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Abubakar IG, Buba F, Oyati AI, Talle MA, Anjorin CO. Prevalence of Doppler-Derived Left Ventricular Diastolic Dysfunction Among Newly Diagnosed Hypertensive Patients. Niger J Clin Pract 2023; 26:1630-1636. [PMID: 38044766 DOI: 10.4103/njcp.njcp_227_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/06/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The initial sign of hypertensive heart disease (HHD) is left ventricular diastolic dysfunction (LVDD), which is caused by remodeling of the left ventricle and left atrium, resulting in impaired relaxation of the left ventricle. LVDD is also partly due to left ventricular hypertrophy (LVH). If left untreated, LVDD can progress to diastolic heart failure and systolic heart failure. In Western countries, the prevalence of LVDD in long-term hypertensive patients ranges from 40.3% to 60%, but it is more common among hypertensive Nigerians. Since systemic hypertension can be asymptomatic in the early stages, it is important to evaluate LVDD early and control blood pressure to slow down its progression. AIMS AND OBJECTIVES The study aims to highlight the prevalence of LVDD and to determine the stages of LVDD among newly diagnosed hypertensive patients at the University of Maiduguri Teaching Hospital (UMTH). METHOD The study design is a hospital-based, cross-sectional, observational study. The study population consists of 352 consecutive treatment Naïve hypertensive adult patients aged 18 years and above who presented to the Cardiology Clinic of UMTH from June 2019 to June 2021. The study used the diagnostic criteria for LVDD and LVH which were based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging. RESULTS A total of 352 newly diagnosed hypertensive patients were recruited, with a mean age of 50.9 ± 11.8 years, and 54.3% were female. The majority of patients (63.6%) were overweight or obese, with a mean body mass index (BMI) of 28.5 ± 4.6 kg/m2. The mean systolic blood pressure (SBP) was 155.7 ± 16.9 mmHg, and the mean diastolic blood pressure (DBP) was 92.8 ± 10.8 mmHg. LVDD was found in 58.5% of the patients, with stage 1 LVDD being the most common (42.6%), followed by stage 2 LVDD (15.9%). The prevalence of LVDD was significantly higher in females compared to males. Patients with LVDD were significantly older and had higher BMI, higher systolic and DBP, higher pulse pressure, higher LAVI, and higher LVMI compared to those without LVDD (P < 0.05). CONCLUSION LVDD is highly prevalent among newly diagnosed hypertensive patients, with stage 1 being the most common. Female gender, older age, higher BMI, higher blood pressure, higher LAVI, and higher LVMI were significant predictors of LVDD. Early detection and appropriate management of LVDD may help to prevent adverse cardiovascular outcomes in hypertensive patients.
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Affiliation(s)
- I G Abubakar
- Department of Medicine, Cardiology Unit, University of Maiduguri Teaching Hospital, Nigeria
| | - F Buba
- Department of Medicine, Cardiology Unit, University of Maiduguri Teaching Hospital, Nigeria
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - A I Oyati
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
- Department of Medicine, Cardiology Unit, Ahmadu Bello University Teaching Hospital, Shika, Nigeria
| | - M A Talle
- Department of Medicine, Cardiology Unit, University of Maiduguri Teaching Hospital, Nigeria
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - C O Anjorin
- Department of Medicine, Cardiology Unit, University of Maiduguri Teaching Hospital, Nigeria
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Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
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Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
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D'Onofrio A, Tessari C, Tarantini G, Cibin G, Lorenzoni G, Pesce R, Fraccaro C, Napodano M, Gregori D, Gerosa G. Transapical TAVI: Survival, Hemodynamics, Devices and Machine Learning. Lessons Learned After 10-Year Experience. Curr Probl Cardiol 2023; 48:101734. [PMID: 37044271 DOI: 10.1016/j.cpcardiol.2023.101734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
Aim of this single-center, retrospective study was to assess early and long-term clinical and hemodynamic results of transapical aortic valve implantation (TA-TAVI), and to identify predictors of survival at follow-up. All patients undergoing TA-TAVI for severe aortic valve stenosis at our institution were reviewed. A hybrid approach based on machine-learning techniques was employed to identify survival predictors, using a Bagging-Decision-Tree algorithm and a Random-Forest algorithm, respectively. Two-hundred-thirty-four consecutive patients underwent TA-TAVI (March 2009-May 2019). All-cause 30-day mortality was 5.1%. Device success was 95.7%. Median follow-up time was 35.2 months. Kaplan-Meier overall survival rates at 2, 5, and 8 years were 75%, 44%, and 15%, respectively. Structural-valve-deterioration occurred in 25 patients (11.3%) overall. The strongest predictors of survival at follow-up were age, body-mass-index, and ejection fraction. TA-TAVI provided valid early and long-term outcomes. These data support its choice as an optimal alternative access whenever the transfemoral route is not feasible.
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Affiliation(s)
- Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova.
| | - Chiara Tessari
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Giuseppe Tarantini
- Division of Biostatistics, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Giorgia Cibin
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Giulia Lorenzoni
- Division of Interventional Cardiology, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Rita Pesce
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Chiara Fraccaro
- Division of Biostatistics, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Massimo Napodano
- Division of Biostatistics, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Dario Gregori
- Division of Interventional Cardiology, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padova
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Correlation between Echocardiographic Diastolic Parameters and Invasive Measurements of Left Ventricular Filling Pressure in Patients with Takotsubo Cardiomyopathy. J Am Soc Echocardiogr 2022; 36:490-499. [PMID: 36442765 DOI: 10.1016/j.echo.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The extent of diastolic dysfunction is of clinical importance in the risk stratification and management of patients with Takotsubo cardiomyopathy (TC). Standard echocardiographic indices of diastolic dysfunction have robust predictive ability in assorted disease states, but have not been validated in TC. The aim of this study was to compare Doppler metrics of diastolic function against catheterization-measured filling pressures in TC. METHODS Patients with TC who met inclusion and exclusion criteria were evaluated using echocardiography and catheterization performed within 24 hours. Both left ventricular (LV) end-diastolic pressure and LV pre-A diastolic pressure were obtained from catheterization tracings. The echocardiographic parameters for diastolic function were extracted using the American Society of Echocardiography recommendations and a previously validated regression equation for mean left atrial pressure (mLAP). RESULTS A total of 51 patients with TC were included. Patients were predominantly women (72.5%), with a mean age of 58 ± 13 years and a mean ejection fraction of 24 ± 10 %. E/e' ratio (septal, average, and lateral) and calculated mLAP correlated positively with catheterization LV pre-A, with fair to moderate correlation (coefficient range, 0.38-0.44). The t-test mean difference between LV pre-A pressure and calculated mLAP was 0.77 ± 7.34 mm Hg (95% CI, ±14.68 mm Hg) suggesting inconsistent measures. mLAP also exhibited poor diagnostic ability to discriminate elevated LV pre-A diastolic pressure, with an area under the receiver operating characteristic curve of 0.69 (95% CI, 0.50-0.88). CONCLUSIONS Commonly used echocardiographic parameters for diastolic function demonstrated less-than-optimal correlation, with poor sensitivity and specificity, compared with invasively measured LV end-diastolic pressure or LV pre-A wave diastolic pressure in patients with TC. Precise characterization of LV filling pressure in patients with TC using contemporary noninvasive echocardiographic parameters appears challenging. Invasive measurements of filling pressure should remain the gold standard for optimal risk stratification and management of patients with TC.
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Sonaglioni A, Lonati C, Tescaro L, Nicolosi GL, Proietti M, Lombardo M, Harari S. Prevalence and clinical outcome of main echocardiographic and hemodynamic heart failure phenotypes in a population of hospitalized patients 70 years old and older. Aging Clin Exp Res 2022; 34:1081-1094. [PMID: 34988931 DOI: 10.1007/s40520-021-02025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart failure (HF) echocardiographic and hemodynamic categories are poorly characterized in the elderly. We aimed to evaluate the prevalence and clinical outcomes of echocardiographic and hemodynamic HF phenotypes in a consecutive series of hospitalized patients aged ≥ 70 years. METHODS All consecutive patients ≥ 70 years old discharged from the Internal Medicine Unit of our Hospital with a diagnosis of HF, between January and November 2020, entered this retrospective study. All patients underwent physical examination, complete blood tests, chest X-ray and transthoracic echocardiography. At 1-year follow-up, we evaluated the occurrence of the composite outcome of all-cause mortality and re-hospitalization. RESULTS Two hundred and sixty-one patients (86.3 ± 6.4 years, 60.9% women) were retrospectively analyzed. From the study group, 106 "old" (70-84 years) and 155 "oldest-old" (≥ 85 years) patients were separately analyzed. A total of 169 (64.7%) patients reported the composite outcome during follow-up: 41 (15.7%) died and 128 (49.0%) were re-hospitalized. At 1-year follow-up, survival analysis did not show any statistically significant difference between age groups (p = 0.31) and between HF echocardiographic categories (p = 0.34), whereas HF patients with "cold-dry" phenotype had significantly poorer survival compared to the other hemodynamic subtypes (p < 0.001). Male sex (HR 1.44, 95% CI 1.04-1.98), "cold-dry" phenotype (HR 3.90, 95% CI 1.73-8.77), high sodium level (HR 1.03, 95% CI 1.01-1.04) and low estimated glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97-0.99) were independently associated with the outcome occurrence. CONCLUSIONS Male sex, "cold-dry" phenotype, high sodium level and low eGFR are the main adverse prognostic indicators over a mid-term follow-up in hospitalized patients aged ≥ 70 years.
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Ilieșiu AM, Hodorogea AS, Balahura AM, Bădilă E. Non-Invasive Assessment of Congestion by Cardiovascular and Pulmonary Ultrasound and Biomarkers in Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12040962. [PMID: 35454010 PMCID: PMC9024731 DOI: 10.3390/diagnostics12040962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Worsening chronic heart failure (HF) is responsible for recurrent hospitalization and increased mortality risk after discharge, irrespective to the ejection fraction. Symptoms and signs of pulmonary and systemic congestion are the most common cause for hospitalization of acute decompensated HF, as a consequence of increased cardiac filling pressures. The elevated cardiac filling pressures, also called hemodynamic congestion, may precede the occurrence of clinical congestion by days or weeks. Since HF patients often have comorbidities, dyspnoea, the main symptom of HF, may be also caused by respiratory or other illnesses. Recent studies underline the importance of the diagnosis and treatment of hemodynamic congestion before HF symptoms worsen, reducing hospitalization and improving prognosis. In this paper we review the role of integrated evaluation of biomarkers and imaging technics, i.e., echocardiography and pulmonary ultrasound, for the diagnosis, prognosis and treatment of congestion in HF patients.
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Affiliation(s)
- Adriana Mihaela Ilieșiu
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Andreea Simona Hodorogea
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Correspondence: ; Tel.: +40-72-631-5872
| | - Ana-Maria Balahura
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| | - Elisabeta Bădilă
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
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Reduction of Hospitalization and Mortality by Echocardiography-Guided Treatment in Advanced Heart Failure. J Cardiovasc Dev Dis 2022; 9:jcdd9030074. [PMID: 35323622 PMCID: PMC8953534 DOI: 10.3390/jcdd9030074] [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: 01/18/2022] [Revised: 02/19/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
In advanced heart failure (AHF) clinical evaluation fails to detect subclinical HF deterioration in outpatient settings. The aim of the study was to determine whether the strategy of intensive outpatient echocardiographic monitoring, followed by treatment modification, reduces mortality and re-hospitalizations at 12 months. Methods: 214 patients with ejection fraction < 30% and >1 hospitalization during the last year underwent clinical evaluation and echocardiography at discharge and were divided into intensive (IMG; N = 143) or standard monitoring group (SMG; N = 71). In IMG, volemic status and left ventricular filling pressure were assessed 14, 30, 90, 180 and 365 days after discharge. HF treatment, particularly diuretic therapy, was temporarily intensified when HF deterioration signs and E/e’ > 15 were detected. In SMG, standard outpatient monitoring without obligatory echocardiography at outpatient visits was performed. Results: We observed lower hospitalization (absolute risk reduction [ARR]-0.343, CI-95%: 0.287−0.434, p < 0.05; number needed to treat [NNT]-2.91) and mortality (ARR-0.159, CI 95%: 0.127−0.224, p < 0.05; NNT-6.29) in IMG at 12 months. One-year survival was 88.8% in IMG and 71.8% in SMG (p < 0.05). Conclusion: In AHF, outpatient monitoring of volemic status and intracardiac filling pressures to individualize treatment may potentially reduce hospitalizations and mortality at 12 months follow-up. Echocardiography-guided outpatient therapy is feasible and clinically beneficial, providing evidence for the larger application of this approach.
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Pilot study on the value of echocardiography combined with lung ultrasound to evaluate COVID-19 pneumonia. Cardiovasc Ultrasound 2022; 20:2. [PMID: 35045881 PMCID: PMC8767359 DOI: 10.1186/s12947-021-00271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to investigate the relationship between echocardiography results and lung ultrasound score (LUS) in coronavirus disease 2019 (COVID-19) pneumonia patients and evaluate the impact of the combined application of these techniques in the evaluation of COVID-19 pneumonia.
Methods
Hospitalized COVID-19 pneumonia patients who underwent daily lung ultrasound and echocardiography were included in this study. Patients with tricuspid regurgitation within three days of admission were enrolled. Moreover, the correlation and differences between their pulmonary artery pressure (PAP) and LUS on days 3, 8, and 13 were analyzed. The inner diameter of the pulmonary artery root as well as the size of the atria and ventricles were also considered.
Results
The PAP on days 3, 8, and 13 of hospitalization was positively correlated with the LUS (r = 0.448, p = 0.003; r = 0.738, p < 0.001; r = 0.325, p = 0.036, respectively). On day 8, the values of both PAP and LUS were higher than on days 3 and 13 (p < 0.01). Similarly, PAP and LUS were significantly increased in 92.9% (39/42) and 90.5% (38/42) of patients, respectively, and at least one of these two values was positive in 97.6% (41/42) of cases. The inner diameters of the right atrium, right ventricle, and pulmonary artery also differed significantly from their corresponding values on days 3 and 13 (p < 0.05).
Conclusions
PAP is positively correlated with LUS in COVID-19 pneumonia. The two values could be combined for a more precise assessment of disease progression and recovery status.
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Uema A, Tamura Y, Uejima T, Hoshiai M, Ueno A, Nagao M, Tomoe T, Ono S, Maeno E, Mizuguchi S, Kawabe A, Sugiyama T, Yasu T. Early diastolic mitral regurgitation in left ventricular aneurysm. Heart Vessels 2021; 37:683-690. [PMID: 34689257 DOI: 10.1007/s00380-021-01958-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
Diastolic mitral regurgitation is a type of functional mitral regurgitation that develops via a reversal of the left atrioventricular pressure gradient during diastole. This study aimed to explore the mechanism underlying early diastolic mitral regurgitation (EDMR) in patients with left ventricular (LV) aneurysms after anterior myocardial infarction (AMI) by assessing the intraventricular pressure difference using vector flow mapping. We enrolled 23 consecutive patients with LV aneurysms (with and without EDMR) and 15 healthy men as controls. In the control group, LV suction began from the apex during early diastole. In contrast, the blood that pooled in the apical aneurysm during systole generated a relatively higher pressure at the apex than at the basal LV during early diastole; consequently, the pressure reversal phenomenon occurred in the LV. Compared to the EDMR- group, the EDMR + group (n = 7) exhibited a significantly higher diastolic time ratio ([time from the second heart sound to the pressure inversion point]/[total diastolic time]) (P < 0.001). The diastolic time ratio was significantly correlated with log BNP, but not with E/A, E/E', or the left atrial expansion index. In conclusion, EDMR in LV aneurysm may be due to a prolonged diastolic time ratio leading to prolonged pressure inversion in the LV during early diastole.
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Affiliation(s)
- Atsuko Uema
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Yuma Tamura
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Minato-ku, Nishiazabu, Tokyo, Japan
| | - Megumi Hoshiai
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Asuka Ueno
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Moeko Nagao
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Takashi Tomoe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Shoya Ono
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Eikou Maeno
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Satoshi Mizuguchi
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Atsuhiko Kawabe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Takushi Sugiyama
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan.
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Schuman ML, Peres Diaz LS, Aisicovich M, Ingallina F, Toblli JE, Landa MS, García SI. Cardiac Thyrotropin-releasing Hormone Inhibition Improves Ventricular Function and Reduces Hypertrophy and Fibrosis After Myocardial Infarction in Rats. J Card Fail 2021; 27:796-807. [PMID: 33865967 DOI: 10.1016/j.cardfail.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac thyrotropin-releasing hormone (TRH) is a tripeptide with still unknown functions. We demonstrated that the left ventricle (LV) TRH system is hyperactivated in spontaneously hypertensive rats and its inhibition prevented cardiac hypertrophy and fibrosis. Therefore, we evaluated whether in vivo cardiac TRH inhibition could improve myocardial function and attenuate ventricular remodeling in a rat model of myocardial infarction (MI). METHODS AND RESULTS In Wistar rats, MI was induced by a permanent left anterior descending coronary artery ligation. A coronary injection of a specific small interfering RNA against TRH was applied simultaneously. The control group received a scrambled small interfering RNA. Cardiac remodeling variables were evaluated one week later. In MI rats, TRH inhibition decreased LV end-diastolic (1.049 ± 0.102 mL vs 1.339 ± 0.102 mL, P < .05), and end-systolic volumes (0.282 ± 0.043 mL vs 0.515 ± 0.037 mL, P < .001), and increased LV ejection fraction (71.89 ± 2.80% vs 65.69 ± 2.85%, P < .05). Although both MI groups presented similar infarct size, small interfering RNA against TRH treatment attenuated the cardiac hypertrophy index and myocardial interstitial collagen deposition in the peri-infarct myocardium. These effects were accompanied by attenuation in the rise of transforming growth factor-β, collagen I, and collagen III, as well as the fetal genes (atrial natriuretic peptide, B-type natriuretic peptide, and beta myosin heavy chain) expression in the peri-infarct region. In addition, the expression of Hif1α and vascular endothelial growth factor significantly increased compared with all groups. CONCLUSIONS Cardiac TRH inhibition improves LV systolic function and attenuates ventricular remodeling after MI. These novel findings support the idea that TRH inhibition may serve as a new therapeutic strategy against the progression of heart failure.
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Affiliation(s)
- Mariano L Schuman
- University of Buenos Aires, School of Medicine, Institute of Medical Research A. Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), University of Buenos Aires (UBA), Institute of Medical Research (IDIM), Department of Molecular Cardiology, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ludmila S Peres Diaz
- University of Buenos Aires, School of Medicine, Institute of Medical Research A. Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), University of Buenos Aires (UBA), Institute of Medical Research (IDIM), Department of Molecular Cardiology, Ciudad Autónoma de Buenos Aires, Argentina
| | - Maia Aisicovich
- University of Buenos Aires, School of Medicine, Institute of Medical Research A. Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), University of Buenos Aires (UBA), Institute of Medical Research (IDIM), Department of Molecular Cardiology, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Ingallina
- University of Buenos Aires, School of Medicine, Institute of Medical Research A. Lanari, Ciudad Autónoma de Buenos Aires, Argentina; University of Buenos Aires (UBA), School of Medicine, Institute of Medical Research "Alfredo Lanari," Department of Cardiology, Ciudad Autonoma de Buenos Aires, Argentina
| | - Jorge E Toblli
- Laboratory of Experimental Medicine, Hospital Alemán, Ciudad Autonoma de Buenos Aires, Argentina
| | - Maria S Landa
- University of Buenos Aires, School of Medicine, Institute of Medical Research A. Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), University of Buenos Aires (UBA), Institute of Medical Research (IDIM), Department of Molecular Cardiology, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), University of Buenos Aires (UBA), Institute of Medical Research (IDIM), Department of Molecular Genetics and Biology of Complex Diseases, Ciudad Autonoma de Buenos Aires, Argentina
| | - Silvia I García
- University of Buenos Aires, School of Medicine, Institute of Medical Research A. Lanari, Ciudad Autónoma de Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), University of Buenos Aires (UBA), Institute of Medical Research (IDIM), Department of Molecular Cardiology, Ciudad Autónoma de Buenos Aires, Argentina; Laboratory of Experimental Medicine, Hospital Alemán, Ciudad Autonoma de Buenos Aires, Argentina.
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11
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Durmaz E, Ikitimur B, Karadag B, Koca D, Ohtaroglu Tokdil K, Raimoglu U, Soysal AU, Incesu G, Belpinar MS, Mutlu D, Yurtseven E, Atici A, Ongen Z. Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study. Int J Cardiovasc Imaging 2021; 37:1587-1594. [PMID: 33624230 DOI: 10.1007/s10554-020-02138-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
Abstract
Backgrounds Assessment of left ventricular filling pressure (LVFP) is of clinical importance in patients with ST elevation myocardial infarction (STEMI). Although several echocardiographic parameters are recommended for the assessment of LVFP, validation of these parameters in patients with STEMI is missing. We aimed to investigate the clinical utility of these parameters in acute settings. Methods: We prospectively included consecutive patients with STEMI. LV end-diastolic pressure (LVEDP) was measured following primary PCI and echocardiographic examination was performed within 24 hours. Mean left atrial pressure (mLAP) was calculated both invasively using Yamamoto's formula and non-invasively using Naugeh's formula. Mean LAP was considered increased when exceeded 18 mmHg. Results: Patients were grouped according to LVEDP, group 1(41 patients) and group 2(114 patients).There was no significant difference between groups in terms of comorbidities. NT pro-BNP levels (p < 0.001) and peak level of Hs-TnT (p-value: 0.002) were significantly higher in group 2. Average E/e' ratio was significantly higher in group 2 (10.19 ± 3.15 vs. 12.04 ± 4.83, p: 0.046). Isovolumetric relaxation time was longer in group 2 (p < 0.001) and left atrial volume index (LAVI) was also significantly higher in group 2 (p < 0.001). Regression analyses revealed that septal, lateral and average E/e' ratio, tricuspid regurgitation velocity, LAVI and left ventricular volume are correlated with mLAP. Among group 2 patients only 14 Patients fulfilled the increased LVFP criteria suggested by current guidelines. Conclusions Echocardiographic parameters indicating increased LVFP require validation and may need to be modified in patients with STEMI. Moreover, current algorithms underestimate the actual number of patients with increased LVFP.
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Affiliation(s)
- Eser Durmaz
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey.
| | - Baris Ikitimur
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Bilgehan Karadag
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Damla Koca
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Kardelen Ohtaroglu Tokdil
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Utku Raimoglu
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Ali Ugur Soysal
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Gündüz Incesu
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Mehmet Semih Belpinar
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Deniz Mutlu
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
| | - Ece Yurtseven
- Department of Cardiology, Koc University, Istanbul, Turkey
| | - Adem Atici
- Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Zeki Ongen
- Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey
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12
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Chubuchny V, Pugliese NR, Taddei C, Poggianti E, Spini V, Barison A, Formichi B, Airò E, Bauleo C, Prediletto R, Pastormerlo LE, Coceani M, Ciardetti M, Petersen C, Pasanisi E, Lombardi C, Emdin M, Giannoni A. A novel echocardiographic method for estimation of pulmonary artery wedge pressure and pulmonary vascular resistance. ESC Heart Fail 2021; 8:1216-1229. [PMID: 33566429 PMCID: PMC8006655 DOI: 10.1002/ehf2.13183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/26/2020] [Accepted: 12/03/2020] [Indexed: 01/28/2023] Open
Abstract
Aims This study aimed to evaluate a novel echocardiographic algorithm for quantitative estimation of pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR) in patients with heart failure and pulmonary hypertension (PH) scheduled to right heart catheterization (RHC). Methods and results In this monocentric study, 795 consecutive patients (427 men; age 68.4 ± 12.1 years) undergoing echocardiography and RHC were evaluated. Multiple regression analysis was performed to identify echocardiographic predictors of PAWP and PVR measured by RHC in the derivation group (the first 200 patients). The diagnostic accuracy of the model was then tested in the validation group (the remaining 595 patients). PH was confirmed by RHC in 507 (63.8%) patients, with 192 (24.2%) cases of precapillary PH, 248 (31.2%) of postcapillary PH, and 67 (8.4%) of combined PH. At regression analysis, tricuspid regurgitation maximal velocity, mitral E/e′ ratio, left ventricular ejection fraction, right ventricular fractional area change, inferior vena cava diameter, and left atrial volume index were included in the model (R = 0.8, P < 0.001). The model showed a high diagnostic accuracy in estimating elevated PAWP (area under the receiver operating characteristic curve = 0.97, 92% sensitivity, and 93% specificity, P < 0.001) and PVR (area under the receiver operating characteristic curve = 0.96, 89% sensitivity, and 92% specificity, P < 0.001), outperforming 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations (P < 0.001) and Abbas' equation (P < 0.001). Bland–Altman analysis showed satisfactory limits of agreement between echocardiography and RHC for PAWP (bias 0.7, 95% confidence interval −7.3 to 8.7) and PVR (bias −0.1, 95% confidence interval −2.2 to 1.9 Wood units), without indeterminate cases. Conclusions A novel quantitative echocardiographic approach for the estimation of PAWP and PVR has high diagnostic accuracy in patients with heart failure and PH.
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Affiliation(s)
- Vladislav Chubuchny
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Elisa Poggianti
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Valentina Spini
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Andrea Barison
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, Pisa, 56127, Italy
| | - Bruno Formichi
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy.,CNR Institute of Clinical Physiology, Pisa, Italy
| | - Edoardo Airò
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Carolina Bauleo
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Renato Prediletto
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy.,CNR Institute of Clinical Physiology, Pisa, Italy
| | - Luigi Emilio Pastormerlo
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Michele Coceani
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Marco Ciardetti
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Christina Petersen
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Emilio Pasanisi
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Carlo Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, Pisa, 56127, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, Pisa, 56127, Italy
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13
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Hammond MM, Shen C, Li S, Kazi DS, Sabe MA, Garan AR, Markson LJ, Manning WJ, Klein AL, Nagueh SF, Strom JB. Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience. PLoS One 2020; 15:e0244379. [PMID: 33351853 PMCID: PMC7755281 DOI: 10.1371/journal.pone.0244379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/08/2020] [Indexed: 01/28/2023] Open
Abstract
Background Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. Methods We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. Results After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). Conclusions In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.
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Affiliation(s)
- Michael M. Hammond
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Changyu Shen
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Stephanie Li
- Harvard Medical School, Boston, MA, United States of America
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Dhruv S. Kazi
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Marwa A. Sabe
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - A. Reshad Garan
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Lawrence J. Markson
- Harvard Medical School, Boston, MA, United States of America
- Information Systems, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Warren J. Manning
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Allan L. Klein
- The Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States of America
| | - Sherif F. Nagueh
- Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, United States of America
| | - Jordan B. Strom
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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14
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Park DY, Kim SS, Sung HH, Park CE. Study on the Relationship between Pro-Brain Natriuretic Peptide and Routine Blood Test Factors at a General Hospital in Gyeonggi-do. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dong Yeop Park
- Department of Clinical Laboratory Medicine, Dongsuwon General Hospital, Suwon, Korea
| | | | - Hyun Ho Sung
- Department of Clinical Laboratory Science, Dongnam Health University, Suwon, Korea
| | - Chang-Eun Park
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan, Korea
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15
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Beladan CC, Botezatu S, Popescu BA. Reversible left ventricular diastolic dysfunction—Overview and clinical implications. Echocardiography 2020; 37:1957-1966. [DOI: 10.1111/echo.14838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Carmen C. Beladan
- Euroecolab Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Simona Botezatu
- Euroecolab Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Bogdan A. Popescu
- Euroecolab Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
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16
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Prasad SB, Holland DJ, Atherton JJ, Whalley G. New Diastology Guidelines: Evolution, Validation and Impact on Clinical Practice. Heart Lung Circ 2019; 28:1411-1420. [PMID: 31064714 DOI: 10.1016/j.hlc.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/22/2019] [Indexed: 01/12/2023]
Abstract
The 2016 American Society of Echocardiography/European Association of Echocardiography (ASE/EACVI) guidelines on the assessment of diastolic function sought to simplify the assessment of diastolic function by recommending a streamlined, stepped approach with a focus on four key variables. Haemodynamic validation using simultaneous cardiac catheterisation and echocardiographic assessment of diastolic function have shown robust prediction of left ventricular filling pressure (LVFP) using the streamlined 2016 algorithms, with favourable comparisons to the 2009 guidelines. Similarly, prognostic validation data demonstrates that the 2016 algorithms are easier to implement in clinical practice, have superior inter-observer reliability across a broad range of observer experience, and are better at predicting clinical outcomes. Furthermore, published data show improved classification of clinical heart failure patients. However, increased specificity of the updated 2016 guidelines results in a lower prevalence of diastolic dysfunction compared to the 2009 recommendations. Further refinement of guidelines for the identification and diagnosis of diastolic dysfunction is possible through incorporation of new diastolic parameters.
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Affiliation(s)
- Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
| | - David J Holland
- Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Qld, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Gillian Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand
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17
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Mozzini C, Cominacini L, Casadei A, Schiavone C, Soresi M. Ultrasonography in Heart Failure: A Story that Matters. Curr Probl Cardiol 2019; 44:116-136. [PMID: 30172551 DOI: 10.1016/j.cpcardiol.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
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18
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Nonin S, Iwata S, Ito A, Tamura S, Kitada R, Kawai Y, Ishikawa S, Doi A, Hanatani A, Yoshiyama M. Right ventricular enlargement predicts responsiveness to tolvaptan in congestive heart failure patients with reduced ejection fraction. IJC HEART & VASCULATURE 2018; 21:69-73. [PMID: 30345343 PMCID: PMC6191974 DOI: 10.1016/j.ijcha.2018.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 12/28/2022]
Abstract
Background Tolvaptan is a vasopressin type 2 receptor antagonist used in heart failure (HF) with refractory diuretic resistance. However, since tolvaptan is also ineffective in some HF patients with reduced ejection fraction (HFrEF), the identification of responders is important. Methods The study population consisted of 51 HFrEF patients who were administered tolvaptan (EF, 28 ± 7%). We defined responders as patients with a ≥50% increase in urine volume during the 24-hours after administration of tolvaptan. All patients underwent comprehensive transthoracic echocardiography before administration of tolvaptan. Patients were followed for 120 days to ascertain secondary events (cardiac death and rehospitalization for HF). Results Multiple regression analysis indicated that right ventricular (RV) enlargement (defined as basal RV diameter > 41 mm and midlevel RV diameter > 35 mm, according to guidelines) remained a predictor of response after adjustment for age, sex, starting dosage of tolvaptan, and estimated glomerular filtration rate (odds ratio, 4.88; 95%-confidence interval, 1.26–18.9; P < 0.05), whereas left ventricular parameters and RV dysfunction were not. Kaplan-Meier curves indicated responsiveness to tolvaptan was associated with better prognosis among the overall population (P < 0.05); similar trends were observed among patients with RV dilatation (P = 0.056). Conclusions These findings suggest that RV enlargement, which represents right-sided volume overload, elevated filling pressure, and diastolic dysfunction similar to that seen in constrictive pericarditis, predicts responsiveness to tolvaptan in patients with HFrEF. Moreover, administration of tolvaptan may have the potential to improve the reportedly poor prognosis for HFrEF patients with RV dilatation.
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Affiliation(s)
- Shinichi Nonin
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Asahiro Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Soichiro Tamura
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Ryoko Kitada
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Yu Kawai
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Sera Ishikawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Akihisa Hanatani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan
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The Importance of the Double Product in the Six-Minute Walk Test to Predict Myocardial Function. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3082690. [PMID: 30069465 PMCID: PMC6057403 DOI: 10.1155/2018/3082690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/20/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
Introduction The Six-Minute Walk Test (6MWT) is a widely used test to measure the physical performance of patients to assess the effectiveness of treatment, to qualify for rehabilitation, and to evaluate its effects.. Aim This paper focuses on the assessment of the growth of a double product (DP) during the 6MWT and its diagnostic value in the assessment of patients with heart failure. Material and Methods The paper has retrospective character. We analyzed medical records of 412 patients hospitalized for cardiac reasons, in whom a 6MWT was performed. The patients were divided into two groups: one with diagnosed heart failure and a control group. Results The patients with diagnosed heart failure, compared to the control group, were characterized by a shorter walking distance and greater DP increase at equal walking intervals. After distinguishing the group with the preserved and decreased left ventricle ejection fraction, the value of the DP increase was still higher compared to the control group. The mean DP increase corresponding to one meter of walk was the only one that correlated negatively with the left ventricular ejection fraction. Conclusion The assessment of the increase of the DP during the march test seems to be a better parameter reflecting the efficiency of the myocardium from the distance of the march.
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Determinants of Normal Left Atrial Volume in Heart Failure with Moderate-to-Severely Reduced Ejection Fraction. Cardiol Res Pract 2018; 2018:7512758. [PMID: 29850229 PMCID: PMC5937574 DOI: 10.1155/2018/7512758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/16/2018] [Accepted: 03/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Indexed left atrial volume (LAVi) is a robust predictor of adverse cardiovascular events. A minority of patients with moderate-to-severe left ventricular (LV) systolic dysfunction maintain normal LAVi. We followed clinical and echocardiographic parameters for at least 6 months to understand how this population is different from patients with similar systolic dysfunction and dilated left atria. Methods and Results We searched our electronic medical records for "normal" (n=817) and "severely dilated" (n=1094) LA size and LV ejection fraction (EF) ≤ 35% on echocardiogram reports from 2009 to 2015. We analyzed 115 subjects for LAVi, biplane EF, and diastolic parameters over 2 echocardiograms at least 6 months apart. Younger age, white race, being on an angiotensin-converting enzyme inhibitor, smaller end-diastolic LV volume (LVEDV), and longer deceleration time (DT) were associated with having a normal LAVi. The receiver-operating characteristic curve has an area under the curve of 0.95 (p < 0.0001) for this model. An increase in LVESVi and early mitral flow velocity and a decrease in DT explain 32% of the variance seen in LAVi increase over time. Conclusion In patients with moderate-to-severely reduced EF, younger age, being on heart failure therapies, and better diastolic dysfunction were independently associated with a normal LAVi. Improvement in systolic and diastolic performances was associated with decreasing LAVi with 6-month to 1-year follow-up.
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21
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Balaney B, Medvedofsky D, Mediratta A, Singh A, Ciszek B, Kruse E, Shah AP, Addetia K, Lang RM, Mor-Avi V. Invasive Validation of the Echocardiographic Assessment of Left Ventricular Filling Pressures Using the 2016 Diastolic Guidelines: Head-to-Head Comparison with the 2009 Guidelines. J Am Soc Echocardiogr 2017; 31:79-88. [PMID: 29111121 DOI: 10.1016/j.echo.2017.09.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines for echocardiographic evaluation of left ventricular (LV) diastolic function provide a practical, simplified diagnostic algorithm for estimating LV filling pressure. The aim of this study was to test the accuracy of this algorithm against invasively measured pressures and compare it with the accuracy of the previous 2009 guidelines in the same patient cohort. METHODS Ninety patients underwent transthoracic echocardiography immediately before left heart catheterization. Mitral inflow E/A ratio, E/e', tricuspid regurgitation velocity, and left atrial volume index were used to estimate LV filling pressure as normal or elevated using the ASE/EACVI algorithm. Invasive LV pre-A pressure was used as a reference, with >12 mm Hg defined as elevated. RESULTS Invasive LV pre-A pressure was elevated in 40 (44%) and normal in 50 (56%) patients. The 2016 algorithm resulted in classification of 9 of 90 patients (10%) as indeterminate but estimated LV filling pressures in agreement with the invasive reference in 61 of 81 patients (75%), with sensitivity of 0.69 and specificity of 0.81. The 2009 algorithm could not definitively classify 4 of 90 patients (4.4%), but estimated LV filling pressures in agreement with the invasive reference in 64 of 86 patients (74%), with sensitivity of 0.79 and specificity of 0.70. CONCLUSIONS The 2016 ASE/EACVI guidelines for estimation of filling pressures are more user friendly and efficient than the 2009 guidelines and provide accurate estimates of LV filling pressure in the majority of patients when compared with invasive measurements. The simplicity of the new algorithm did not compromise its accuracy and is likely to encourage its incorporation into clinical decision making.
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Affiliation(s)
- Bhavna Balaney
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Diego Medvedofsky
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Anuj Mediratta
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Amita Singh
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Boguslawa Ciszek
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Eric Kruse
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Atman P Shah
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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22
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Nagueh SF. Non-invasive assessment of left ventricular filling pressure. Eur J Heart Fail 2017; 20:38-48. [DOI: 10.1002/ejhf.971] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sherif F. Nagueh
- Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute; The Methodist Hospital; Houston TX USA
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23
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Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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24
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Andersen OS, Smiseth OA, Dokainish H, Abudiab MM, Schutt RC, Kumar A, Sato K, Harb S, Gude E, Remme EW, Andreassen AK, Ha JW, Xu J, Klein AL, Nagueh SF. Estimating Left Ventricular Filling Pressure by Echocardiography. J Am Coll Cardiol 2017; 69:1937-1948. [DOI: 10.1016/j.jacc.2017.01.058] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
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25
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D’Onofrio A, Besola L, Rizzoli G, Bizzotto E, Manzan E, Tessari C, Bianco R, Tarantini G, Badano LP, Napodano M, Fraccaro C, Pittarello D, Gerosa G. Impact of Changes in Left Ventricular Ejection Fraction on Survival After Transapical Aortic Valve Implantation. Ann Thorac Surg 2017; 103:559-566. [DOI: 10.1016/j.athoracsur.2016.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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26
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Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17:1321-1360. [PMID: 27422899 DOI: 10.1093/ehjci/jew082] [Citation(s) in RCA: 1516] [Impact Index Per Article: 189.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- The University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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28
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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29
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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30
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8798] [Impact Index Per Article: 1099.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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31
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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32
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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33
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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34
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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35
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Badkoubeh RS, Tavoosi A, Jabbari M, Parsa AFZ, Geraeli B, Saadat M, Larti F, Meysamie AP, Salehi M. Acceleration rate of mitral inflow E wave: a novel transmitral doppler index for assessing diastolic function. Cardiovasc Ultrasound 2016; 14:24. [PMID: 27287228 PMCID: PMC4902964 DOI: 10.1186/s12947-016-0067-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/04/2016] [Indexed: 12/03/2022] Open
Abstract
Background We performed comprehensive transmitral and pulmonary venous Doppler echocardiographic studies to devise a novel index of diastolic function. This is the first study to assess the utility of the acceleration rate (AR) of the E wave of mitral inflow as a primary diagnostic modality for assessing diastolic function. Methods Study group consisted of 84 patients (53 + 11 years) with left ventricle (LV) diastolic dysfunction and 34 healthy people (35 ± 9 years) as control group, who were referred for clinically indicated two-dimensional transthoracic echocardiogram (TTE) during 2012 and 2013 to Imam Hospital. Normal controls were defined as patients without clinical evidence of cardiac disease and had normal TTE. LV diastolic function was determined according to standardized protocol of American Society of Echocardiography (ASE). As our new parameter, AR of E wave of mitral inflow was also measured in all patients. It was represented by the slope of the line between onset of E wave and peak of it. Correlation between AR of E wave and LV diastolic function grade was measured using the Spearman correlation coefficient. Receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of AR of E wave in diagnosing LV diastolic dysfunction in randomly selected two-thirds of population then its derived cutoff was evaluated in rest of the population. The institutional review board of the hospital approved the study protocol. All participants gave written informed consent. This investigation was in accordance with the Declaration of Helsinki. Results The mean value of AR was 1010 ± 420 cm/s2 in patients whereas the mean value for the normal controls was 701 ± 210 cm/s2. There was a strong and graded relation between AR of E wave of mitral inflow and LV diastolic function grade (Spearman P ≤0.0001, rs =0.69). ROC curve analysis revealed that AR of E wave of mitral inflow =750 cm/s2 predicted moderate or severe LV diastolic dysfunction with 89 % sensitivity and 89 % specificity (area under curve [AUC] = 0.903, P <0.0001). Application of this cutoff on test group showed 96 % sensitivity and 77 % specificity with AUC = 0.932 and P <0.0001. Conclusion AR of E wave of mitral inflow could be used for assessment of diastolic function, especially moderate or severe diastolic dysfunction. However, before its clinical application, external validation should be considered.
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Affiliation(s)
| | - Anahita Tavoosi
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Jabbari
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Farhang Zand Parsa
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Geraeli
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadat
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Pasha Meysamie
- Department of community medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Salehi
- Cardiology Department of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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36
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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37
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Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277-314. [PMID: 27037982 DOI: 10.1016/j.echo.2016.01.011] [Citation(s) in RCA: 3257] [Impact Index Per Article: 407.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
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38
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Ferre RM, Chioncel O, Pang PS, Lang RM, Gheorghiade M, Collins SP. Acute heart failure: the role of focused emergency cardiopulmonary ultrasound in identification and early management. Eur J Heart Fail 2015; 17:1223-7. [DOI: 10.1002/ejhf.421] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/15/2015] [Accepted: 08/27/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Robinson M. Ferre
- Department of Emergency Medicine; Vanderbilt University; Nashville TN USA
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases C.C.Iliescu; University of Medicine Carol Davila; Bucuresti Romania
| | - Peter S. Pang
- Department of Emergency Medicine; Indiana University; Indianapolis IN USA
| | - Roberto M. Lang
- Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, Department of Medicine; University of Chicago Medical Center; Chicago IL USA
| | - Mihai Gheorghiade
- Division of Cardiology, Center for Cardiovascular Innovation; Northwestern University; Evanston IL USA
| | - Sean P. Collins
- Department of Emergency Medicine; Vanderbilt University; Nashville TN USA
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Selmeryd J, Henriksen E, Leppert J, Hedberg P. Interstudy heterogeneity of definitions of diastolic dysfunction severely affects reported prevalence. Eur Heart J Cardiovasc Imaging 2015; 17:892-9. [PMID: 26374880 PMCID: PMC4955290 DOI: 10.1093/ehjci/jev211] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/02/2015] [Indexed: 01/26/2023] Open
Abstract
Aims The aim of this article is to examine how the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) recommendations on the classification of diastolic dysfunction (DDF) are interpreted in the scientific community and to explore how variations in the DDF definition affect the reported prevalence. Methods and results A systematic review of studies citing the EACVI/ASE consensus document ‘Recommendations for the evaluation of left ventricular diastolic function by echocardiography’ was performed. The definition of DDF used in each study was recorded. Subsequently, several possible interpretations of the EACVI/ASE classification scheme were used to obtain DDF prevalence in a community-based sample (n = 714). In the systematic review, 60 studies were included. In 13 studies, no specification of DDF definition was presented, a one-level classification tree was used in 13, a two-level classification tree in 18, and in the remaining 16 studies, a DDF definition was presented but no grading of DDF was performed. In 17 studies, the DDF definition relied solely on early diastolic tissue velocity and/or left atrial size. In eight of these studies, a single parameter was used, in two studies the logical operator AND was used to combine two or more parameters, and the remaining seven studies used the logical operator OR. The resulting prevalence of DDF in the community-based sample varied from 12 to 84%, depending on the DDF definition used. Conclusion A substantial heterogeneity of definitions of DDF was evident among the studies reviewed, and the different definitions had a substantial impact on the reported prevalence of DDF.
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Affiliation(s)
- Jonas Selmeryd
- Department of Clinical Physiology, Västmanland County Hospital, SE-72189 Västerås, Sweden Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Egil Henriksen
- Department of Clinical Physiology, Västmanland County Hospital, SE-72189 Västerås, Sweden Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Jerzy Leppert
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Pär Hedberg
- Department of Clinical Physiology, Västmanland County Hospital, SE-72189 Västerås, Sweden Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
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Mitral peak early diastolic filling velocity to deceleration time ratio as a predictor of prognosis in patients with chronic heart failure and preserved or reduced ejection fraction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:346-52. [PMID: 26346482 PMCID: PMC4554776 DOI: 10.11909/j.issn.1671-5411.2015.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/09/2015] [Accepted: 06/01/2015] [Indexed: 11/21/2022]
Abstract
Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio (E/DT) has been proposed as parameter for predicting prognosis in general population. This study prospectively investigates the incremental prognostic value of E/DT over clinical, conventional echocardiographic and mitral-Doppler variables in patients hospitalized for decompensated heart failure (HF). Methods We analyzed 95 HF patients (mean age 64.8 ± 12.2 years) hospitalized at our institution from January 2010 to March 2012. The primary end-point was cardiac death or hospitalization, whichever occurred first. Cox regression analysis was performed to identify significant predictors of outcomes. Results During follow-up (median 37.7 months) 13 patients died and 44 were hospitalized for a cardiac event. At univariable analysis, New York Heart Association (NYHA) functional class, furosemide dosage, lateral tricuspidal annular plane systolic excursion, deceleration time and E/DT were predictive of outcome. At multivariable analysis, E/DT was the only predictor of prognosis (hazard ratio = 1.02, P = 0.018), giving incremental prognostic information to clinical and other echocardio-graphic measures (global chi-square from 15.4 to 25.2; P = 0.032). Conclusions E/DT gives independent and incremental prognostic information in HF patients.
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Mathur M, Al Maluli H, Patil P. Assessment of Cardiac Function by Echocardiography. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:397. [PMID: 26096624 DOI: 10.1007/s11936-015-0397-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OPINION STATEMENT Accurate assessment of cardiac function by transthoracic echocardiography (TTE) plays an essential role in clinical cardiology. While left ventricular ejection fraction (LVEF) assessment has traditionally been the most commonly used objective echocardiographic marker, many other echocardiographic parameters exist that permit an enhanced understanding of cardiac function. These range from 2-dimensional (2D) and 3-dimensional (3D) morphologic parameters to functional parameters such as wall strain and myocardial performance index. In this review, we survey a variety of TTE-based techniques that are utilized in practice to assess the systolic cardiac function of both the left and right ventricles.
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Affiliation(s)
- Moses Mathur
- Section of Cardiology, Department of Medicine, Temple University Hospital, Suite 945, Zone C, 3401 N Broad Street, Philadelphia, PA, 19140, USA,
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Garbi M, McDonagh T, Cosyns B, Bucciarelli-Ducci C, Edvardsen T, Kitsiou A, Nieman K, Lancellotti P. Appropriateness criteria for cardiovascular imaging use in heart failure: report of literature review. Eur Heart J Cardiovasc Imaging 2014; 16:147-53. [PMID: 25550363 DOI: 10.1093/ehjci/jeu299] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Imaging Task Force appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI) identified the need to develop appropriateness criteria for the use of cardiovascular imaging in heart failure as a result of continuously increasing demand for imaging in diagnosis, definition of aetiology, follow-up, and treatment planning. This article presents the report of literature review performed in order to inform the process of definition of clinical indications and to aid the decisions of the appropriateness criteria voting panel. The report is structured according to identified common heart failure clinical scenarios.
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Affiliation(s)
- Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Theresa McDonagh
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Bernard Cosyns
- Universitair Ziekenhuis van Brussel, CHVZ and ICMI Laboratory, CHIREC, Brussels, Belgium
| | - Chiara Bucciarelli-Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Norway
| | | | - Koen Nieman
- Department of Cardiology and Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Patrizio Lancellotti
- Department of GIGA Cardiovascular Sciences, Heart Valve Clinic, Department of Cardiology, University of Liège Hospital, University Hospital SartTilman, Liège, Belgium Department of GVM Care and Research, Bologna, Italy
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Impact of Inodilator Drugs on Echocardiographic Assessments of Left Ventricular Filling Pressure in Patients With Decompensated End-Stage Heart Failure*. Crit Care Med 2014; 42:2508-17. [DOI: 10.1097/ccm.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Prognostic role of transthoracic echocardiography in patients affected by heart failure and reduced ejection fraction. Heart Fail Rev 2014; 20:305-16. [DOI: 10.1007/s10741-014-9461-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Oliveira GH, Mukerji S, Hernandez AV, Qattan MY, Banchs J, Durand JB, Iliescu C, Plana JC, Tang WHW. Incidence, predictors, and impact on survival of left ventricular systolic dysfunction and recovery in advanced cancer patients. Am J Cardiol 2014; 113:1893-8. [PMID: 24837270 DOI: 10.1016/j.amjcard.2014.03.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 02/03/2023]
Abstract
Although left ventricular (LV) dysfunction occurs not uncommonly in the course of cancer therapy, little is known about its natural history and prognostic impact on patients. To investigate the incidence, predictors, and impact on survival of LV systolic dysfunction and recovery during cancer therapy, we conducted a retrospective cohort observational study over 1 year at the University of Texas MD Anderson Cancer Center. We enrolled patients with a decrease in ejection fraction by echocardiography to <50% while undergoing cancer therapy from January 2009 to December 2009. We collected and analyzed their chart data. Of 7,648 patients with echocardiograms in 2009, 366 (4.8%) had ejection fraction <50% and 104 met study criteria. LV systolic dysfunction was associated with cardiotoxic therapy in 53 patients (51%). Recovery occurred in 57 patients (55%) and was independently predicted by younger age, smaller left atrial volume index, and lower B-type natriuretic peptide. At last follow-up, 69 patients (66%) were dead, and 35 (34%) were alive. There was a 20% advantage in 2-year survival among patients with LV systolic recovery compared with those without (95% confidence interval 4% to 41%, p = 0.02). In this retrospective study, LV systolic dysfunction recovery occurred in over half of the patients, appeared independent of cardiotoxic etiology, and associated with a 20% survival benefit at 2 years. Multivariable predictors of recovery are younger age, a small left atrial volume index, and lower B-type natriuretic peptide.
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Affiliation(s)
- Guilherme H Oliveira
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio.
| | - Siddarth Mukerji
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Adrian V Hernandez
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Departamento de Cardiologia, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Marwan Y Qattan
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jose Banchs
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Bernard Durand
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cezar Iliescu
- Division of Internal Medicine, Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Carlos Plana
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Ørn S, Parissis JT, Ponikowski P. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 2014; 14:803-69. [PMID: 22828712 DOI: 10.1093/eurjhf/hfs105] [Citation(s) in RCA: 1818] [Impact Index Per Article: 181.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Nguyen TD, Shingu Y, Schwarzer M, Schrepper A, Doenst T. The E-wave deceleration rate E/DT outperforms the tissue Doppler-derived index E/e' in characterizing lung remodeling in heart failure with preserved ejection fraction. PLoS One 2013; 8:e82077. [PMID: 24312628 PMCID: PMC3849461 DOI: 10.1371/journal.pone.0082077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022] Open
Abstract
Background Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT) in predicting lung remodeling in a rat model of HFpEF. Methods and Results Rats underwent aortic banding (AoB) to induce pressure overload (PO). Left ventricular hypertrophy fully developed 2 weeks after AoB. At 4 and 6 weeks, the lung weight-to-body weight ratio (LW/BW), a sensitive marker for pulmonary congestion and remodeling, dramatically increased despite preserved fractional shortening, indicating the presence of HFpEF. The time course of LW/BW was well reflected by E/DT, by the ratio of early to late transmitral diastolic velocity (E/A) and the deceleration time of E (DT), but not by the ratio of transmitral to mitral annular early diastolic velocity (E/e'). In agreement, the best correlation with LW/BW was found for E/DT (r = 0.76; p<0.0001), followed by E/A (r = 0.69; p<0.0001), DT (r = −0.62; p<0.0001) and finally E/e' (r = 0.51; p<0.001). Furthermore, analysis of receiver-operating characteristic curves for the prediction of increased LW/BW revealed excellent area under the curve values for E/DT (AUC = 0.98) and DT (AUC = 0.95), which are significantly higher than that of E/e' (AUC = 0.82). In a second approach, we also found that the new parameter E/DT correlated well with right ventricular weight index and echocardiographic measures of right ventricular systolic function. Conclusions The novel parameter E/DT outperforms the tissue Doppler index E/e' in detecting and monitoring lung remodeling induced by pressure overload. The results may provide a handy tool to point towards secondary lung disease in HFpEF and warrant further clinical investigations.
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Affiliation(s)
- T. Dung Nguyen
- Department of Cardiothoracic Surgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Yasushige Shingu
- Department of Cardiovascular Surgery, Hokkaido University, School of Medicine, Sapporo, Japan
| | - Michael Schwarzer
- Department of Cardiothoracic Surgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- * E-mail:
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Paterson I, Mielniczuk LM, O'Meara E, So A, White JA. Imaging Heart Failure: Current and Future Applications. Can J Cardiol 2013; 29:317-28. [DOI: 10.1016/j.cjca.2013.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 01/11/2023] Open
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Gabbert DD, Entenmann A, Jerosch-Herold M, Frettlöh F, Hart C, Voges I, Pham M, Andrade A, Pardun E, Wegner P, Hansen T, Kramer HH, Rickers C. Determination of volume-time curves for the right ventricle and its outflow tract for functional analyses. Magn Reson Med 2013; 70:1718-27. [PMID: 23382056 DOI: 10.1002/mrm.24609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/15/2012] [Accepted: 11/30/2012] [Indexed: 11/08/2022]
Abstract
PURPOSE The determination of right ventricular volumes and function is of increasing interest for the postoperative care of patients with congenital heart defects. The presentation of volumetry data in terms of volume-time curves allows a comprehensive functional assessment. By using manual contour tracing, the generation of volume-time curves is exceedingly time-consuming. METHODS This study describes a fast and precise method for determining volume-time curves for the right ventricle and for the right ventricular outflow tract. The method applies contour detection and includes a feature for identifying the right ventricular outflow tract volume. The segregation of the outflow tract is performed by four-dimensional curved smooth boundary surfaces defined by prespecified anatomical landmarks. RESULTS The comparison with manual contour tracing demonstrates that the method is accurate and improves the precision of the measurement. Compared to manual contour tracing the bias is <0.1% ± 4.1% (right ventricle) and -2.6% ± 20.0% (right ventricular outflow tract). The standard deviations of inter- and intraobserver variabilities for determining the volume of the right ventricular outflow tract are reduced to less than half the values of manual contour tracing. The time consumption per patient is reduced from 341 ± 80 min (right ventricle) and 56 ± 11 min (right ventricular outflow tract) using manual contour tracing to 46 ± 9 min for a combined analysis of right ventricle and right ventricular outflow tract. CONCLUSION The analysis of volume-time curves for the right ventricle and its outflow tract discloses new evaluation methods in clinical routine and science.
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Affiliation(s)
- Dominik D Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
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