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Wagdy R, Fathy A, Elnekidy A, Salaheldin G, Nazir H, Fahmy R, Elkafrawy H, Elkafrawy F. Evaluation of cardiac fibrosis and subclinical cardiac changes in children with sickle cell disease using magnetic resonance imaging, echocardiography, and serum galectin-3. Pediatr Radiol 2023; 53:2515-2527. [PMID: 37715793 PMCID: PMC10635955 DOI: 10.1007/s00247-023-05750-2] [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: 05/25/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Myocardial fibrosis has recently been proposed as one of the contributing factors to the diverse pathogenicity of cardiomyopathy in sickle cell disease. OBJECTIVE In this study, cardiac fibrosis and subclinical cardiac changes in children with sickle cell disease were evaluated using cardiac magnetic resonance imaging (MRI), tissue Doppler echocardiography and serum galectin-3. MATERIALS AND METHODS The study included 34 children with sickle cell disease who were compared with a similar number of healthy controls. Cardiac MRI was used to evaluate late gadolinium enhancement, native T1 mapping, extracellular volume, and T2* for estimation of iron load. Cardiac function and myocardial performance index (MPI, evaluated by tissue Doppler echocardiography) and serum galectin-3 were compared to controls. RESULTS The mean age of the included patients was 13.3 ± 3.2 years. Myocardial iron load by T2* was normal. The mean level of extracellular volume (35.41 ± 5.02%) was significantly associated with the frequency of vaso-occlusive crises (P = 0.017) and negatively correlated with hemoglobin levels (P = 0.005). Galectin-3 levels were significantly higher among cases than controls (P = 0.00), at a cutoff value on the receiver operating characteristic curve of 6.5 ng/ml, sensitivity of 82.5% and specificity of 72.8%. The extracellular volume was significantly higher in cases, with a MPI > 0.4. CONCLUSION Diffuse interstitial myocardial fibrosis can be detected early in children with sickle cell disease using T1 mapping and is associated with a high frequency of vaso-occlusive crisis. MPI of the left ventricle and serum galectin-3 are recommended screening tools for subclinical cardiac abnormalities.
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Affiliation(s)
- Reham Wagdy
- Department of Pediatrics, Pediatrics Cardiology Unit, Faculty of Medicine, Alexandria University, Alexandria, 21648, Egypt.
| | - Alaa Fathy
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdelaziz Elnekidy
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Geylan Salaheldin
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanan Nazir
- Department of Pediatrics, Faculty of Medicine, Hematology Unit, Alexandria University, Alexandria, Egypt
| | - Rana Fahmy
- Department of Pediatrics, Pediatrics Cardiology Unit, Faculty of Medicine, Alexandria University, Alexandria, 21648, Egypt
| | - Hagar Elkafrawy
- Department of Medial Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Fatma Elkafrawy
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Yan W, Luo Q, Nie Q, Wang H, Wu J. Association between systemic sclerosis and left ventricle dysfunction: Findings from observational studies. Heliyon 2023; 9:e14110. [PMID: 36938434 PMCID: PMC10020007 DOI: 10.1016/j.heliyon.2023.e14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives Cardiac involvement is common in systemic sclerosis (SSc) patients. In this study, we aimed to systematically evaluate the relationship between SSc and left ventricular dysfunction (LVD), especially the left ventricular diastolic dysfunction, by ultrasound and cardiac magnetic resonance data. Methods We searched The Cochrane Library, PubMed and Embase databases collected studies about comparing LVD parameters in SSc patients and controls from establishment to January 2022. Furthermore, we also performed a two-sample MR using summary statistics from genome-wide association studies (GWAS) important LVD parameters, including left ventricular end-diastolic volume (LVEDV), left ventricular mass (LVM) and left ventricular ejection fraction (LVEF). Results Our meta-analysis included 31 eligible studies with 1448 SSc patients. According to the results, SSc patients had lower peak of early diastolic flow velocity/peak of late diastolic flow velocity ratio (E/A ratio), E, trans-mitral early filling peak velocity (E'), and left ventricular end-diastolic diameter (LVEDD) compared to controls. The E/E' ratio, A, left ventricular isovolumetric relaxation time (IVRT), deceleration Time (DT) and left atrial (LA) diameter were higher in SSc patients in comparison with controls. Moreover, we observed that the SSc patients had lower LVEF than controls. And in MR analysis, we also found that SSc was causally correlated with LVEF (OR = 0.9966, 95% CI 0.9935-0.998, P = 0.0398). However, unfortunately, there was no significant correlation between SSC and LVM (OR = 1.0048, 95% CI 0.9919-1.0179, P = 0.4661) and LVEDV (LVEDV OR = 0.9976, 95%CI 0.9888-1.0066, P = 0.6019). Conclusion SSc patients had diastolic/systolic dysfunction. However, MR analysis cannot confirm the genetic relationship between SSc and LVDD because of insufficient data. More research is needed to confirm the causal relationship between the two.
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Affiliation(s)
- Wei Yan
- Southwest Jiaotong University, Department of Geriatrics, Southwest Jiaotong University College of Medicine, The Third People's Hospital of Chengdu, No.82, Qinglong Street, Sichuan, China
| | - Qiang Luo
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No.82, Qinglong Street, Sichuan, China
| | - Qiong Nie
- Southwest Jiaotong University, Department of Geriatrics, Southwest Jiaotong University College of Medicine, The Third People's Hospital of Chengdu, No.82, Qinglong Street, Sichuan, China
| | - Han Wang
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No.82, Qinglong Street, Sichuan, China
- Corresponding author.
| | - Jing Wu
- Southwest Jiaotong University, Department of Geriatrics, Southwest Jiaotong University College of Medicine, The Third People's Hospital of Chengdu, No.82, Qinglong Street, Sichuan, China
- Corresponding author.
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Mousseaux E, Agoston-Coldea L, Marjanovic Z, Baudet M, Reverdito G, Bollache E, Kachenoura N, Messas E, Soulat G, Farge D. Diastolic Function Assessment of Left and Right Ventricles by MRI in Systemic Sclerosis Patients. J Magn Reson Imaging 2022; 56:1416-1426. [PMID: 35258133 DOI: 10.1002/jmri.28143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Heart involvement is frequent although often clinically silent in systemic sclerosis (SSc) patients. Early identification of cardiac involvement can be improved by noninvasive methods such as MRI, in addition to transthoracic echocardiography (TTE). PURPOSE To assess the ability of phase-contrast (PC)-MRI to detect subclinical left (LV) and right (RV) ventricular diastolic dysfunction in SSc patients. STUDY TYPE Prospective. POPULATION Thirty-five consecutive SSc patients (49 ± 14 years) and 35 sex- and age-matched healthy controls (48.6 ± 13.5 years) who underwent TTE and MRI in the same week. FIELD STRENGTH/SEQUENCE 5 T/PC-MRI using a breath-hold velocity-encoded gradient echo sequence. ASSESSMENT LV TTE (E/E') and LV and RV PC-MRI indices of diastolic function (LV early and late transmitral [EM , EfM , AM , AfM ] and RV transtricuspid [ET , EfT , AT , AfT ] peak filling flow velocities and flow rates, as well as LV [ E M ' ] and RV [ E T ' ] peak longitudinal myocardial velocities during diastole) were measured. STATISTICAL TESTS Two-tailed t-test, Wilcoxon test, or Fischer test for comparison of variables between SSc and healthy control groups; sensitivity, specificity, receiver-operating-characteristic (ROC) area under the curve (AUC) to assess discriminative ability of variables. A P-value <0.05 was considered statistically significant. RESULTS TTE LV E/E' and MRI EM / E M ' and ET / E T ' were significantly higher in SSc patients than in controls (8.27 ± 1.25 vs. 6.70 ± 1.66; 9.43 ± 2.7 vs. 6.51 ± 1.50; 6.51 [4.70-10.40] vs. 4.13 [3.22-5.75], respectively) and separated SSc patients and healthy controls with good sensitivity (68%, 71%, and 80%), specificity (85%, 94%, and 62%), and AUC (0.787, 0.807, and 0.765). LV EfM was significantly higher in SSc patients than in controls (347.1 ± 113.7 vs. 284.7 ± 94.6) as RVAfT (277 [231-355] vs. 220 [154-253] mL/sec) with impaired relaxation pattern (EfT /AfT , 0.95 [0.87-1.21] vs. 1.12 [0.93-1.47]). DATA CONCLUSION MRI was able to detect LV and RV diastolic dysfunction in SSc patients with good accuracy in the absence of LV systolic dysfunction at echocardiography. Use of MRI can allow to better assess the early impact of myocardial fibrosis related to SSc. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Elie Mousseaux
- Paris-Cardiovascular Research Center INSERM 970, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Lucia Agoston-Coldea
- Paris-Cardiovascular Research Center INSERM 970, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Zora Marjanovic
- Service d'Hématologie, Hôpital Saint Antoine (APHP), Paris, France
| | - Mathilde Baudet
- Cardiology Department, APHP, Lariboisiere Hospital, Paris, France
| | - Guillaume Reverdito
- Paris-Cardiovascular Research Center INSERM 970, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Emilie Bollache
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Nadjia Kachenoura
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Emmanuel Messas
- Paris-Cardiovascular Research Center INSERM 970, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Soulat
- Paris-Cardiovascular Research Center INSERM 970, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Dominique Farge
- Unité de Médecine Interne (UF 04): CRMR MATHEC, Maladies Auto-Immunes et Thérapie Cellulaire, Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, FAI2R, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France.,Recherche Clinique Appliquée à l'hématologie, Institut de Recherche Saint Louis, Université de Paris, Paris, France.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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Karna SK, Rohit MK, Wanchu A. Right ventricular thickness as predictor of global myocardial performance in systemic sclerosis: A Doppler tissue imaging study. Indian Heart J 2015; 67:521-8. [PMID: 26702679 PMCID: PMC4699958 DOI: 10.1016/j.ihj.2015.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/13/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Cardiopulmonary involvement in systemic sclerosis (SSc) is a poor prognostic factor, due to pulmonary hypertension and right ventricular dysfunction. We assessed the echocardiographic parameters of right ventricular (RV) function in SSc and correlated echocardiographic findings to clinical features of the disease. METHODS Thirty patients with SSc (cases) and 30 healthy, age-matched subjects (controls) were studied. Echocardiography, including tissue Doppler imaging, was used to evaluate cardiac function. RESULTS Pulmonary hypertension could be documented in only 5 cases by Doppler echo, using Bernoulli principle. RV diastolic function was significantly deranged in cases. RV systolic function and left ventricle (LV) diastolic function were also significantly deranged in the cases. RV thickness was increased in patients with SSc. There were no significant differences in the echocardiographic variables between diffuse and limited subtypes of SSc. Myocardial performance index (MPI) of both ventricles were increased in cases. We could demonstrate RV thickness as the single most important predictor of MPI of both ventricles with sensitivity of 82% and specificity of 72% for RV-MPI and 63% for LV-MPI. Diastolic function was not found to be affected by disease duration or Rodnan skin score. CONCLUSION Patients with SSc exhibit abnormal RV and LV diastolic functions as well as abnormal RV systolic function. RV wall thickness was found to be simple and the single best predictor of global myocardial performance. RV dysfunction may be a response to intermittent pulmonary arterial hypertension, lung parenchymal involvement, or secondary to LV diastolic dysfunction in SSc.
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Affiliation(s)
- S K Karna
- Assistant Professor, Department of Cardiology, Pramukhswami Medical College, Anand, Gujarat 388325, India.
| | - M K Rohit
- Additional Professor, Department of Cardiology, PGIMER, Chandigarh 160012, India
| | - A Wanchu
- Associate Professor, Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR 97239, USA
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Gerede DM, Turhan S, Hural R, Acıbuca A, Kucuksahin O, Ozcan OU, Goksuluk H, Vurgun VK, Erol C. Evaluation of global function of the heart in scleroderma patients. Echocardiography 2014; 32:912-9. [PMID: 25250771 DOI: 10.1111/echo.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Scleroderma is a connective tissue disease characterized by diffuse vascular lesions and fibrosis of the skin and major organs including lungs, kidneys, and heart. When cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. The early detection of cardiac involvement in scleroderma would be desirable both for implementation of preventive measures in the early stages of the disease and for optimal treatment. METHODS Left (LV) and right (RV) ventricular function were examined in 31 scleroderma patients and 21 healthy controls. Conventional and tissue Doppler echocardiography was used to evaluate systolic and diastolic function. Systolic indices including systolic (S) velocity, isovolumetric acceleration (IVA), ejection time (ET), and isovolumetric contraction time (IVCT) were measured. Early diastolic (E) velocity, late diastolic (A) velocity, E/A and E'/A' ratios, isovolumetric relaxation time (IVRT), and deceleration time (DT) were the diastolic measurements obtained. Myocardial performance index (Tei index) calculated by 2 different methods was used to assess global ventricular function. RESULTS In our study; mitral S velocity, biventricular ET, E', E/A, E'/A', RV IVA, LV IVA, and tricuspid S velocity were significantly lower in scleroderma patients. Mitral DT, IVCT, and biventricular IVRT, were significantly higher in scleroderma patients (P < 0.0001). In addition, RV and LV Tei indices were significantly increased in scleroderma patients compared with the control group (P < 0.0001 and P < 0.001, respectively). CONCLUSIONS In scleroderma patients, global function was depressed prior to the onset of clinical symptoms. Biventricular diastolic and systolic function abnormalities were also observed.
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Affiliation(s)
| | - Sibel Turhan
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Refika Hural
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Aynur Acıbuca
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Orhan Kucuksahin
- Department of Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Ozgur Ulas Ozcan
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Huseyin Goksuluk
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Veysel Kutay Vurgun
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
| | - Cetin Erol
- Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey
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Kiatchoosakun S, Wongvipaporn C, Nanagara R, Hoit BD. Right ventricular systolic pressure assessed by echocardiography: a predictive factor of mortality in patients with scleroderma. Clin Cardiol 2011; 34:488-93. [PMID: 21717471 DOI: 10.1002/clc.20920] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 03/29/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a well-known complication of systemic sclerosis (SSc). Doppler echocardiographic screening for the detection of PAH (by measuring right ventricular systolic pressure [RVSP]) is therefore recommended for all patients with SSc. However, the validity of RVSP as a predictor of mortality in patients with SSc is not well established. HYPOTHESIS Doppler-determined PAH identifies a high-risk subset of patients with SSc with decreased survival. METHODS We performed echocardiography in 155 consecutive patients with SSc between May 2005 and July 2006 and tested the value of an RVSP level of ≥36 mm Hg to predict mortality. Cox proportional hazards model was used to examine the individual relationship between each variable and the mortality rate. RESULTS Tricuspid regurgitant jets for RVSP determination were quantified in 129 patients (82.6%), of which 47 (36.4%) had RVSP ≥36 mm Hg. The median follow-up time was 34 months. The 1-, 2-, and 3-year survival rates were significantly lower among SSc patients with RVSP ≥36 vs ≤36 mm Hg (82%, 78%, and 67% vs 98%, 90%, and 86%, respectively, P < 0.01 by Wilcoxon test). In a multivariate analysis including echocardiographic and clinical variables, only an RVSP ≥36 mm Hg and a New York Heart Association III/IV class were associated with increased mortality; the respective Cox hazard ratios were 2.22 (95% confidence interval [CI]: 1.01-4.89, P = 0.048) and 4.77 (95% CI: 2.09-10.90, P = 0.000). CONCLUSIONS Our results indicate that Doppler RVSP identifies a high-risk subset and supports the use of Doppler RVSP as a screening test in patients with SSc who may warrant early treatment of their PAH.
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Affiliation(s)
- Songsak Kiatchoosakun
- Division of Cardiology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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HORI Y, KUNIHIRO SI, KANAI K, HOSHI F, ITOH N, HIGUCHI SI. The relationship between invasive hemodynamic measurements and tissue Doppler-derived myocardial velocity and acceleration during isovolumic relaxation in healthy dogs. J Vet Med Sci 2010; 71:1419-25. [PMID: 19959890 DOI: 10.1292/jvms.001419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the feasibility of using the values of tissue Doppler imaging (TDI)-derived myocardial velocity during isovolumic relaxation (V(IR)) and myocardial acceleration during isovolumic relaxation (ACC) obtained from the left ventricular (LV) free wall to evaluate LV relaxation in normal dogs. Seven dogs were anesthetized, and dobutamine or esmolol was infused at a rate of 5.0 and 10.0 mug/kg/min or 100 and 500 mug/kg/min, respectively, via a cephalic vein. The order of drug administration (dobutamine or esmolol) was assigned to each dog. Simultaneous pulsed-Doppler (PD) echocardiography, TDI and hemodynamic measurements were performed. Compared with the baseline values, dobutamine significantly increased dP/dt min, but significantly shortened tau (tau). Similarly, esmolol significantly decreased dP/dt min, but significantly prolonged tau. Compared with the baseline values, dobutamine significantly increased V(IR) and ACC, and esmolol significantly decreased V(IR) and ACC. Both dP/dt min and tau were significantly correlated with TDI-derived IVRT (r=-0.43 and 0.74), V(IR) (r=0.85 and -0.49) and ACC (r=0.84 and -0.52). These results indicate that the TDI-derived V(IR) and ACC values obtained from the LV free wall can potentially be used to assess LV relaxation in dogs.
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Affiliation(s)
- Yasutomo HORI
- Department of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Towada, Aomori, Japan.
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Regional diastolic function by tissue Doppler echocardiography in systemic sclerosis: correlation with clinical variables. Rheumatol Int 2008; 29:913-9. [DOI: 10.1007/s00296-008-0827-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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