to the group with pseudonormalisation (15; 78.9%). In the group of patients with restrictive diastolic filling type also was recorded the highest number of lethal outcomes (6; 23.1%), as well as cardiovascular complications (10; 38.5%). CONCLUSIONS Restrictive LV diastolic filling type was the marker of poor prognosis in the patients with clinical heart failure undergoing surgical revascularization. The patients with heart failure and preserved systolic function were associated with similar prognosis.
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Hori Y, Ukai Y, Hoshi F, Higuchi SI. Volume loading-related changes in tissue Doppler images derived from the tricuspid valve annulus in dogs. Am J Vet Res 2008; 69:33-8. [PMID: 18167084 DOI: 10.2460/ajvr.69.1.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between preload and tricuspid valve annulus-derived tissue Doppler imaging (TDI) as an index of right ventricular (RV) filling in dogs. ANIMALS 7 Beagles. PROCEDURES Peak systolic RV pressure and RV end-diastolic pressure (RVEDP) were measured in anesthetized dogs. Pulsed Doppler was used to measure tricuspid valve inflow and pulmonary valve outflow velocities. The TDI velocities were measured at the lateral corner of the tricuspid valve annulus. Lactated Ringer's solution was infused at 200 mL/kg/h for 60 minutes via the cephalic vein. RESULTS IV infusion significantly increased heart rate, RV pressure, and RVEDP. Early diastolic flow (E-wave) and ejection time significantly increased. The myocardial performance index (MPI) significantly decreased. Intravenous infusion significantly increased the ratio of the E'-wave (peak myocardial velocity during early diastole) to the A'-wave (peak myocardial velocity during late diastole; E':A' ratio) and myocardial velocity during systole (S'), early diastole (E'), and late diastole (A'). The TDI-isovolumic relaxation time and TDI-MPI decreased significantly. The RVEDP was correlated with late diastolic flow (A-wave), ratio of the E-wave to the A-wave (E:A ratio), E'-wave, A'-wave, S'-wave (peak myocardial velocity during systole), TDI-isovolumic relaxation time, TDI-MPI, and ratio of the E-wave to the E'-wave (E: E' ratio). The A-wave and E:A ratio and TDI-derived isovolumic relaxation time, S' duration, and E'-wave could predict the RVEDP. CONCLUSIONS AND CLINICAL RELEVANCE The TDI velocities were affected by RV filling pressure in healthy dogs, whereas other TDI profiles, such as MPI and E':A' ratio, were independent of acute filling abnormalities.
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Affiliation(s)
- Yasutomo Hori
- Department of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Towada, Aomori 034-8628, Japan
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