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Stendahl JC, Liu Z, Boutagy NE, Parajuli N, Lu A, Alkhalil I, Lin BA, Duncan JS, Sinusas AJ. Multiaxial pressure-strain analysis of regional myocardial work in the setting of graded coronary stenoses and dobutamine stress. Am J Physiol Heart Circ Physiol 2023; 325:H492-H509. [PMID: 37417870 PMCID: PMC10538990 DOI: 10.1152/ajpheart.00735.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
We present a detailed analysis of regional myocardial blood flow and work to better understand the effects of coronary stenoses and low-dose dobutamine stress. Our analysis is based on a unique open-chest model in anesthetized canines that features invasive hemodynamic monitoring, microsphere-based blood flow analysis, and an extensive three-dimensional (3-D) sonomicrometer array that provides multiaxial deformational assessments in the ischemic, border, and remote vascular territories. We use this model to construct regional pressure-strain loops for each territory and quantify the loop subcomponent areas that reflect myocardial work contributing to the ejection of blood and wasted work that does not. We demonstrate that reductions in coronary blood flow markedly alter the shapes and temporal relationships of pressure-strain loops, as well as the magnitudes of their total and subcomponent areas. Specifically, we show that moderate stenoses in the mid-left anterior descending coronary artery decrease regional midventricle myocardial work indices and substantially increase indices of wasted work. In the midventricle, these effects are most pronounced along the radial and longitudinal axes, with more modest effects along the circumferential axis. We further demonstrate that low-dose dobutamine can help to restore or even improve function, but often at the cost of increased wasted work. This detailed, multiaxial analysis provides unique insight into the physiology and mechanics of the heart in the presence of ischemia and low-dose dobutamine, with potential implications in many areas, including the detection and characterization of ischemic heart disease and the use of inotropic support for low cardiac output.NEW & NOTEWORTHY Our unique experimental model assesses cardiac pressure-strain relationships along multiple axes in multiple regions. We demonstrate that moderate coronary stenoses decrease regional myocardial work and increase wasted work and that low-dose dobutamine can help to restore myocardial function, but often with further increases in wasted work. Our findings highlight the significant directional variation of cardiac mechanics and demonstrate potential advantages of pressure-strain analyses over traditional, purely deformational measures, especially in characterizing physiological changes related to dobutamine.
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Affiliation(s)
- John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Zhao Liu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nabil E Boutagy
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, United States
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nripesh Parajuli
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Allen Lu
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Imran Alkhalil
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Ben A Lin
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - James S Duncan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
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Herling L, Johnson J, Ferm-Widlund K, Zamprakou A, Westgren M, Acharya G. Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:853-863. [PMID: 34096674 DOI: 10.1002/uog.23703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The primary aim of this study was to evaluate the feasibility of automated measurement of fetal atrioventricular (AV) plane displacement (AVPD) over several cardiac cycles using myocardial velocity traces obtained by color tissue Doppler imaging (cTDI). The secondary objectives were to establish reference ranges for AVPD during the second half of normal pregnancy, to assess fetal AVPD in prolonged pregnancy in relation to adverse perinatal outcome and to evaluate AVPD in fetuses with a suspicion of intrauterine growth restriction (IUGR). METHODS The population used to develop the reference ranges consisted of women with an uncomplicated singleton pregnancy at 18-42 weeks of gestation (n = 201). The prolonged-pregnancy group comprised women with an uncomplicated singleton pregnancy at ≥ 41 + 0 weeks of gestation (n = 107). The third study cohort comprised women with a singleton pregnancy and suspicion of IUGR, defined as an estimated fetal weight < 2.5th centile or an estimated fetal weight < 10th centile and umbilical artery pulsatility index > 97.5th centile (n = 35). Cineloops of the four-chamber view of the fetal heart were recorded using cTDI. Regions of interest were placed at the AV plane in the left and right ventricular walls and the interventricular septum, and myocardial velocity traces were integrated and analyzed using an automated algorithm developed in-house to obtain mitral (MAPSE), tricuspid (TAPSE) and septal (SAPSE) annular plane systolic excursion. Gestational-age specific reference ranges were constructed and normalized for cardiac size. The correlation between AVPD measurements obtained using cTDI and those obtained by anatomic M-mode were evaluated, and agreement between these two methods was assessed using Bland-Altman analysis. The mean Z-scores of fetal AVPD in the cohort of prolonged pregnancies were compared between cases with normal and those with adverse outcome using Mann-Whitney U-test. The mean Z-scores of fetal AVPD in IUGR fetuses were compared with those in the normal reference population using Mann-Whitney U-test. Inter- and intraobserver variability for acquisition of cTDI recordings and offline analysis was assessed by calculating coefficients of variation (CV) using the root mean square method. RESULTS Fetal MAPSE, SAPSE and TAPSE increased with gestational age but did not change significantly when normalized for cardiac size. The fitted mean was highest for TAPSE throughout the second half of gestation, followed by SAPSE and MAPSE. There was a significant correlation between MAPSE (r = 0.64; P < 0.001), SAPSE (r = 0.72; P < 0.001) and TAPSE (r = 0.84; P < 0.001) measurements obtained by M-mode and those obtained by cTDI. The geometric means of ratios between AVPD measured by cTDI and by M-mode were 1.38 (95% limits of agreement (LoA), 0.84-2.25) for MAPSE, 1.00 (95% LoA, 0.72-1.40) for SAPSE and 1.20 (95% LoA, 0.92-1.57) for TAPSE. In the prolonged-pregnancy group, the mean ± SD Z-scores for MAPSE (0.14 ± 0.97), SAPSE (0.09 ± 1.02) and TAPSE (0.15 ± 0.90) did not show any significant difference compared to the reference ranges. Twenty-one of the 107 (19.6%) prolonged pregnancies had adverse perinatal outcome. The AVPD Z-scores were not significantly different between pregnancies with normal and those with adverse outcome in the prolonged-pregnancy cohort. The mean ± SD Z-scores for SAPSE (-0.62 ± 1.07; P = 0.006) and TAPSE (-0.60 ± 0.89; P = 0.002) were significantly lower in the IUGR group compared to those in the normal reference population, but the differences were not significant when the values were corrected for cardiac size. The interobserver CVs for the automated measurement of MAPSE, SAPSE and TAPSE were 28.1%, 17.7% and 15.3%, respectively, and the respective intraobserver CVs were 33.5%, 15.0% and 17.9%. CONCLUSIONS This study showed that fetal AVPD can be measured automatically by integrating cTDI velocities over several cardiac cycles. Automated analysis of AVPD could potentially help gather larger datasets to facilitate use of machine-learning models to study fetal cardiac function. The gestational-age associated increase in AVPD is most likely a result of increasing cardiac size, as the AVPD normalized for cardiac size did not change significantly between 18 and 42 weeks. A decrease was seen in TAPSE and SAPSE in IUGR fetuses, but not after correction for cardiac size. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Herling
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - J Johnson
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - K Ferm-Widlund
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - A Zamprakou
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Pregnancy and Delivery Medical Unit, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - M Westgren
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - G Acharya
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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Wolf M, Lucina SB, Silva VBC, Tuleski GLR, Sarraff AP, Komatsu EY, Sousa MG. Assessment of longitudinal systolic function using tissue motion annular displacement in dogs with degenerative mitral valve disease. J Vet Cardiol 2021; 38:44-58. [PMID: 34800922 DOI: 10.1016/j.jvc.2021.10.004] [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: 09/25/2020] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Although degenerative mitral valve disease (DMVD) is essentially a disorder of the valve, the progression of the disease leads to structural myocardial changes that may compromise left ventricular systolic function. Tissue motion annular displacement (TMAD) is a surrogate for longitudinal fiber function based on speckle tracking assessment of the movement of the mitral annulus toward the apex during systole. The aim of this study was to evaluate longitudinal systolic function with TMAD in dogs with DMVD. ANIMALS Ninety-four dogs with DMVD and 32 healthy dogs. METHODS Prospective cross-sectional observational study. Dogs with DMVD of various American College of Veterinary Internal Medicine classification stages and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, as well as a standard and speckle tracking echocardiography. Global longitudinal strain (GLS) and TMAD were used to assess longitudinal systolic function. RESULTS The global TMADmm and global TMAD% were higher in American College of Veterinary Internal Medicine B2 animals than in the stage CD. Global TMAD (mm/kg,mm/bodyweight3, mm/m2) were correlated with GLS and ejection fraction. Global TMAD (mm/kg,mm/m2,%) and GLS were influenced by sex. In addition, systolic blood pressure influenced GLS (P < 0.01; r = -0.23), global TMADmm/kg (P = 0.017; r = -0.21) and global TMADmm/m2 (P = 0.031; r = -0.19). Tissue motion annular displacement was fast to be performed and produced good repeatability in dogs with DMVD. CONCLUSIONS Global TMAD (mm,%), was reduced in DMVD dogs with clinical signs of heart failure compared with stage B2. Tissue motion annular displacement was shown to be a repeatable technique for evaluation of longitudinal systolic function in dogs with DMVD.
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Affiliation(s)
- M Wolf
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil.
| | - S B Lucina
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - V B C Silva
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - G L R Tuleski
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - A P Sarraff
- School of Life Sciences, Pontifical Catholic University of Paraná (PUC-PR), Rua Rockfeller 1311, Curitiba, 80230-130, Brazil
| | - E Y Komatsu
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - M G Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
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Sabatino J, De Rosa S, Leo I, Strangio A, Spaccarotella C, Polimeni A, Sorrentino S, Di Salvo G, Indolfi C. Prediction of Significant Coronary Artery Disease Through Advanced Echocardiography: Role of Non-invasive Myocardial Work. Front Cardiovasc Med 2021; 8:719603. [PMID: 34504879 PMCID: PMC8421730 DOI: 10.3389/fcvm.2021.719603] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Non-invasive prediction of critical coronary artery stenosis (CAST) in patients with coronary artery disease (CAD) is challenging. Strain parameters can often capture an impairment of regional longitudinal function; however, they are load dependent. A novel non-invasive method to estimate Myocardial Work (MW) has been recently proposed, showing a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW to predict the ischaemic risk area underlying a CAST. Methods and Results: The study population comprises 80 individuals: 50 patients with CAST and 30 controls (CTRL). Echocardiography recordings were obtained before coronary angiography to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial Work Efficiency (MWE). Global MWI (p = 0.048), MWE (p < 0.001), and MCW (p = 0.048) at baseline were significantly reduced in patients with CAST compared to controls (p < 0.05). Regional MWE within the myocardial segments underlying the CAST, but not LS, was significantly reduced compared to non-target segments (p < 0.001). At ROC analysis, the diagnostic performance to predict CAST for regional MWE (AUC = 0.920, p < 0.001) was higher compared to both regional post-systolic shortening index (PSI) (AUC = 0.600, p = 0.129) and regional LS (AUC = 0.546, p = 0.469). Conclusions: Non-invasive estimation of MW work indices is able to predict a CAST before invasive angiography.
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Affiliation(s)
- Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.,Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy.,Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.,Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Antonio Strangio
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.,Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.,Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.,Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.,Cardiovascular Research Center, Magna Graecia University, Catanzaro, Italy.,Mediterranea Cardiocentro, Naples, Italy
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Magelssen MI, Palmer CL, Hjorth-Hansen A, Nilsen HO, Kiss G, Torp H, Mjolstad OC, Dalen H. Feasibility and Reliability of Automatic Quantitative Analyses of Mitral Annular Plane Systolic Excursion by Handheld Ultrasound Devices: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:341-350. [PMID: 32710577 DOI: 10.1002/jum.15408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Handheld ultrasound devices (HUDs) have previously been limited to grayscale imaging without options for left ventricle (LV) quantification. We aimed to study the feasibility and reliability of automatic measurements of mitral annular plane systolic excursion (MAPSE) by HUDs. METHODS An algorithm that automatically measured MAPSE from live grayscale recordings was implemented in a HUD. Twenty patients at a university hospital were examined by either a cardiologist or a sonographer. Standard echocardiography using a high-end scanner was performed. The apical 4-chamber view was recorded 4 times by both echocardiography and the HUD. MAPSE was measured by M-mode and color tissue Doppler (cTD) during echocardiography and automatically by the HUD. RESULTS The automatic method underestimated mean MAPSE ± SD versus M-mode (9.6 ± 2.2 versus 10.9 ± 2.6 mm; difference, 1.2 ± 1.4 mm, P < .005). The difference between the automatic and cTD measurements was not significant (0.8 ± 1.8 mm; P = .073). The intraclass correlation coefficients (ICCs) between automatic and M-mode measurements was 0.85, and 0.81 for cTD measurements. There was good agreement between the methods, and the intra- and inter-rater ICCs were excellent for all methods (≥0.86). CONCLUSIONS In this novel study evaluating automatic quantification of LV longitudinal function by HUD, we showed the high feasibility and reliability of the method. Compared to M-mode imaging, the automatic method underestimated MAPSE by 8% to 10%, but the difference with cTD imaging was nonsignificant. We conclude that this study's method for automatic quantitative assessment of LV function can be integrated in HUDs.
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Affiliation(s)
- Malgorzata Izabela Magelssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, Trondheim, Norway
| | - Cameron Lowell Palmer
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Hjorth-Hansen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hans Olav Nilsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, Trondheim, Norway
| | - Gabriel Kiss
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Operating Room of the Future, St Olav's Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Christian Mjolstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, Trondheim, Norway
| | - Håvard Dalen
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Sabatino J, De Rosa S, Leo I, Spaccarotella C, Mongiardo A, Polimeni A, Sorrentino S, Di Salvo G, Indolfi C. Non-invasive myocardial work is reduced during transient acute coronary occlusion. PLoS One 2020; 15:e0244397. [PMID: 33370359 PMCID: PMC7769261 DOI: 10.1371/journal.pone.0244397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background During ischemia a close relationship exists between sub-endocardial blood flow and myocardial function. Strain parameters can capture an impairment of regional longitudinal function but are load dependent. Recently, a novel non-invasive method to calculate Myocardial Work (MW) showed a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW indices to identify the ischaemic risk area during transient acute coronary occlusion (TACO). Methods and results The study population comprises 50 individuals with critical coronary stenosis (CCS). Echocardiography recordings were obtained before coronary angiography, during TACO and after revascularization to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial work efficiency (MWE). Compared to baseline, we found a significant reduction of GLS (p = 0.005), MWI, MCW and MWE (p<0.001) during TACO. Conclusions The non-invasive measurement of MW parameters is a sensitive and early marker of myocardial ischemia during TACO.
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Affiliation(s)
- Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
- * E-mail: (SDR); (CI)
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro (CZ), Italy
- Cardiovascular Research Center, “Magna Graecia” University, Catanzaro (CZ), Italy
- Mediterranea Cardiocentro, Naples (NA), Italy
- * E-mail: (SDR); (CI)
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Berthoud D, Schwarzwald CC. Echocardiographic assessment of left ventricular size and systolic function in Warmblood horses using linear measurements, area-based indices, and volume estimates: A retrospective database analysis. J Vet Intern Med 2020; 35:504-520. [PMID: 33247461 PMCID: PMC7848374 DOI: 10.1111/jvim.15968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/20/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Echocardiographic assessment of left ventricular (LV) size and function using area‐based indices and volumetric estimates is not well established in horses. Objective To report reference intervals and measurement variability for uni‐, 2‐, and 3‐dimensional echocardiographic indices of LV size and systolic function in Warmblood horses and to provide proof of concept for allometric scaling of variables to body weight. Unidimensional indices were to be compared to area‐based indices and LV volume estimates to establish their clinical use. Animals Thirty healthy Warmblood horses and 70 Warmblood horses with a primary diagnosis of mitral regurgitation or aortic regurgitation. Methods Echocardiographic indices of LV size and systolic function were measured using an existing echocardiography database. Weight‐related variables were scaled to body weight (BWT). Reference intervals and measurement variability were calculated, the influence of valvular regurgitation on LV size and function was investigated and agreement between different variables for detection of reduced, normal, and increased LV size and systolic function was assessed. Results Reference values for healthy Warmblood horses were reported. Measurement variability was sufficiently low for clinical use of all variables. Allometric scaling was effective to correct diastolic LV dimensions and cardiac output for differences in BWT. Various echocardiographic indices resulted in different conclusions regarding identification of LV enlargement and systolic dysfunction in healthy horses and horses with valvular regurgitation. Conclusions and Clinical Importance Echocardiographic assessment of LV size and systolic function should include joint assessment of multiple uni‐ and multidimensional indices. Area‐based or volumetric indices that reflect LV long‐axis motion should be included.
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Affiliation(s)
- Djamila Berthoud
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Colin C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Bottaro G, Zappulla P, Deste W, Famà F, Agnello F, Trovato D, Indelicato A, Barbanti M, Sgroi C, Monte IP, Tamburino C. Severe Aortic Valve Stenosis: Symptoms, Biochemical Markers, and Global Longitudinal Strain. J Cardiovasc Echogr 2020; 30:154-161. [PMID: 33447506 PMCID: PMC7799072 DOI: 10.4103/jcecho.jcecho_13_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/23/2020] [Accepted: 09/18/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND According to the actual guidelines regarding severe aortic valve stenosis (AS), symptoms are the most important trigger for aortic valve replacement (AVR). However, the objective analysis of cardiological clinic can be confused, considering the aging population this disease affects and the comorbidities. OBJECTIVES Looking for an objective marker of disease, useful for scheduling the correct AVR, we researched the relation between some biochemical markers of left ventricular (LV) dysfunction and its global longitudinal strain. MATERIALS AND METHODS We analyzed 74 consecutive patients (82 ± 4 years) with severe AS. We identified 61 patients with symptoms (angina, dyspnea, and syncope) and 13 asymptomatic patients. The clinical and echocardiographic parameters were compared between these two groups. LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), NT-pro-B-type brain natriuretic peptide (BNP), troponin T (TNT), creatine kinase-MB (CPK-MB), and myoglobin were determined at the time of evaluation. RESULTS Compared with the asymptomatic group, patients in the symptomatic group had a lower LVGLS (P = 0.002) and an increased pro-BNP (P = 0.0002). LVGLS showed a good correlation with pro-BNP as a marker of myocardial damage, with a linear increase of pro-BNP in patients with a linear decrease of LVGLS (r = 0.43). Despite the normal value of LVEF > 50% in asymptomatic patients, some of them (46%) have an early dysfunction of LVGLS. No other statistically significant difference emerged from the biochemical analysis, in TNT (P = 0.29), CPK-MB (P = 0.36), and myoglobin (P = 0.38). CONCLUSIONS Pro-BNP and LVGLS can be considered an objective marker of clinical severity of AS disease, useful for management and scheduling of AVR, especially in asymptomatic patients.
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Affiliation(s)
- Giuseppe Bottaro
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Paolo Zappulla
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Wanda Deste
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Francesca Famà
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Federica Agnello
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Danilo Trovato
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Antonio Indelicato
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Ines P. Monte
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Italy
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9
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Nakata M, Sakuma J, Takano M, Nagasaki S. Assessment of fetal cardiac function with echocardiography. J Obstet Gynaecol Res 2019; 46:31-38. [PMID: 31595615 DOI: 10.1111/jog.14143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/28/2022]
Abstract
The circulatory physiology of fetuses differs from that of neonates. The concept of biventricular combined cardiac output is necessary to understand and assess the fetal cardiac function. Fetal cardiac function has been estimated using echocardiographic methods such as M-mode, B-mode and pulsed wave Doppler. In addition, recent studies have reported the utility of tissue Doppler imaging in fetal echocardiography. However, parameters for fetal cardiac function remain to be established. Recently, we developed two novel techniques for assessing fetal cardiac function: an automatic fractional shortening method and E/e' determination using the dual-gate Doppler method. These two techniques are expected to be reliable and useful for assessing the fetal status in various pathological conditions.
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Affiliation(s)
- Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junya Sakuma
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Sumito Nagasaki
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
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10
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Shenouda RB, Bytyçi I, Sobhy M, Henein MY. Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome. Clin Physiol Funct Imaging 2019; 40:21-29. [PMID: 31549763 DOI: 10.1111/cpf.12597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS. METHODS In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention. RESULTS Of the 80 patients, one-vessel stenosis (>70%) was present in 53 (66%), two-vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending - LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤-0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67-0·93, P = 0·01), SR of LCx territories of ≤-0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58-0·87, P = 0·02) and SR of RCA territories ≤-0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66-0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion. CONCLUSION In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.
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Affiliation(s)
- Rafik B Shenouda
- International Cardiac Centre, Alexandria, Egypt.,Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Albania
| | - Mohammed Sobhy
- International Cardiac Centre, Alexandria, Egypt.,Cardiology Department, Alexandria University, Alexandria, Egypt
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Molecular and Clinic Research Institute, St George University, London, UK.,Brunel University, Uxbridge, UK
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11
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Nagasaki S, Nakata M, Takano M, Usui K, Sakuma J, Hayata E, Morita M. Feasibility of automated fetal fractional shortening measurement with two-dimensional tracking and construction of a reference range for normal fetuses. J Med Ultrason (2001) 2019; 46:467-472. [PMID: 30953235 DOI: 10.1007/s10396-019-00942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/02/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the feasibility of an automated fractional shortening (Auto FS) measurement method using two-dimensional tracking and to construct a reference range for normal fetuses. METHODS This study was conducted from May 2017 to March 2018. First, cardiac motion in the four-chamber view was recorded in the B-mode. Subsequently, the region of interest was set on the edge of the ventricular septum or ventricular muscle at a point one-third away from the atrioventricular valve toward the cardiac apex. Tracking was automatically performed. Values measured between the ventricular septum and right ventricle were defined as R-Auto FS, whereas those measured between the ventricular septum and left ventricle were defined as L-Auto FS. Those on each ventricular muscle were defined as Combined-Auto FS. RESULTS Data were obtained from 131 singleton fetuses. R-Auto FS significantly decreased with an increase in the number of gestational weeks, and L-Auto FS and Combined-Auto FS showed the same tendency (Spearman's correlation analysis: p = - .528, p = - .351, and p = - .636, respectively). CONCLUSION We succeeded in defining a reference Auto FS value for normal singleton pregnancies. Auto FS was negatively correlated with gestational age. This novel technique can assess fetal heart contractility.
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Affiliation(s)
- Sumito Nagasaki
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota City, Tokyo, 143-8541, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota City, Tokyo, 143-8541, Japan. .,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota City, Tokyo, 143-8541, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kento Usui
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Junya Sakuma
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota City, Tokyo, 143-8541, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
| | - Mineto Morita
- Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota City, Tokyo, 143-8541, Japan.,Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
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12
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Peverill RE. Aging and the relationships between long-axis systolic and early diastolic excursion, isovolumic relaxation time and left ventricular length-Implications for the interpretation of aging effects on e`. PLoS One 2019; 14:e0210277. [PMID: 30615676 PMCID: PMC6322720 DOI: 10.1371/journal.pone.0210277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Both the left ventricular (LV) long-axis peak early diastolic lengthening velocity (e`) and long-axis early diastolic excursion (EDExc) decrease with age, but the mechanisms underlying these decreases are not fully understood. The aim of this study was to investigate the relative contributions to aging-related decreases in e`and EDExc from LV long-axis systolic excursion (SExc), isovolumic relaxation time (IVRT, as a measure of the speed of relaxation) and LV end-diastolic length (LVEDL). METHODS The study group was 50 healthy adult subjects of ages 17-75 years with a normal LV ejection fraction. SExc, EDExc, e`and IVRT were measured from pulsed wave tissue Doppler signals acquired from the septal and lateral walls. Multivariate modelling was performed to identify independent predictors of EDExc and e`which were consistent for the septal and lateral walls. RESULTS EDExc decreased with age and the major determinant of EDExc was SExc, which also decreased with age. There was also a decrease of e`with age, and the major determinant of e`was EDExc. IVRT decreased with age and on univariate analysis was not only inversely correlated with EDExc and e`, but also with SExc. IVRT was only a minor contributor to models of EDExc which included SExc, and was an inconsistent contributor to models of e`which included EDExc. LVEDL decreased with age independent of sex and body size, and was positively correlated with SExc, EDExc and e`. CONCLUSION Major mechanisms underlying the decrease in e`seen during aging are the concomitant decreases in long-axis contraction and early diastolic excursion, which are in turn related in part to long-axis remodelling of the left ventricle. After adjusting for the extent of systolic and early diastolic excursion, slowing of relaxation, as reflected in prolongation of the IVRT, makes no more than a minor contribution to aging-related decreases in EDExc and e`.
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Affiliation(s)
- Roger E. Peverill
- Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine (School of Clinical Sciences at Monash Health), Monash University and Monash Health, Clayton, Victoria, Australia
- * E-mail:
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13
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Gehlen H, Bildheim LM. Evaluation of age-dependent changes of myocardial velocity using pulsed wave and colour tissue Doppler imaging in adult warmblood horses. J Anim Physiol Anim Nutr (Berl) 2018; 102:1731-1742. [DOI: 10.1111/jpn.12962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Heidrun Gehlen
- Equine Clinic; Free University of Berlin; Berlin Germany
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14
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Wolf M, Lucina SB, Brüler BC, Tuleski GL, Silva VB, Sousa MG. Assessment of longitudinal systolic function using tissue motion annular displacement in healthy dogs. J Vet Cardiol 2018; 20:175-185. [DOI: 10.1016/j.jvc.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 01/19/2023]
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15
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Duchenne J, Turco A, Bézy S, Ünlü S, Pagourelias ED, Beela AS, Degtiarova G, Vunckx K, Nuyts J, Coudyzer W, Claus P, Rega F, Gheysens O, Voigt JU. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging 2018; 20:84-91. [DOI: 10.1093/ehjci/jey043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Anna Turco
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ganna Degtiarova
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiothoracic Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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16
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Lopez-Candales A, Hernandez-Suarez DF, Menendez FL. Are Measures of Left Ventricular Longitudinal Shortening Affected by Left Atrial Enlargement? Cardiol Res 2018; 9:1-6. [PMID: 29479378 PMCID: PMC5819621 DOI: 10.14740/cr637w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Even though left atrial (LA) size and function are intimately related to left ventricular (LV) diastolic dysfunction, the role of LA with regard to LV systolic function is less clear. Consequently, we examined the potential association that might exist between measures of longitudinal LV systolic shortening and LA dilation using LA volume index (LAVI). METHODS In this retrospective analysis, data from 75 echocardiograms (mean age 53 ± 14; range 24 - 89 years; mean body surface area (BSA) 2.0 ± 0.3) were analyzed. RESULTS Peak global longitudinal (PGLS) correlated best with LV mass index (LVMI) followed by mitral annular systolic excursion (MAPSE), and age. Similar results were obtained when analyzing the best variables that correlated with LAVI. Finally, MAPSE correlated best with PGLS, then with MA tissue Doppler systolic velocity, BSA, and LAVI in that order. All patients had normal LV ejection fraction (LVEF) and normal sinus rhythm when studied. CONCLUSIONS LAVI does not directly affect LV systolic function and longitudinal measures of LV shortening are mainly dependent on LV mass. Additional studies are now required to determine how these associations vary when different degrees of LV dilatation and systolic dysfunction are included in the analysis.
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Affiliation(s)
- Angel Lopez-Candales
- Cardiovascular Medicine Division, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Francisco Lopez Menendez
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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17
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Howard-Quijano K, McCabe M, Cheng A, Zhou W, Yamakawa K, Mazor E, Scovotti JC, Mahajan A. Left ventricular endocardial and epicardial strain changes with apical myocardial ischemia in an open-chest porcine model. Physiol Rep 2017; 4:4/24/e13042. [PMID: 28039400 PMCID: PMC5210372 DOI: 10.14814/phy2.13042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
Early detection of acute myocardial ischemia is critical to prevent permanent myocardial damage. The impact of apical ischemia on global left ventricular (LV) function can be difficult to characterize using traditional volume‐based echocardiography measures. Myocardial strain imaging is a sensitive, quantitative marker of myocardial deformation that can measure ventricular function. Recent advances allow layer‐specific measurement of endo‐ and epicardial strain, enhancing the ability to evaluate myocardial ischemia. This study investigates the effects of apical ischemia on LV function using epi‐ and endocardial strain. We hypothesize that myocardial strain will identify changes in regional and global myocardial function associated with focal apical ischemia as compared to ejection fraction (EF), and that longitudinal strain will be a better indicator of myocardial dysfunction compared to circumferential or radial strain. In a porcine model (n = 9), acute ischemia was induced by left anterior descending coronary artery occlusion. Echocardiograms were performed at baseline, during 15‐min ischemia, and after reperfusion. Global longitudinal strain decreased with acute focal ischemia of the left ventricular apical region (baseline: −16.4% vs. ischemia: −12.2%; P = 0.010), with no change observed in global circumferential and radial strain or EF. Both endocardial and epicardial longitudinal strain decreased by 68% (P < 0.001) in the ischemic and peri‐ischemic zone, while circumferential and radial strain only decreased in endocardium of the ischemic zone. Longitudinal strain was more sensitive to ischemia, being able to detect changes in global LV function and thus may confer clinical diagnostic advantage in the evaluation of acute LV apical ischemia.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Melissa McCabe
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Alexander Cheng
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Wei Zhou
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Kentaro Yamakawa
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Einat Mazor
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Jennifer C Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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18
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Szokol M, Priksz D, Bombicz M, Varga B, Kovacs A, Fulop GA, Csipo T, Posa A, Toth A, Papp Z, Szilvassy Z, Juhasz B. Long Term Osmotic Mini Pump Treatment with Alpha-MSH Improves Myocardial Function in Zucker Diabetic Fatty Rats. Molecules 2017; 22:molecules22101702. [PMID: 29023410 PMCID: PMC6151765 DOI: 10.3390/molecules22101702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/03/2017] [Indexed: 01/20/2023] Open
Abstract
The present investigation evaluates the cardiovascular effects of the anorexigenic mediator alpha-melanocyte stimulating hormone (MSH), in a rat model of type 2 diabetes. Osmotic mini pumps delivering MSH or vehicle, for 6 weeks, were surgically implanted in Zucker Diabetic Fatty (ZDF) rats. Serum parameters, blood pressure, and weight gain were monitored along with oral glucose tolerance (OGTT). Echocardiography was conducted and, following sacrifice, the effects of treatment on ischemia/reperfusion cardiac injury were assessed using the isolated working heart method. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity was measured to evaluate levels of oxidative stress, and force measurements were performed on isolated cardiomyocytes to determine calcium sensitivity, active tension and myofilament co-operation. Vascular status was also evaluated on isolated arterioles using a contractile force measurement setup. The echocardiographic parameters ejection fraction (EF), fractional shortening (FS), isovolumetric relaxation time (IVRT), mitral annular plane systolic excursion (MAPSE), and Tei-index were significantly better in the MSH-treated group compared to ZDF controls. Isolated working heart aortic and coronary flow was increased in treated rats, and higher Hill coefficient indicated better myofilament co-operation in the MSH-treated group. We conclude that MSH improves global heart functions in ZDF rats, but these effects are not related to the vascular status.
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Affiliation(s)
- Miklos Szokol
- Department of Cardiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Daniel Priksz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Mariann Bombicz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Balazs Varga
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Arpad Kovacs
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Gabor Aron Fulop
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Tamas Csipo
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Aniko Posa
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, H-6720 Szeged, Hungary.
| | - Attila Toth
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Zoltan Papp
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Zoltan Szilvassy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Bela Juhasz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
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Price S, Platz E, Cullen L, Tavazzi G, Christ M, Cowie MR, Maisel AS, Masip J, Miro O, McMurray JJ, Peacock WF, Martin-Sanchez FJ, Di Somma S, Bueno H, Zeymer U, Mueller C. Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol 2017; 14:427-440. [PMID: 28447662 PMCID: PMC5767080 DOI: 10.1038/nrcardio.2017.56] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Echocardiography is increasingly recommended for the diagnosis and assessment of patients with severe cardiac disease, including acute heart failure. Although previously considered to be within the realm of cardiologists, the development of ultrasonography technology has led to the adoption of echocardiography by acute care clinicians across a range of specialties. Data from echocardiography and lung ultrasonography can be used to improve diagnostic accuracy, guide and monitor the response to interventions, and communicate important prognostic information in patients with acute heart failure. However, without the appropriate skills and a good understanding of ultrasonography, its wider application to the most acutely unwell patients can have substantial pitfalls. This Consensus Statement, prepared by the Acute Heart Failure Study Group of the ESC Acute Cardiovascular Care Association, reviews the existing and potential roles of echocardiography and lung ultrasonography in the assessment and management of patients with acute heart failure, highlighting the differences from established practice where relevant.
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Affiliation(s)
- Susanna Price
- Royal Brompton &Harefield NHS Foundation Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115, USA
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Butterfield St &Bowen Bridge Road, Herston, Queensland 4029, Australia
| | - Guido Tavazzi
- University of Pavia Intensive Care Unit 1st Department, Fondazione Policlinico IRCCS San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Michael Christ
- Department of Emergency and Critical Care Medicine, Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419 Nürnberg, Germany
| | - Martin R Cowie
- Department of Cardiology, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, California 92161, USA
| | - Josep Masip
- Critical Care Department, Consorci Sanitari Integral, Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet, University of Barcelona, Grand Via de las Corts Catalanes 585, 08007 Barcelona, Spain
| | - Oscar Miro
- Emergency Department, Hospital Clínic de Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain
| | - John J McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - W Frank Peacock
- Emergency Medicine, Baylor College of Medicine, Scurlock Tower, 1 Baylor Plaza, Houston, Texas 77030, USA
| | - F Javier Martin-Sanchez
- Emergency Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos, Calle del Prof Martín Lagos, 28040 Madrid, Spain
| | - Salvatore Di Somma
- Emergency Department, Sant'Andrea Hospital, Faculty of Medicine and Psychology, LaSapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares and Department of Cardiology, Hospital 12 de Octubre, Avenida de Córdoba, 28041 Madrid, Spain
| | - Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen, Bremserstraße 79, 67063 Ludwigshafen am Rhein, Germany
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Toyama K, Rader F, Ayabe K, Kar S, Trento A, Nishioka T, De Robertis MA, Siegel RJ. Mitral annular motion in patients after transcatheter MitraClip and mitral valve surgery. Echocardiography 2017; 34:334-339. [DOI: 10.1111/echo.13459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kentaro Toyama
- The Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Florian Rader
- The Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Kengo Ayabe
- Department of Anesthesia; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Saibal Kar
- The Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Alfredo Trento
- The Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Toshihiko Nishioka
- Department of Cardiology; Saitama Medical Center; Saitama Medical University; Kawagoe Japan
| | | | - Robert J. Siegel
- The Heart Institute; Cedars-Sinai Medical Center; Los Angeles CA USA
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Utsunomiya H, Mihara H, Itabashi Y, Siegel RJ, Chakravarty T, Jilaihawi H, Makkar RR, Shiota T. Impact of Mitral Annular Displacement on Left Ventricular Diastolic Function Improvement After Transcatheter Aortic Valve Implantation. Circ J 2017; 81:558-566. [DOI: 10.1253/circj.cj-16-1105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroto Utsunomiya
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
- Department of Cardiovascular Medicine, Hiroshima University Hospital
| | - Hirotsugu Mihara
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
- Department of Cardiology, Yokkaichi Municipal Hospital
| | - Yuji Itabashi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
- Department of Cardiology, Keio University
| | | | | | | | - Raj R. Makkar
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
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22
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Geometrical characteristics of aortic root and left ventricular dysfunction in aortic stenosis: quantification of 256-slice coronary CT angiography. Heart Vessels 2016; 32:558-565. [DOI: 10.1007/s00380-016-0902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
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23
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Bakhoum SW, Taha HS, Abdelmonem YY, Fahim MA. Value of resting myocardial deformation assessment by two dimensional speckle tracking echocardiography to predict the presence, extent and localization of coronary artery affection in patients with suspected stable coronary artery disease. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2016.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Shiran A, Blondheim DS, Shimoni S, Jabarren M, Rosenmann D, Sagie A, Leibowitz D, Leitman M, Feinberg M, Beeri R, Adawi S, Shotan A, Goland S, Bloch L, Kobal SL, Liel-Cohen N. Two-dimensional strain echocardiography for diagnosing chest pain in the emergency room: a multicentre prospective study by the Israeli echo research group. Eur Heart J Cardiovasc Imaging 2016; 18:1016-1024. [DOI: 10.1093/ehjci/jew168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022] Open
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25
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Factors related to outcome in heart failure with a preserved (or normal) left ventricular ejection fraction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:153-163. [DOI: 10.1093/ehjqcco/qcw026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 12/15/2022]
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26
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Valocikova I, Vachalcova M, Valocik G, Kurecko M, Dvoroznakova M, Mitro P, Cocherova J, Bujnakova SB, Holoubek D. Incremental value of global longitudinal strain in prediction of all-cause mortality in predialysis and dialysis chronic kidney disease patients. Wien Klin Wochenschr 2016; 128:495-503. [DOI: 10.1007/s00508-016-0978-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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Addetia K, Takeuchi M, Maffessanti F, Nagata Y, Hamilton J, Mor-Avi V, Lang RM. Simultaneous Longitudinal Strain in All 4 Cardiac Chambers. Circ Cardiovasc Imaging 2016; 9:e003895. [DOI: 10.1161/circimaging.115.003895] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karima Addetia
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
| | - Masaaki Takeuchi
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
| | - Francesco Maffessanti
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
| | - Yasufumi Nagata
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
| | - James Hamilton
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
| | - Victor Mor-Avi
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
| | - Roberto M. Lang
- From the Department of Medicine, Section of Cardiology, University of Chicago, IL (K.A., F.M., V.M.-A., R.M.L.); School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (M.T., Y.N.); and Epsilon Imaging, Ann Arbor, MI (J.H.)
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28
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He B, Ding S, Qiao Z, Gao L, Wang W, Ge H, Shen X, Pu J. Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion. Int J Cardiovasc Imaging 2016; 32:711-9. [DOI: 10.1007/s10554-015-0834-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022]
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Improvement in left ventricular deformational indices following radiofrequency ablation in patients with tachycardia: A comparative study between AVRT and AVNRT regarding left ventricular strain and strain rates. Res Cardiovasc Med 2016. [DOI: 10.5812/cardiovascmed.30414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Shoucri RM. End-systolic Pressure-Volume Relation, Ejection Fraction, and Heart Failure: Theoretical Aspect and Clinical Applications. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:111-20. [PMID: 26244035 PMCID: PMC4500589 DOI: 10.4137/cmc.s18740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/10/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
Abstract
A mathematical formalism describing the nonlinear end-systolic pressure–volume relation (ESPVR) is used to derive new indexes that can be used to assess the performance of the heart left ventricle by using the areas under the ESPVR (units of energy), the ordinates of the ESPVR (units of pressure), or from slopes of the curvilinear ESPVR. New relations between the ejection fraction (EF) and the parameters describing the ESPVR give some insight into the problem of heart failure (HF) with normal or preserved ejection fraction. Relations between percentage occurrence of HF and indexes derived from the ESPVR are also discussed. When ratios of pressures are used, calculation can be done in a noninvasive way with the possibility of interesting applications in routine clinical work. Applications to five groups of clinical data are given and discussed (normal group, aortic stenosis, aortic valvular regurgitation, mitral valvular regurgitation, miscellaneous cardiomyopathies). No one index allows a perfect segregation between all clinical groups, it is shown that appropriate use of two indexes (bivariate analysis) can lead to better separation of different clinical groups.
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Affiliation(s)
- Rachad M Shoucri
- Department of Mathematics and Computer Science, Royal Military College of Canada, Kingston, Ontario, Canada
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31
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Weidemann F, Liu D, Niemann M, Herrmann S, Hu H, Gaudron P, Ertl G, Hu K. Abschätzung der linksventrikulären systolischen Funktion bei Patienten mit schlechter Bildqualität. Herz 2015; 40:240-9. [DOI: 10.1007/s00059-013-3924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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32
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Huang FQ, Tan RS, Sim D, Le TT, Zhong L. Left Ventricular Diastolic Function Assessment Using Time Differences Between Mitral Annular Velocities and Transmitral Inflow Velocities in Patients with Heart Failure. Heart Lung Circ 2015; 24:257-63. [DOI: 10.1016/j.hlc.2014.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
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33
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Wang Q, Sun QW, Wu D, Yang MW, Li RJ, Jiang B, Yang J, Li ZA, Wang Y, Yang Y. Early detection of regional and global left ventricular myocardial function using strain and strain-rate imaging in patients with metabolic syndrome. Chin Med J (Engl) 2015; 128:226-32. [PMID: 25591567 PMCID: PMC4837843 DOI: 10.4103/0366-6999.149211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Strain and strain-rate imaging (SRI) have been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. The aim of this study was to evaluate the regional and global left ventricular (LV) myocardial function in metabolic syndrome (MS) with SRI so that we can provide more myocardial small lesions in patients with MS, which is robust and reliable basis for early detection of LV function. METHODS Thirty-nine adults with MS were enrolled in the study. There was a control group of 39 healthy adults. In addition to classic echocardiographic assessment of LV global functional changes, SRI was used to evaluate regional and global LV function. Including: Peak systolic strain (S), peak systolic strain-rate (SR-s), peak diastolic strain-rate (SR-e). RESULTS There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of S, SR-s, SR-e in regional LV function. Multiple stepwise regression analyses revealed that S and SR significantly were negatively correlated with blood pressure, waist circumference, fasting plasma glucose, uric acid, suggesting that risk factories were relevant to regional systolic dysfunction. CONCLUSION In MS with normal LV ejection fraction, there was regional myocardial dysfunction, risk factors contributed to the impairment of systolic and diastolic function of the regional myocardium. Assessment of myocardial function using SRI could be more accurate in MS patient evaluation than conventional echocardiography alone.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ya Yang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling Related Cardiovascular Diseases, Ministry of Education, Beijing 100029, China
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Pepine CJ, Petersen JW, Bairey Merz CN. A microvascular-myocardial diastolic dysfunctional state and risk for mental stress ischemia: a revised concept of ischemia during daily life. JACC Cardiovasc Imaging 2015; 7:362-5. [PMID: 24742891 DOI: 10.1016/j.jcmg.2013.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/15/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
| | - John W Petersen
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
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Gökdeniz T, Boyaci F, Hatem E, Bektaş H, Kalaycıoğlu E, Gürsoy MO, Aykan AÇ, Yıldız BŞ, Altıntaş B. Association of Mitral Annular Calcification with Left Ventricular Mechanics: A Speckle Tracking Study. Echocardiography 2014; 32:1374-83. [DOI: 10.1111/echo.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tayyar Gökdeniz
- Department of Cardiology; Medical School; Kafkas University; Kars Turkey
| | - Faruk Boyaci
- Department of Cardiology; Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon Turkey
| | - Engin Hatem
- Department of Cardiology; Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon Turkey
| | - Hüseyin Bektaş
- Department of Cardiology; Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon Turkey
| | - Ezgi Kalaycıoğlu
- Department of Cardiology; Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology; Gaziemir Salih Nevvar İşgören State Hospital; İzmir Turkey
| | - Ahmet Çağrı Aykan
- Department of Cardiology; Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital; Trabzon Turkey
| | - Banu Şahin Yıldız
- Department of Internal Medicine; Dr Lutfu Kırdar Kartal Educational and Research Hospital; İstanbul Turkey
| | - Bernas Altıntaş
- Department of Cardiology; Diyarbakır Education and Research Hospital; Diyarbakır Turkey
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Gromadziński L, Pruszczyk P. Echocardiographic changes in patients with stage 3-5 chronic kidney disease and left ventricular diastolic dysfunction. Cardiorenal Med 2014; 4:234-43. [PMID: 25737688 DOI: 10.1159/000369106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/07/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients frequently leads to the development of congestive heart failure. We evaluated changes in echocardiographic parameters among CKD patients with LV diastolic dysfunction. METHODS We examined 70 ambulatory patients with CKD at stages 3-5 and 26 patients without CKD as a control group. Standard echocardiography and tissue Doppler imaging were performed on all patients. Patients with CKD were divided into two groups according to the results of lateral mitral early diastolic velocity (EmLVlat): a group with diastolic dysfunction (DD group; EmLVlat <8 cm/s) and a group without diastolic dysfunction (WDD group; EmLVlat ≥8 cm/s). RESULTS Compared to the patients in the WDD group, those in the DD group were characterized by lower values of mitral annular plane systolic excursion [MAPSE; 13 (11-17) vs. 14 (11-16) mm, p < 0.0001] and lateral mitral annular systolic velocity [SmLVlat; 7 (5-14) vs. 8 (5-13) cm/s, p = 0.006]. The area under the receiver operating characteristic (ROC) curve of the MAPSE level for the detection of LV diastolic dysfunction was 0.801 [95% CI 0.684-0.890, p < 0.0001], whereas a ROC-derived MAPSE value of ≤13 mm was characterized by a sensitivity of 84.4% and a specificity of 75.8% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction was MAPSE [OR = 0.39; 95% CI 0.21-0.74, p = 0.003]. CONCLUSION We showed that reduced MAPSE, but not SmLVlat, is an independent predictive factor for LV diastolic dysfunction in CKD patients.
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Affiliation(s)
- Leszek Gromadziński
- Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, Olsztyn, Poland ; Department of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Thapa P, Xing YY, Li YH. Mitral annulus displacement measured by two-dimensional speckle tracking imaging to assess the left ventricular longitudinal systolic function in coronary heart disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:544-549. [PMID: 24942839 DOI: 10.1002/jcu.22181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/30/2014] [Accepted: 05/06/2014] [Indexed: 06/03/2023]
Abstract
AIM To assess the clinical utility of measuring mitral annulus displacement (MAD) by two-dimensional speckle tracking for the rapid evaluation of left ventricular longitudinal systolic function in patients with coronary heart disease (CHD). METHODS Left ventricular longitudinal systolic function was evaluated by MAD using speckle tracking echocardiography in 30 healthy volunteers (controls) as well as in 30 patients with mild, 30 patients with moderate, and 30 patients with severe CHD. All participants had their apical four-chamber and two-chamber view echocardiographic images recorded. Left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction were calculated by the biplane Simpson method. MAD of interventricular septum (MADsep), left ventricular lateral wall (MADlat), and the middle point of the mitral annulus (MADmid) were measured offline with speckle-tracking echocardiography. MADmid% was defined as MADmid divided by left ventricular end-diastolic diameter. RESULTS MADmid% was 16.9 ± 1.9, 11.8 ± 3.2, 11.8 ± 2.9, and 10.3 ± 3.6, respectively, in controls and in patients with mild, moderate, and severe CHD. All MAD indexes were lower in patients with moderate or severe CHD than in controls or patients with mild CHD. CONCLUSIONS MAD is an early and rapid index for the assessment of left ventricular longitudinal systolic function in patients with different degrees of coronary artery disease.
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Affiliation(s)
- Pooja Thapa
- The First Affiliated Hospital of Liaoning Medical College, No. 2, Sec. 5, Renmin Road, Guta District, Jinzhou City, Liaoning Province, People's Republic of China
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Ishigaki T, Yoshida T, Izumi H, Fujisawa Y, Shimizu S, Masuda K, Asanuma T, Okabe H, Nakatani S. Different implication of elevated B-type natriuretic peptide level in patients with heart failure with preserved ejection fraction and in those with reduced ejection fraction. Echocardiography 2014; 32:623-9. [PMID: 25115860 DOI: 10.1111/echo.12707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There have been no reports that show significant direct relationship between echocardiographic parameters and B-type natriuretic peptide (BNP) level. This could be due to the heterogeneous pathophysiology of heart failure and a lack of appropriate echocardiographic parameters. We sought to determine the best echocardiographic parameter that described elevated BNP level in patients with heart failure with and without systolic dysfunction. METHODS AND RESULTS We studied 111 consecutive heart failure patients. They were divided into patients with heart failure and preserved ejection fraction (HFPEF, n = 61) and that with heart failure and reduced ejection fraction (HFREF, n = 50). Conventional and new echocardiographic parameters including myocardial strains were measured. BNP did not reflect any single echocardiographic parameter in patients with heart failure in total. The ratio of early diastolic transmitral flow velocity and mitral annular velocity had strong positive correlation with BNP level in the HFPEF group but not in the HFREF group. In the group of HFREF, global longitudinal and circumferential strains were positively correlated. Multivariate analysis revealed that predicted factors for BNP value in HFPEF and in HFREF were different. CONCLUSION High BNP level may indicate high filling pressure when ejection fraction is preserved and may indicate myocardial dysfunction when it is reduced.
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Affiliation(s)
- Takako Ishigaki
- Department of Health Sciences, Division of Functional Diagnostics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Jorstig S, Emilsson K, Lidén M, Thunberg P. A study to determine the contribution to right ventricle stroke volume from pulmonary and tricuspid valve displacement volumes. Clin Physiol Funct Imaging 2014; 35:283-90. [PMID: 24810859 DOI: 10.1111/cpf.12162] [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: 09/19/2013] [Accepted: 04/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Describing the systolic function of the right ventricle (RV) is a difficult task due to the complex shape and orientation of the RV. The purpose of this study was to investigate the extent to which the volumes encompassed by the pulmonary and tricuspid valve displacements contribute to the total right ventricle stroke volume (RVSV). METHODS Twelve healthy volunteers were examined using cardiac magnetic resonance (CMR). Two series of time-resolved axially rotated MR images were acquired that encompassed the tricuspid valve and the pulmonary valve, respectively. The volume related to each valve movement, the tricuspid plane displacement (TPD) and the pulmonary plane displacement (PPD), was determined by delineation in diastole and systole. These volumes, RVSV(TPD) and RVSV(PPD) , were compared to the stroke volume to determine the contributions to the total stroke volume from the TPD and the PPD. The remaining volume of the total RVSV was referred to as RVSV(Other) . An initial in vitro study was carried out to validate the accuracy of volume measurements using axially rotated images. RESULTS In vitro measurements indicated that the method for volumetric measurements using axially rotated images was a very accurate one, with a mean difference of 0·04 ± 0·10 ml. The in vivo measurements of RVSV(TPD) , RVSV(PPD) and RVSVOther were 45 ± 10%, 13 ± 2% and 42 ± 11%, respectively. CONCLUSIONS Right ventricle stroke volume is determined by different individual volume changes as follows: RVSV(TPD) together with RVSVOther contributes to almost the entire RVSV in nearly equal proportions, while RVSV(PPD) contributes only a small amount and is approximately 30% of either RVSV(TPD) or RVSV(Other) .
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Affiliation(s)
- Stina Jorstig
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kent Emilsson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.,Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden
| | - Mats Lidén
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.,Department of Radiology, Örebro University Hospital, Örebro, Sweden
| | - Per Thunberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Physics, Örebro University Hospital, Örebro, Sweden
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Pislaru C, Pellikka PA. Tissue Doppler and strain-rate imaging in cardiac ultrasound imaging: valuable tools or expensive ornaments? Expert Rev Cardiovasc Ther 2014; 3:1-4. [PMID: 15723568 DOI: 10.1586/14779072.3.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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López-Candales A. Automated Functional Imaging for Assessment of Left Ventricular Mechanics in the Presence of Left Ventricular Hypertrophy. Echocardiography 2013; 31:605-14. [DOI: 10.1111/echo.12441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Angel López-Candales
- Division of Cardiovascular Diseases; University of Cincinnati College of Medicine; Cincinnati Ohio
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Daskalov IR, Daskalova IK, Demirevska LD, Atzev BG. The relationship between mitral annular systolic velocity and ejection fraction in patients with preserved global systolic function of the left ventricle. BMC Cardiovasc Disord 2013; 13:92. [PMID: 24160570 PMCID: PMC4231345 DOI: 10.1186/1471-2261-13-92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/16/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the study was to investigate the relationship between the ejection fraction (EF) and the mitral annular systolic velocity (Sm) in patients with preserved left ventricular systolic function (EF>55%). The study task was to evaluate whether the assessment of Sm(avg) can be used as an alternative to the Simpson's method in assessment of the EF. The expected benefit was that Sm could be used to predict EF, when EF is difficult to assess due to poor image quality (IQ). METHOD Sm was obtained by spectral pulse wave Tissue Doppler Imaging (pwTDI) from the lateral and septal sites of the mitral annulus (MA) and an averaged value was calculated - Sm(avg). EF was assessed using Simpson's rule. Participants were divided into controls (n=70), hypertensive (HTN, n=56), HTN with diastolic dysfunction (HTN/DD, n=65), HTN with diabetes mellitus (HTN/DM, n=52) and HTN with DD and DM (HTN/DD/DM, n=65). RESULTS Sm(avg) showed strong correlation with EF (r=0.978; p<0.0001). There were no significant differences between the correlation coefficients between the subgroups and the controls. The mathematical model that the study recommended to assess the EF is: EF=45.0 + 2 × Sm(avg). CONCLUSION The assessment of Sm(avg) could be used as an alternative to EF. This approach may be useful especially when the IQ is poor. The method maintains high accuracy and reproducibility in prediction of the EF.
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Affiliation(s)
- Ivaylo Rilkov Daskalov
- Department of Cardiology and Intensive Care, Cardiology Clinic, Military Medical Academy, 3 Georgi Sofiiski Blvd, Sofia 1606, Bulgaria
| | - Ivona Kirilova Daskalova
- Department of Endocrinology and Metabolic Disorders, Endocrinology, Military Medical Academy, 3 Georgi Sofiiski Blvd, Sofia 1606, Bulgaria
| | - Lilia Davidkova Demirevska
- Department of Cardiology and Intensive Care, Cardiology Clinic, Military Medical Academy, 3 Georgi Sofiiski Blvd, Sofia 1606, Bulgaria
| | - Borislav Georgiev Atzev
- Department of Cardiology, University Hospital “St.Ekaterina”, 52A Pencho Slaveikov Blvd, Sofia 1000, Bulgaria
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Pauliks LB, Valdes-Cruz LM, Perryman R, Scholl FG. Right ventricular wall-motion changes after infant open heart surgery--a tissue Doppler study. Echocardiography 2013; 31:209-17. [PMID: 24103038 DOI: 10.1111/echo.12347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a well-recognized complication of cardiopulmonary bypass surgery (CPB) in adults. Infants and neonates may also be at high risk for this due to immature myocardium. Conventional assessment of RV function is just qualitative, but novel tissue Doppler echocardiographic (TDI) markers including peak systolic strain rate (SR) and isovolumic contraction acceleration (IVA) permit noninvasive quantitation of RV function. This study assessed myocardial velocities, IVA and SR in infants and neonates undergoing open heart surgery using TDI to study regional myocardial function perioperatively. METHODS Transthoracic TDI data were obtained in the OR before and 24 hours post-CPB on 53 consecutive infants (age 0.39 ± 0.23 years). They were followed with TDI through hospital discharge. RESULTS Mean CPB time was 87 ± 49 min (cross-clamp 52 ± 26 min). Peak systolic (STDI ) and diastolic myocardial velocities (ETDI , ATDI ), IVA, and peak SR were recorded in RV and LV from standard views for offline analysis. Postoperatively, LV systolic function and diastolic longitudinal function were unchanged or improved from baseline. LV radial velocities were increased postoperatively indicating adequate support. In contrast, RV longitudinal systolic and diastolic function was significantly diminished after CPB. RV changes persisted through hospital discharge. CONCLUSIONS In infants and neonates, perioperative measurements of systolic and diastolic tissue Doppler parameters are feasible and revealed significant RV systolic and diastolic dysfunction post-CPB with preserved LV function. As such, TDI provides a sensitive tool to monitor the infant heart after CPB and may potentially be useful to assess different myocardial protection strategies.
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Affiliation(s)
- Linda B Pauliks
- Pediatric Cardiology, Penn State Hershey Medical College, Hershey, Pennsylvania
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Lu Z, Wei Q, Ning Z, Qian-Zi Z, Xiao-Ming S, Guo-Chun W. Left Ventricular Diastolic Dysfunction — Early Cardiac Impairment in Patients with Polymyositis/Dermatomyositis: A Tissue Doppler Imaging Study. J Rheumatol 2013; 40:1572-7. [DOI: 10.3899/jrheum.130044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective.To investigate early cardiac involvement in patients with polymyositis/dermatomyositis (PM/DM), and to evaluate the risk factors for early cardiac impairment.Methods.The study population included 46 patients with PM/DM who did not have overt cardiovascular manifestations and 21 age- and sex-matched healthy controls. Traditional echocardiography and tissue Doppler imaging (TDI) were used to evaluate cardiac function in both groups. Clinical characteristics were recorded. Multivariate logistics regression analysis was applied to investigate risk factors for early cardiac impairment in patients with PM/DM.Results.No significant difference was found between patients and controls by traditional echocardiography. However, compared to controls, PM/DM patients had a significantly lower ratio of early diastolic mitral annulus velocity to late diastolic mitral annulus velocity (Em/Am; 1.23 ± 0.52, 1.79 ± 0.37, respectively; t = −4.485, p < 0.001) and a higher ratio of peak early diastolic transmitral flow velocity to Em (E/Em; 8.26 ± 2.57, 6.76 ± 1.17; t = 3.287, p < 0.05) as found by TDI measurements. There was no significant difference between the TDI variables of patients with PM and DM. The multivariate regression analysis showed that female sex (OR 11.044, 95% CI 1.066–114.357, p = 0.044), late onset (OR 1.157, 95% CI 1.047–1.278, p = 0.004), and duration of disease (OR 1.060, 95% CI 1.008–1.115, p = 0.023) were risk factors for abnormal left ventricular filling pressures.Conclusion.TDI is useful for detecting early cardiac impairment in patients with PM/DM. Left ventricular diastolic dysfunction is an early feature of cardiac involvement. Female sex, late onset, and long course of disease are 3 independent risk factors for predicting left ventricular diastolic dysfunction in patients with PM/DM.
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Acharya G. Measurement of atrioventricular annular plane displacement has been revived: will it prove to be useful in assessing fetal cardiac function? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:125-129. [PMID: 23775904 DOI: 10.1002/uog.12542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 06/05/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Affiliation(s)
- G Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø & University Hospital of Northern Norway, Tromsø, Norway.
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Petersen JW, Nazir TF, Lee L, Garvan CS, Karimi A. Speckle tracking echocardiography-determined measures of global and regional left ventricular function correlate with functional capacity in patients with and without preserved ejection fraction. Cardiovasc Ultrasound 2013; 11:20. [PMID: 23764185 PMCID: PMC3693869 DOI: 10.1186/1476-7120-11-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/06/2013] [Indexed: 11/29/2022] Open
Abstract
Background Standard measures of left ventricular systolic and diastolic function often fail to identify left ventricular dysfunction in patients with heart failure and do not correlate with measures of functional capacity. Aim To determine if speckle tracking echocardiography (STE)–determined measures of global and regional myocardial contractility have a linear association with functional capacity in patients with and without preserved ejection fraction. Methods In 68 adult patients, functional status was estimated with the Duke Activity Status Index (DASI), left ventricular ejection fraction was determined with Simpson’s biplane method, and QLAB advanced quantification software (Philips, The Netherlands) was used to determine peak measures of strain. Results Global and regional measures of longitudinal, circumferential, and radial strain had a strong linear association with the DASI score. Longitudinal strain in the inferolateral segments had the strongest correlation with DASI (r = −0.72, P < 0.001). In patients with an ejection fraction ≥45%, ejection fraction and E/e’ had no correlation with DASI, whereas longitudinal strain in the inferolateral segments had significant correlation with DASI (r = −0.53, P = 0.03, n = 16). Conclusions STE–determined measures of global and regional left ventricular function have a strong linear association with estimates of functional capacity in patients with and without preserved ejection fraction. STE–determined measures of strain, especially longitudinal strain, are likely to be important targets for therapy and should be considered in future studies aimed at improving our diagnosis of left ventricular inadequacy in patients with heart failure, especially those with preserved ejection fraction.
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Affiliation(s)
- John W Petersen
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
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Huang FQ, Zhong L, Zhang RS, Tan LK, Chua YLH, Ding ZP. Left Ventricular Diastolic Function Assessment Using the Timing of Mitral Annular and Transmitral Flow Velocities. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and aims: Evaluation of left ventricular (LV) diastolic function plays an important role in clinical echocardiography. The relationship between mitral annular velocities from tissue Doppler imaging (TDI) (E′ and A′) and mitral inflow velocities (E and A) from Doppler echocardiography (DE) provide additional information about LV filling and diastolic function. The aims of this study are to i) assess the time differences between peak E and peak E′, peak A and peak A′, peak Ar and peak A, and ii) examine the effects of age and gender on these time intervals parameters in normal subjects. Methods: A total of 117 healthy subjects (age ranging from 22- to 78-years-old) were recruited for a standard of echocardiogram (ECHO). During early diastole, the time intervals from the peak of R-wave on the ECG to the peak of E-wave (R-pE), to the peak of E wave to peak of E′-wave (R-pE′) were measured. During late diastole, the time intervals from the onset of P-wave on the ECG to the peak A-wave (P-pA), to the peak Ar-wave on the pulmonary valve flow (P-pAr), to the peak A′-wave (P-pA′) were measured. Early-diastolic temporal discordance (EDTD) and late-diastolic temporal discordance (LDTD) were calculated as the differences between (R-pE) and (R-pE′), and (P-pA) and (P-pA′), respectively. Results: The mean EDTD and LDTD were 28.7 ± 10.6 ms and 21.2 ± 15.9 ms, respectively. Similarly, the mean time difference [(P-pA) - (P-pAr)] was 21.5 ± 14.1 ms. EDTD was not associated with age (r=0.15, p=NS), while LDTD was inversely correlated with age (r=-0.65, p<0.01). No significant differences were found for both EDTD and LDTD between genders. Conclusion: EDTD and LDTD, the temporal discordances between mitral annulus motion and trans-mitral flow, embody one of the earliest events at early- and late-diastole. Age is not associated with EDTD, but is accompanied by a decline in LDTD. With respect to gender, both EDTD and LDTD are not influenced.
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Affiliation(s)
| | - Liang Zhong
- National Heart Centre Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | | | | | | | - Zee Pin Ding
- National Heart Centre Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore
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Bergenzaun L, Ohlin H, Gudmundsson P, Willenheimer R, Chew MS. Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients. Cardiovasc Ultrasound 2013; 11:16. [PMID: 23718803 PMCID: PMC3679845 DOI: 10.1186/1476-7120-11-16] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 05/24/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome. METHODS In a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality. RESULTS MAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1-2, 4-6). CONCLUSIONS MAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.
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Affiliation(s)
- Lill Bergenzaun
- Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Institute for Clinical Sciences Malmö, Lund University, Malmö, Sweden.
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Sengupta SP, Nugurwar A, Jaju R, Khandheria BK. Left ventricular myocardial performance in patients with dengue hemorrhagic fever and thrombocytopenia as assessed by two-dimensional speckle tracking echocardiography. Indian Heart J 2013; 65:276-82. [PMID: 23809381 DOI: 10.1016/j.ihj.2013.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/13/2013] [Accepted: 04/03/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We obtained longitudinal, radial and circumferential strains in patients with dengue hemorrhagic fever (DhF) and thrombocytopenia using two-dimensional (2D) speckle tracking echocardiography to analyze left ventricular (LV) myocardial performance. METHODS In this prospective study, 2D echocardiographic images of the left ventricle in the four-, three- and two-chamber views and parasternal short-axis views at the basal, mid and apical levels were obtained in 40 subjects: 20 patients (23 ± 8 years, 12 male) with DhF and thrombocytopenia and 20 healthy controls (23 ± 5 years, 11 male). Of the 20 patients, imaging was performed again in 19 at discharge after a hospital stay of 8 ± 1 days. Longitudinal, circumferential and radial strains were quantified and compared in an 18-segment model using a novel speckle tracking system. RESULTS Left ventricular global ejection fraction was reduced in patients with DhF at presentation as compared with controls (51.25 ± 0.96% vs. 59.32 ± 1.26%; p = 0.032). Peak longitudinal strain in patients with DhF was significantly attenuated in the subendocardial region compared with normal controls (p < 0.001). A significant increase in circumferential strain for patients with DhF was evident only in the subepicardial region (p = 0.009). Patients with DhF showed significantly higher radial strain than controls (p < 0.001). On multivariate analysis, subendocardial longitudinal strain independently predicted the duration of hospital stay in patients with DhF. CONCLUSION Assessment of speckle tracking echocardiography-derived LV mechanics helps in understanding myocardial mechanics in patients with DhF and thrombocytopenia. Identification of reduced LV longitudinal strain helps in understanding the mechanism of reduced LV myocardial performance seen in patients with DhF.
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Negishi K, Lucas S, Negishi T, Hamilton J, Marwick TH. What is the primary source of discordance in strain measurement between vendors: imaging or analysis? ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:714-720. [PMID: 23414723 DOI: 10.1016/j.ultrasmedbio.2012.11.021] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/16/2012] [Accepted: 11/23/2012] [Indexed: 06/01/2023]
Abstract
Strain imaging quantifies myocardial deformation in both overt and subclinical myocardial diseases. Strain values have been shown to vary between vendors. The aim of this study was to investigate whether this variation reflects differences of image characteristics or analysis software. We enrolled 45 patients (age 54 ± 14 years, 26 males) who underwent two echocardiograms on the same day with two different commercially available ultrasound systems. Three apical views were analyzed by two vendor-specific and two digital imaging and communications in medicine (DICOM)-based software packages. The results were compared in two ways; comparison of global longitudinal strain (GLS) by nine different combinations of ultrasound systems and strain software, and comparison of strains by wall, view and global levels. Comparison of GLS between two vendor-specific software packages yielded poor correlation (ρ = 0.35). The use of the same software on the images from different vendors was concordant (ρ = 0.74 and 0.64; bias = 0.0 and -0.5). There were no significant differences in correlation coefficients among the comparisons with DICOM-based software. There was no significant difference in correlation coefficients among three views (4CV vs. 3CV, p = 0.44; 4CV vs. 2CV, p = 0.47). Comparison of walls showed the septum to have the best correlation (ρ = 0.73), and the posterior wall (ρ = 0.31; p = 0.005 vs. septum) had the worst. Use of the same software to measure strain in images from different vendors minimizes the variation of GLS. Post-processing is the most important determinant in inter-vendor variation, with differences in acquisition having a small effect. These findings should be examined and confirmed with other combinations of ultrasound machines and deformation software.
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Affiliation(s)
- Kazuaki Negishi
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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