1
|
Duzen IV, Tuluce SY, Ozturk S, Savcılıoglu MD, Goksuluk H, Altunbas G, Kaplan M, Vuruskan E, Tabur S, Sucu M, Taysi S. Assessment of Left Ventricular Strain Echocardiography in Individuals with Hashimoto's Thyroiditis and Its Association with Serum TIMP-1 Concentration. J Clin Med 2025; 14:1705. [PMID: 40095713 PMCID: PMC11900031 DOI: 10.3390/jcm14051705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Revised: 02/15/2025] [Accepted: 02/25/2025] [Indexed: 03/19/2025] Open
Abstract
Background: Hashimoto's thyroiditis (HT), which is an autoimmune condition and the primary cause of hypothyroidism, has numerous impacts on the cardiovascular system. This research aimed to compare TIMP-1 levels and LV strain values in euthyroid HT, hypothyroid HT, and healthy control persons. Materials and Methods: This study included 40 hypothyroid HT patients, 42 HT patients who became euthyroid with thyroid hormone replacement therapy, and 40 healthy controls. All subjects had conventional echocardiography and STE. Global and segmental LV longitudinal strain values (LVGLS) were calculated. Participants' blood was tested for TIMP-1, thyroid function, and anti-TPO. Results: Higher serum TIMP-1 levels were found in euthyroid and hypothyroid HT patients than in the control group. Additionally, patients with euthyroid and hypothyroid HT displayed lower segmental and global LV strain values than the control group. A negative correlation was observed between strain values and TIMP-1 and anti-TPO levels. No significant difference was observed in serum TIMP-1 and strain values between euthyroid and hypothyroid HT patients. Patients with hypothyroid HT exhibited impaired diastolic function and reduced ejection fraction when compared to both euthyroid HT and control groups. However, euthyroid HT patients and the controls had similar diastolic function and ejection fractions. Conclusions: Hashimoto's thyroiditis causes impairment of LV strain, regardless of thyroid hormone levels. Additionally, the condition is associated with elevated TIMP-1 levels. The relationship between LV strain values and anti-TPO levels indicates that the autoimmune component of the disease may be responsible for the impaired LV strain.
Collapse
Affiliation(s)
- Irfan V. Duzen
- Department of Cardiology, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey; (G.A.); (M.K.); (E.V.); (M.S.)
| | - Selcen Y. Tuluce
- Department of Cardiology, Cardiology Clinic, Heart Izmir Clinic, Izmir 35610, Turkey;
| | - Sadettin Ozturk
- Department of Endocrinology and Metabolic Disease, Gaziantep City Hospital, Gaziantep 27470, Turkey;
| | - Mert D. Savcılıoglu
- Department of Cardiology, Cardiology Clinic, Gaziantep City Hospital, Gaziantep 27470, Turkey;
| | - Huseyin Goksuluk
- Department of Cardiology, Cardiology Clinic, Bursa Anadolu Hospital, Bursa 16320, Turkey;
| | - Gokhan Altunbas
- Department of Cardiology, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey; (G.A.); (M.K.); (E.V.); (M.S.)
| | - Mehmet Kaplan
- Department of Cardiology, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey; (G.A.); (M.K.); (E.V.); (M.S.)
| | - Ertan Vuruskan
- Department of Cardiology, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey; (G.A.); (M.K.); (E.V.); (M.S.)
| | - Suzan Tabur
- Department of Endocrinology and Metabolic Disease, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey;
| | - Murat Sucu
- Department of Cardiology, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey; (G.A.); (M.K.); (E.V.); (M.S.)
| | - Seyithan Taysi
- Department of Medical Biochemistry, Faculty of Medicine, Gaziantep University Sahinbey Education and Research Hospital, Gaziantep University, Gaziantep 27310, Turkey;
| |
Collapse
|
2
|
Wu D, Li X, Guo T, Feng X, Li X, Wang Y, Chen W. Unmasking the Hidden Threat: The Role of Left Ventricular Subendocardial Involvement in Autoimmune Rheumatic Disease. Clin Cardiol 2025; 48:e70069. [PMID: 39743740 PMCID: PMC11693844 DOI: 10.1002/clc.70069] [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: 05/28/2024] [Revised: 11/13/2024] [Accepted: 12/12/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) has been found in patients with autoimmune rheumatic disease (ARD). However, the prognostic implications of some specific LGE patterns in ARD patients remain unclear. PURPOSE To investigate the prevalence and prognostic significance of left ventricular (LV) subendocardium-involved LGE (LGEse) in a cohort of ARD patients. MATERIALS AND METHODS This retrospective study evaluated 176 patients diagnosed with ARD with clinically suspected cardiac involvement between 2018 and 2023. LV LGEse was defined as LGE involving the LV subendocardium that did not correspond to a coronary vascular distribution. The endpoints included a composite of cardiac death, heart failure-related admission, cardiogenic shock, and appropriate pacemaker or implantable cardioverter-defibrillator therapy. RESULTS Of the 176 consecutive patients, LV LGEse was observed in 22 patients (13%). During a median follow-up of 776 days (interquartile range, 395-1405 days), 20 patients (11%) experienced a composite endpoint. Compared with those without LV LGEse, the LV LGEse group had a greater proportion of men (64% vs. 14%; p < 0.001), lower LV ejection fraction (50% vs. 60%; p = 0.001), greater LV end-diastolic volume index (78 vs. 75; p = 0.043), and more adverse outcomes (32% vs. 8%; p = 0.005). In the univariable and multivariable Cox regression analyses, the LV LGEse showed independent prognostic value. In the sensitivity analyses, the prognostic difference in terms of LV subendocardial involvement remained. CONCLUSION In our cohort, LV subendocardial involvement, an underrecognized LGE pattern, was observed in 13% of all patients with autoimmune disease and indicated a worse prognosis.
Collapse
Affiliation(s)
- Danni Wu
- Department of CardiologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xiao Li
- Department of RadiologyPeking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical CollegeBeijingChina
| | - Tianchen Guo
- Department of CardiologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xiaojin Feng
- Department of CardiologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xinhao Li
- Department of CardiologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yining Wang
- Department of RadiologyPeking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical CollegeBeijingChina
| | - Wei Chen
- Department of CardiologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| |
Collapse
|
3
|
Malagoli A, Albini A, Benfari G, Ilardi F, Lisi M, Mandoli GE, Pastore MC, Sperlongano S, Cameli M, D'Andrea A. Arrhythmic mitral valve prolapse: a practical approach for asymptomatic patients. Eur Heart J Cardiovasc Imaging 2024; 25:293-301. [PMID: 38061000 DOI: 10.1093/ehjci/jead332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/24/2024] Open
Abstract
Mitral valve prolapse (MVP) is usually regarded as a benign condition though the proportion of patients with a life-threatening arrhythmic MVP form remains undefined. Recently, an experts' consensus statement on arrhythmic MVP has proposed approaches for risk stratification across the spectrum of clinical manifestation. However, sudden cardiac death may be the first presentation, making clinicians focused to early unmasking this subset of asymptomatic patients. Growing evidence on the role of cardiac imaging in the in-deep stratification pathway has emerged in the last decade. Pathology findings have suggested the fibrosis of papillary muscles and inferobasal left ventricular wall as the malignant hallmark. Cardiac magnetic resonance, while of limited availability, allows the identification of this arrhythmogenic substrate. Therefore, speckle-tracking echocardiography may be a gateway to prompt referring patients to further advanced imaging investigation. Our review aims to summarize the phenotypic features linked to the arrhythmic risk and to propose an image-based algorithm intended to help stratifying asymptomatic MVP patients.
Collapse
Affiliation(s)
- Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 1355 Pietro Giardini Street, Modena 41126, Italy
| | - Alessandro Albini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular diseases, IRCCS San Gerardo dei Tintori Foundation, Monza, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
- Department of Cardiology, Umberto I Hospital, Nocera Inferiore, Italy
| |
Collapse
|
4
|
de Lourdes Castro de Oliveira Figueirôa M, Costa MCM, Costa MCM, Lobo PR, Sanches LV, Martins KMA, Sousa APMD, Pedreira ALS, Barreto Santiago M. Prevalence of subclinical systolic dysfunction in Takayasu's arteritis and its association with disease activity: a cross-sectional study. Adv Rheumatol 2023; 63:41. [PMID: 37596632 DOI: 10.1186/s42358-023-00322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/24/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Takayasu's arteritis (TA) is a vasculitis that affects the aorta and its branches and causes stenosis, occlusion, and aneurysms. Up to 60% of TA patients are associated with cardiac involvement which confers a poor prognosis. Global longitudinal strain (GLS) analysis is an echocardiographic technique that can detect the presence of subclinical systolic dysfunction. Hence, this study aimed to describe the prevalence of subclinical systolic dysfunction in patients with TA using the GLS method and to correlate this finding with disease activity using the ITAS-2010 (Indian Takayasu Activity Score). METHODS Thirty patients over 18 years of age who met the American College of Rheumatology (ACR) 1990 criteria for TA were included. The sample was submitted for medical record review, clinical and echocardiographic evaluation, and application of ITAS-2010. The cutoff for systolic dysfunction was GLS > - 20%. RESULTS Of the 30 patients analyzed, 25 (83.3%) were female, and the mean age was 42.6 years (± 13.2). The median time since diagnosis was 7.5 years [range, 3-16.6 years], and the type V angiographic classification was the most prevalent (56.7%). Regarding echocardiographic findings, the median ejection fraction (EF) was 66% [61-71%] and the GLS was - 19.5% [-21.3 to -15.8%]. Although half of the participants had reduced GLS, only two had reduced EF. Eleven patients (33.%) met the criteria for activity. An association was found between disease activity and reduced GLS in eight patients (P = 0.02) using the chi-square test. CONCLUSION GLS seems to be an instrument capable of the early detection of systolic dysfunction in TA. The association between GLS and disease activity in this study should be confirmed in a study with a larger sample size.
Collapse
Affiliation(s)
| | | | - Maria Clara Moura Costa
- Department of Internal Medicine, Prof. Edgard Santos University Hospital/UFBA, Salvador, Brazil
| | - Paulo Rocha Lobo
- Department of Echocardiography, Prof. Edgard Santos University Hospital/UFBA, Salvador, Brazil
| | | | | | - Anna Paula Mota Duque Sousa
- Department of Rheumatology, Prof. Edgard Santos University Hospital/UFBA, Salvador, Rua Dr. Augusto Viana, s/n - Canela, BA, 40110-060, Brazil
| | - Ana Luisa Souza Pedreira
- Department of Rheumatology, Prof. Edgard Santos University Hospital/UFBA, Salvador, Rua Dr. Augusto Viana, s/n - Canela, BA, 40110-060, Brazil
| | - Mittermayer Barreto Santiago
- Department of Rheumatology, Prof. Edgard Santos University Hospital/UFBA, Salvador, Rua Dr. Augusto Viana, s/n - Canela, BA, 40110-060, Brazil
| |
Collapse
|
5
|
Hou X, Xiong X, Li X, Bi J, Xu G, Wang Y, Jiang S. Predictive value of cardiac magnetic resonance mechanical parameters for myocardial fibrosis in hypertrophic cardiomyopathy with preserved left ventricular ejection fraction. Front Cardiovasc Med 2022; 9:1062258. [PMID: 36588558 PMCID: PMC9797817 DOI: 10.3389/fcvm.2022.1062258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Myocardial fibrosis leads to systolic dysfunction in hypertrophic cardiomyopathy (HCM) patients. This study aims to investigate the relationship between cardiac magnetic resonance mechanical parameters for evaluating the left ventricular function in HCM with preserved left ventricular ejection fraction (LVEF ≥50%) and the association between myocardial fibrosis defined by late gadolinium enhancement (LGE). Methods This study was a retrospective analysis of CMR images of 93 patients with HCM with preserved ejection fraction (HCMpEF) and 96 controls diagnosed by cardiac magnetic resonance (CMR) at our hospital from July 2019 to January 2022. The myocardial contraction fraction (MCF) was calculated, and myocardial mechanical parameters, including global myocardial longitudinal strain (GLS), circumferential strain (GLS), and myocardial strain (GLS), were obtained by tissue tracking and LGE quantitative modules of dedicated software, respectively. The correlation between myocardial strain and LGE was analyzed, and a multivariate logistic regression model was developed to discuss the risk predictors of LGE. Results Compared to the control group, the left ventricular mechanical parameters GLS (-13.90 ± 3.80% versus -18.20 ± 2.10%, p < 0.001), GCS (-16.62 ± 3.50% versus -18.4 ± 2.69%, p < 0.001), GRS (28.99 ± 10.38% versus 33.02 ± 6.25%, p < 0.01), and MCF (64 ± 16% versus 99 ± 18%, p < 0.001) were found significantly lower in HCM group. Moreover, even in LGE-negative HCM patients, GLS (-16.3 ± 3.9%) and MCF (78 ± 19%) were significantly lower compared to the control group. Left ventricular GLS [OR = 1.61, (1.29, 2.02), p = 0.001] and MCF [OR = 0.90, (0.86, 0.94), p = 0.001] independently predicted myocardial late gadolinium enhancement (LGE). Conclusion In participants of HCM with preserved ejection fraction, the early onset of reduced left ventricular GLS and MCF in patients with HCMpEF may provide new evidence for evaluating impaired myocardial systolic function. The reduction of myocardial mechanical indexes may reflect the presence and extent of myocardial fibrosis, and the more significant the reduction, the more severe the myocardial fibrosis; GLS and MCF may be ideal predictors for LGE.
Collapse
Affiliation(s)
- Xian Hou
- Department of Radiology, Quzhou Kecheng People’s Hospital, Quzhou, China
| | - Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xia Li
- Department of General Medicine, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People’s Hospital, Yancheng, China
| | - Jianhua Bi
- Department of Medical College, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Gaofeng Xu
- Department of Radiology, The First people’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China,*Correspondence: Yining Wang,
| | - Shu Jiang
- Department of Radiology, The First people’s Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China,Shu Jiang,
| |
Collapse
|
6
|
Zhu L, Wang Y, Zhao S, Lu M. Detection of myocardial fibrosis: Where we stand. Front Cardiovasc Med 2022; 9:926378. [PMID: 36247487 PMCID: PMC9557071 DOI: 10.3389/fcvm.2022.926378] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Myocardial fibrosis, resulting from the disturbance of extracellular matrix homeostasis in response to different insults, is a common and important pathological remodeling process that is associated with adverse clinical outcomes, including arrhythmia, heart failure, or even sudden cardiac death. Over the past decades, multiple non-invasive detection methods have been developed. Laboratory biomarkers can aid in both detection and risk stratification by reflecting cellular and even molecular changes in fibrotic processes, yet more evidence that validates their detection accuracy is still warranted. Different non-invasive imaging techniques have been demonstrated to not only detect myocardial fibrosis but also provide information on prognosis and management. Cardiovascular magnetic resonance (CMR) is considered as the gold standard imaging technique to non-invasively identify and quantify myocardial fibrosis with its natural ability for tissue characterization. This review summarizes the current understanding of the non-invasive detection methods of myocardial fibrosis, with the focus on different techniques and clinical applications of CMR.
Collapse
Affiliation(s)
- Leyi Zhu
- State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Yining Wang
- State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Minjie Lu
| |
Collapse
|