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Viola F, Bustamante M, Bolger A, Engvall J, Ebbers T. Diastolic function assessment with four-dimensional flow cardiovascular magnetic resonance using automatic deep learning E/A ratio analysis. J Cardiovasc Magn Reson 2024; 26:101042. [PMID: 38556134 PMCID: PMC11058894 DOI: 10.1016/j.jocmr.2024.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diastolic left ventricular (LV) dysfunction is a powerful contributor to the symptoms and prognosis of patients with heart failure. In patients with depressed LV systolic function, the E/A ratio, the ratio between the peak early (E) and the peak late (A) transmitral flow velocity, is the first step to defining the grade of diastolic dysfunction. Doppler echocardiography (echo) is the preferred imaging technique for diastolic function assessment, while cardiovascular magnetic resonance (CMR) is less established as a method. Previous four-dimensional (4D) Flow-based studies have looked at the E/A ratio proximal to the mitral valve, requiring manual interaction. In this study, we compare an automated, deep learning-based and two semi-automated approaches for 4D Flow CMR-based E/A ratio assessment to conventional, gold-standard echo-based methods. METHODS Ninety-seven subjects with chronic ischemic heart disease underwent a cardiac echo followed by CMR investigation. 4D Flow-based E/A ratio values were computed using three different approaches; two semi-automated, assessing the E/A ratio by measuring the inflow velocity (MVvel) and the inflow volume (MVflow) at the mitral valve plane, and one fully automated, creating a full LV segmentation using a deep learning-based method with which the E/A ratio could be assessed without constraint to the mitral plane (LVvel). RESULTS MVvel, MVflow, and LVvel E/A ratios were strongly associated with echocardiographically derived E/A ratio (R2 = 0.60, 0.58, 0.72). LVvel peak E and A showed moderate association to Echo peak E and A, while MVvel values were weakly associated. MVvel and MVflow EA ratios were very strongly associated with LVvel (R2 = 0.84, 0.86). MVvel peak E was moderately associated with LVvel, while peak A showed a strong association (R2 = 0.26, 0.57). CONCLUSION Peak E, peak A, and E/A ratio are integral to the assessment of diastolic dysfunction and may expand the utility of CMR studies in patients with cardiovascular disease. While underestimation of absolute peak E and A velocities was noted, the E/A ratio measured with all three 4D Flow methods was strongly associated with the gold standard Doppler echocardiography. The automatic, deep learning-based method performed best, with the most favorable runtime of ∼40 seconds. As both semi-automatic methods associated very strongly to LVvel, they could be employed as an alternative for estimation of E/A ratio.
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Affiliation(s)
- Federica Viola
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mariana Bustamante
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; deCODE Genetics/Amgen Inc., Reykjavik, Iceland
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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Wenzel JP, Kellen RBD, Magnussen C, Blankenberg S, Schrage B, Schnabel R, Nikorowitsch J. Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction. Clin Res Cardiol 2022; 111:416-427. [PMID: 34269862 PMCID: PMC8971165 DOI: 10.1007/s00392-021-01907-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/07/2021] [Indexed: 12/01/2022]
Abstract
AIM Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. METHODS AND RESULTS From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. CONCLUSION The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.
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Affiliation(s)
- Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- Epidemiological Study Center, Hamburg, Germany
| | | | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Epidemiological Study Center, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Renate Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Yeung DF, Jiang R, Behnami D, Jue J, Sharma R, Turaga M, Luong CL, Tsang MYC, Gin KG, Girgis H, Lee PK, Nair P, Abolmaesumi P, Tsang TSM. Impact of the updated diastolic function guidelines in the real world. Int J Cardiol 2020; 326:124-130. [PMID: 33137327 DOI: 10.1016/j.ijcard.2020.10.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Echocardiographic assessment of diastolic function is complex but can aid in the diagnosis of heart failure, particularly in patients with preserved ejection fraction. In 2016, the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) published an updated algorithm for the evaluation of diastolic function. The objective of our study was to assess its impact on diastolic function assessment in a real-world cohort of echo studies. METHODS We retrospectively identified 71,727 consecutive transthoracic echo studies performed at a tertiary care center between February 2010 and March 2016 in which diastolic function was reported based on the 2009 ASE Guidelines. We then programmed a software algorithm to assess diastolic function in these echo studies according to the 2016 ASE/EACVI Guidelines. RESULTS When diastolic function assessment based on the 2009 guidelines was compared to that using the 2016 guidelines, there were significant differences in proportion of studies classified as normal (23% vs. 32%) or indeterminate (43% vs. 36%) function, and mild (23% vs. 23%), moderate (10% vs. 8%), or severe (1% vs. 2%) diastolic dysfunction, with poor agreement between the two methods (Kappa 0.323, 95% CI 0.318-0.328). Furthermore, within the subgroup of studies with preserved ejection fraction and no evidence of myocardial disease, there was significant reclassification from mild diastolic dysfunction to normal diastolic function. CONCLUSION The updated guidelines result in significant differences in diastolic function interpretation in the real world. Our findings have important implications for the identification of patients with or at risk for heart failure.
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Affiliation(s)
- Darwin F Yeung
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - River Jiang
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Delaram Behnami
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
| | - John Jue
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Rajat Sharma
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Mansi Turaga
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Christina L Luong
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Michael Y C Tsang
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Kenneth G Gin
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Hany Girgis
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Pui-Kee Lee
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Parvathy Nair
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Purang Abolmaesumi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
| | - Teresa S M Tsang
- Division of Cardiology, University of British Columbia, Vancouver, Canada.
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Setti M, Benfari G, Mele D, Rossi A, Ballo P, Galderisi M, Henein M, Nistri S. Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms-A Primary Care Study. Diagnostics (Basel) 2020; 10:diagnostics10100850. [PMID: 33092136 PMCID: PMC7589762 DOI: 10.3390/diagnostics10100850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.
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Affiliation(s)
- Martina Setti
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Piercarlo Ballo
- Santa Maria Annunziata Hospital, Cardiology Unit, 50012 Florence, Italy;
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden;
| | - Stefano Nistri
- CMSR Veneto Medica-Cardiology Service, 36077 Altavilla Vicentina (VI), Italy
- Correspondence: ; Tel.: +39-0444225111
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Nistri S, Mazzone C, Cioffi G, Barbati G, Gentile P, Ballo P, Borca EC, Faganello G, Cherubini A, Bussani R, Sinagra G, Di Lenarda A. Tissue Doppler indices of diastolic function as prognosticator in patients without heart failure in primary care. J Cardiol 2020; 76:18-24. [PMID: 32094011 DOI: 10.1016/j.jjcc.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/28/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) indices of left ventricular (LV) diastolic function provide incremental prognostic information on mortality and morbidity in the general population and in several clinical scenarios. Their independent, additional role in outpatients with normal LV ejection fraction (LVEF) and without heart failure (HF) is undefined. METHODS We reviewed clinical and echocardiographic records of 2628 consecutive outpatients 52.8% male, median age 71 years) with LVEF > 50% without concurrent or prior HF, from the Cardiovascular Center of Trieste. We analyzed septal early mitral annular velocity (e') and its combination with mitral peak early filling velocity (E/e') in relation to the composite end-point of death and cardiovascular hospitalizations. RESULTS During follow-up of 26 months (interquartile range: 12-41), 392 (15%) patients experienced the endpoint (88 deaths). Increasing E/e' showed an overall association with the clinical end-point (log rank p < 0.02), but with no prognostic difference between the middle and upper tertile. Decreasing e' also showed an association with the end-point, with a more balanced stepwise risk increase for increasing tertiles (log rank p < 0.01 for all contrasts). At multivariable analysis, E/e' (either in tertiles or dichotomized according to the threshold of 15) was no longer associated with clinical outcome, whereas e' independently predicted the combined endpoint [hazard ratio 0.73 (0.53-0.94), p = 0.04]. The prognostic value of e' was incremental to that of other clinical and echocardiographic variables (p = 0.04). CONCLUSIONS In outpatients with normal LVEF and without HF, e' and E/e' are both associated with clinical end-points, though only e' is an independent and incremental predictor of outcome. These findings suggest a potential role for e' as a prognosticator, and spread a cautionary word about the utilization of septal E/e' alone as a surrogate for a comprehensive assessment of diastolic function in this context.
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Affiliation(s)
- Stefano Nistri
- CMSR Veneto Medica, Cardiology Service, Altavilla Vicentina, Italy.
| | - Carmine Mazzone
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giovanni Cioffi
- Villa Bianca Hospital, Department of Cardiology, Trento, Italy
| | - Giulia Barbati
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piero Gentile
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Piercarlo Ballo
- Santa Maria Annunziata Hospital, Cardiology Unit, Florence, Italy
| | | | - Giorgio Faganello
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | | | | | - Andrea Di Lenarda
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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Chetrit M, Cremer PC, Klein AL. Imaging of Diastolic Dysfunction in Community-Based Epidemiological Studies and Randomized Controlled Trials of HFpEF. JACC Cardiovasc Imaging 2020; 13:310-326. [DOI: 10.1016/j.jcmg.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
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Hasegawa T, Asakura M, Asanuma H, Amaki M, Takahama H, Sugano Y, Kanzaki H, Yasuda S, Anzai T, Izumi C, Kitakaze M. Difference in the prevalence of subclinical left ventricular impairment among left ventricular geometric pattern in a community-based population. J Cardiol 2019; 75:439-446. [PMID: 31813675 DOI: 10.1016/j.jjcc.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/27/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Left ventricular (LV) hypertrophy is reported to cause LV diastolic dysfunction. This study aimed to examine the prevalence of LV diastolic dysfunction in each group categorized by the geometric pattern of LV hypertrophy in a community-based population. METHODS We studied 1260 community-dwelling subjects who experienced no symptoms of obvious heart disease (461 men, 799 women) and who participated in annual health check-ups in a rural Japanese community. The subjects were divided into 4 groups according to LV mass index and relative wall thickness: normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. We investigated the prevalence of LV diastolic dysfunction in the overall and stratified population by LV geometric pattern. LV diastolic function was determined by 3 echocardiographic parameters of LV diastolic function: early diastolic myocardial velocity, the ratio of early diastolic mitral inflow velocity and myocardial velocity, and indexed left atrial dimension. LV diastolic dysfunction was defined as the presence of abnormal values in more than 2 of 3 echocardiographic parameters. RESULTS The prevalence of LV diastolic dysfunction was higher in the categories with more severe LV hypertrophy. However, LV mass index, rather than relative wall thickness, was a significant determinant of LV diastolic dysfunction, after adjustment for comorbidities. In addition, 71 (10%) out of 740 subjects with normal LV geometric pattern had LV diastolic dysfunction even without obvious LV geometric change. CONCLUSIONS The prevalence of LV diastolic dysfunction was higher in the subjects with more severe LV hypertrophy in a community-based population. Subclinical LV diastolic dysfunction without obvious LV geometric change should be noted and its clinical impact should be elucidated.
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Affiliation(s)
- Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Masanori Asakura
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Asanuma
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Suita, Japan
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Selmeryd J, Henriksen E, Dalen H, Hedberg P. Derivation and Evaluation of Age-Specific Multivariate Reference Regions to Aid in Identification of Abnormal Filling Patterns. JACC Cardiovasc Imaging 2018; 11:400-408. [DOI: 10.1016/j.jcmg.2017.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/01/2017] [Indexed: 11/27/2022]
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Farcaş AD, Anton FP, Goidescu CM, Gavrilă IL, Vida-Simiti LA, Stoia MA. Serum Soluble ST2 and Diastolic Dysfunction in Hypertensive Patients. Dis Markers 2017; 2017:2714095. [PMID: 28566800 DOI: 10.1155/2017/2714095] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Abstract
Background Echocardiographic evaluation of left ventricular (LV) structural and functional alterations in hypertension has some limitations, potentially overcome by using biomarkers. ST2, a prognostic biomarker for heart failure and myocardial infarction patients, was less studied in hypertension. Aim To analyze the relationship between serum ST2 levels and diastolic dysfunction (DD) in hypertension. Method We enrolled 88 hypertensive outpatients (average age 65 years, 69.3% females) in a prospective study, stratified for presence of LV hypertrophy (LVH). For each patient clinical examination, lab workup (routine and serum ST2 levels) and echocardiography were performed. Results Hypertensive patients with LVH had higher age, pulse pressure, mean arterial pressure, and serum ST2, while having lower serum albumin than those without LVH. Serum ST2 levels correlate with parameters of LV remodeling and DD. We found that 5.3% of ST2 level variability was caused by a 1-unit variation of cardiovascular risk. We identified cut-off values for discriminating hypertension with LVH versus that without LVH and grade 2 DD versus normal diastolic performance. Conclusion ST2 could be used as diagnostic biomarker for cardiac remodeling and altered diastolic performance in hypertension, providing additional data to echocardiography. It could represent a milestone in early detection of cardiac performance alteration.
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Ballo P, Nistri S, Mele D, Henein MY. Simplified vs comprehensive echocardiographic grading of left ventricular diastolic dysfunction in primary care. Int J Cardiol 2016; 214:243-5. [DOI: 10.1016/j.ijcard.2016.03.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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