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Yang Z, Tao J, Fan X, Feng Z, Liu Z. Comparison of clinical outcomes between transthoracic echocardiography- and X-ray-guided left bundle branch pacing for bradycardia: A randomized controlled trial. J Cardiovasc Electrophysiol 2024; 35:875-882. [PMID: 38424662 DOI: 10.1111/jce.16212] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Left bundle branch pacing (LBBP) is a physiological pacing modality. However, the long procedure and fluoroscopy time of LBBP is still a problem. This study aims to compare the clinical outcomes between transthoracic echocardiography (TTE)- and X-ray-guided LBBP. METHODS This is a single-center, prospective, randomized controlled study. Consecutive patients who underwent LBBP in our team from June 2022 to November 2022 were enrolled. Procedure and fluoroscopy time, pacing parameters, electrophysiological and echocardiographic characteristics, as well as complications were recorded at implantation and during follow-up. RESULTS In this study, 60 patients were enrolled and divided into two groups: 30 patients were allocated to the X-ray group and the remaining 30 to the TTE group. There was no significant difference in the success rate between the two groups (86.7% vs. 76.7%, p = .317). The procedure time of TTE group was comparable to that of the X-ray group (9.0 vs. 12.0 min, p = .063). However, the fluoroscopy time in the TTE group was significantly lower than that of the X-ray group (2.5 vs. 5.0 min, p = .002). There were no statistically significant differences in pacing parameters, electrophysiological and echocardiographic characteristics, or complications between the two groups at implantation and during follow-up. CONCLUSION TTE-guided LBBP is a feasible and safe method. Compared with X-ray, TTE showed a comparable success rate and procedure time, but it could significantly reduce the fluoroscopy time of LBBP.
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Affiliation(s)
- Zhihan Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Tao
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuoxi Feng
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Takiishi A, Baba Y, Ochi Y, Hotta M, Okazaki N, Yoshinaga Y, Miyamoto S, Hirakawa D, Kawaguchi J, Kubo T, Yamasaki N, Tokuhiro S, Kitaoka H. Clinical features of quadricuspid aortic valve in middle-aged and elderly patients: Insights from a regional study. Echocardiography 2024; 41:e15817. [PMID: 38648213 DOI: 10.1111/echo.15817] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Quadricuspid aortic valve (QAV) is a rare congenital disease. The clinical characteristics of this disease remain unclear except for those in relatively young patients reported from tertiary referral hospitals. The aim of this study was to determine the clinical features of QAV in a regional population. METHODS AND RESULTS We retrospectively investigated 25 340 consecutive patients over middle age (median age, 73 (IQR 65-80) years; range, 45-102 years) who underwent transthoracic echocardiography (TTE) at our institute during the period from April 2008 to December 2023. Eight (0.032%) of the patients (median age, 65 years; range, 47-91 years) were diagnosed with QAV. Six patients suffered from aortic regurgitation (AR), and one patient had mild aortic stenosis at the time of QAV diagnosis. Two patients who had severe AR at referral underwent aortic valve surgery. The severity of AR in the other patients was moderate or less. During a median follow-up period of 27 months (range, 1-171 months), none of the patients other than above two patients had cardiac events. One patient died from a non-cardiac cause at 94 years of age. CONCLUSIONS Patients diagnosed with QAV after middle age, who do not exhibit severe valve insufficiency at the time of diagnosis, may not experience worse clinical outcomes. However, further research is required for a better understanding of the long-term outcomes.
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Affiliation(s)
- Azumi Takiishi
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Mizuki Hotta
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Nagisa Okazaki
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Yuna Yoshinaga
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Shohei Miyamoto
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Daigo Hirakawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Juri Kawaguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Shinji Tokuhiro
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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Shiokawa N, Izumo M, Shimamura T, Kurosaka Y, Sato Y, Okamura T, Akashi YJ. Accuracy and Efficacy of Artificial Intelligence-Derived Automatic Measurements of Transthoracic Echocardiography in Routine Clinical Practice. J Clin Med 2024; 13:1861. [PMID: 38610628 PMCID: PMC11012797 DOI: 10.3390/jcm13071861] [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: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Transthoracic echocardiography (TTE) is the gold standard modality for evaluating cardiac morphology, function, and hemodynamics in clinical practice. While artificial intelligence (AI) is expected to contribute to improved accuracy and is being applied clinically, its impact on daily clinical practice has not been fully evaluated. Methods: We retrospectively examined 30 consecutive patients who underwent AI-equipped TTE at a single institution. All patients underwent manual and automatic measurements of TTE parameters using the AI-equipped TTE. Measurements were performed by three sonographers with varying experience levels: beginner, intermediate, and expert. Results: A comparison between the manual and automatic measurements assessed by the experts showed extremely high agreement in the left ventricular (LV) filling velocities (E wave: r = 0.998, A wave: r = 0.996; both p < 0.001). The automated measurements of LV end-diastolic and end-systolic diameters were slightly smaller (-2.41 mm and -1.19 mm) than the manual measurements, although without significant differences, and both methods showing high agreement (r = 0.942 and 0.977, both p < 0.001). However, LV wall thickness showed low agreement between the automated and manual measurements (septum: r = 0.670, posterior: r = 0.561; both p < 0.01), with automated measurements tending to be larger. Regarding interobserver variabilities, statistically significant agreement was observed among the measurements of expert, intermediate, and beginner sonographers for all the measurements. In terms of measurement time, automatic measurement significantly reduced measurement time compared to manual measurement (p < 0.001). Conclusions: This preliminary study confirms the accuracy and efficacy of AI-equipped TTE in routine clinical practice. A multicenter study with a larger sample size is warranted.
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Affiliation(s)
- Noriko Shiokawa
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (Y.S.); (Y.J.A.)
| | - Toshio Shimamura
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Yui Kurosaka
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (Y.S.); (Y.J.A.)
| | - Takanori Okamura
- Ultrasound Center, St. Marianna University Hospital, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (N.S.); (T.S.); (Y.K.); (T.O.)
| | - Yoshihiro Johnny Akashi
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan; (Y.S.); (Y.J.A.)
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Okoh AK, Amponsah MKD, Cheffet-Walsh S, Patel M, Carfagno D, Linton D, Dimeff R, Braunreiter D, Harrington P, Brennan FH, Kavinsky C, Everett M, Park B, Gunnarsson M, Snowden S, Mootz L, Koepnick T, Wheeler J, Clarke SE, Prince H, Sannino A, Grayburn P, Rice EL. Prevalence of Cardiovascular Disease and Risk Factors among National Football League Alumni and Family Members. J Am Coll Cardiol 2024:S0735-1097(24)00988-4. [PMID: 38593943 DOI: 10.1016/j.jacc.2024.03.371] [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: 02/20/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited. OBJECTIVE The HUDDLE trial aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events. METHODS HUDDLE was a multi-city, cross-sectional study of NFL alumni and family members aged 50 years and above. Subjects reported their health history and participated in CVD education and screening (blood pressure [BP], electrocardiogram [EKG], and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30-days post-screening to review results and recommendations. This analysis focuses on former NFL athletes. RESULTS Of 498 participants screened, 57.2% (N=285) were former NFL players, majority of which were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that HTN was a significant predictor of clinically-relevant structural abnormalities on TTE. CONCLUSION The HUDDLE trial identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by HTN, affirming the role of TTE for CVD screening in this over 50 population.
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Affiliation(s)
| | | | | | - Mehul Patel
- Methodist LeBonheur Healthcare / Sutherland Cardiology Clinic, Germantown, TN
| | | | | | | | | | | | - Fred H Brennan
- BayCare Health System / University of South Florida / Turley Family Health Center, Clearwater, FL
| | | | | | | | | | | | | | | | | | | | | | - Anna Sannino
- Baylor Scott & White Research Institute, Dallas, TX
| | | | - E Lee Rice
- San Diego Sports Medicine & Family Health Center / Lifewellness Institute, San Diego, CA.
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Gerhardy B, Sivapathan S, Bowcock E, Orde S, Morgan L. Right Ventricular Dysfunction on Transthoracic Echocardiography and Long-Term Mortality in the Critically Unwell: A Systematic Review and Meta-Analysis. J Intensive Care Med 2024; 39:203-216. [PMID: 38056074 DOI: 10.1177/08850666231218713] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Right ventricular dysfunction (RVD) is common in the critically ill. To date studies exploring RVD sequelae have had heterogenous definitions and diagnostic methods, with limited follow-up. Additionally much literature has been pathology specific, limiting applicability to the general critically unwell patient. METHOD AND STUDY DESIGN We conducted a systematic review and meta-analysis to evaluate the impact of RVD diagnosed with transthoracic echocardiography (TTE) on long-term mortality in unselected critically unwell patients compared to those without RVD. A systematic search of EMBASE, Medline and Cochrane was performed from inception to March 2022. All RVD definitions using TTE were included. Patients were those admitted to a critical or intensive care unit, irrespective of disease processes. Long-term mortality was defined as all-cause mortality occurring at least 30 days after hospital admission. A priori subgroup analyses included disease specific and delayed mortality (death after hospital discharge/after the 30th day from hospital admission) in patients with RVD. A random effects model analysis was performed with the Dersimionian and Laird inverse variance method to generate effect estimates. RESULTS Of 5985 studies, 123 underwent full text review with 16 included (n = 3196). 1258 patients had RVD. 19 unique RVD criteria were identified. The odds ratio (OR) for long term mortality with RVD was 2.92 (95% CI 1.92-4.54, I2 76.4%) compared to no RVD. The direction and extent was similar for cardiac and COVID19 subgroups. Isolated RVD showed an increased risk of delayed mortality when compared to isolated left/biventricular dysfunction (OR 2.01, 95% CI 1.05-3.86, I2 46.8%). CONCLUSION RVD, irrespective of cause, is associated with increased long term mortality in the critically ill. Future studies should be aimed at understanding the pathophysiological mechanisms by which this occurs. Commonly used echocardiographic definitions of RVD show significant heterogeneity across studies, which contributes to uncertainty within this dataset.
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Affiliation(s)
- Benjamin Gerhardy
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Shanthosh Sivapathan
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Emma Bowcock
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Sam Orde
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Lucy Morgan
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Department of Respiratory Medicine, Concord Repatriation Hospital, Concord, NSW, Australia
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Ho YJ, Sung CW, Chen YC, Lien WC, Chang WT, Huang CH. Performance of Intra-arrest Echocardiography: A Systematic Review. West J Emerg Med 2024; 25:166-174. [PMID: 38596913 PMCID: PMC11000560 DOI: 10.5811/westjem.18440] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Intra-arrest transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been introduced in adult patients with cardiac arrest (CA). Whether the diagnostic performance of TTE or TEE is superior during resuscitation is unclear. We conducted a systematic review following PRISMA guidelines. Methods We searched databases from PubMed, Embase, and Google Scholar and evaluated articles with intra-arrest TTE and TEE in adult patients with non-traumatic CA. Two authors independently screened and selected articles for inclusion; they then dual-extracted study characteristics and target conditions (pericardial effusion, aortic dissection, pulmonary embolism, myocardial infarction, hypovolemia, left ventricular dysfunction, and sonographic cardiac activity). We performed quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Version 2 criteria. Results A total of 27 studies were included: 14 studies with 2,145 patients assessed TTE; and 16 with 556 patients assessed TEE. A high risk of bias or applicability concerns in at least one domain was present in 20 studies (74%). Both TTE and TEE found positive findings in nearly one-half of the patients. The etiology of CA was identified in 13% (271/2,145), and intervention was performed in 38% (102/271) of patients in the TTE group. In patients who received TEE, the etiology was identified in 43% (239/556), and intervention was performed in 28% (68/239). In the TEE group, a higher incidence regarding the etiology of CA was observed, particularly for those with aortic dissection. However, the outcome of those with aortic dissection in the TEE group was poor. Conclusion While TEE could identify more causes of CA than TTE, sonographic cardiac activity was reported much more in the TTE group. The impact of TTE and TEE on the return of spontaneous circulation and further survival was still inconclusive in the current dataset.
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Affiliation(s)
- Yi-Ju Ho
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Chih-Wei Sung
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University Hsin-Chu Hospital, Department of Emergency Medicine, Hsinchu, Taiwan
| | - Yi-Chu Chen
- National Taiwan University, Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan
| | - Wan-Ching Lien
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Wei-Tien Chang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
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Veillette S, Beaudouin J, Couture EJ. A Case of Abnormal Right Ventricular Color-Flow Doppler Jet. J Cardiothorac Vasc Anesth 2024; 38:843-847. [PMID: 37953175 DOI: 10.1053/j.jvca.2023.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Transthoracic echocardiography is used routinely during the follow-up after heart transplant surgery to screen possible complications and adverse events such as rejection. It often results in incidental findings that bring diagnostic challenges for sonographers. This E-challenge shows a Doppler flow abnormality associated with a rare cardiovascular diagnosis. Its physiopathology and its association with echocardiography findings are reviewed.
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Affiliation(s)
- Simon Veillette
- Department of Anesthesiology and Intensive Care Medicine, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jonathan Beaudouin
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Etienne J Couture
- Department of Anesthesiology and Intensive Care Medicine, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Deng X, Zhou J, Diao M, Li H, Lin X. Effects of different fractions of inspired oxygen on gas embolization during hysteroscopic surgery: A double-blind, randomized, controlled trial. Int J Gynaecol Obstet 2024; 164:1101-1107. [PMID: 37789807 DOI: 10.1002/ijgo.15159] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Gas embolism is a common complication of hysteroscopic surgery that causes serious concern among gynecologists and anesthesiologists due to the potential risk to patients. The factors influencing gas embolism in hysteroscopic surgery have been extensively studied. However, the effect of the oxygen concentration inhaled by patients on gas embolism during hysteroscopic surgery remains elusive. Therefore, we designed a double-blind, randomized, controlled trial to determine whether different inhaled oxygen concentrations influence the occurrence of gas embolism during hysteroscopic surgery. METHODS This trial enrolled 162 adult patients undergoing elective hysteroscopic surgery who were randomly divided into three groups with inspired oxygen fractions of 30%, 50%, and 100%. Transthoracic echocardiography (four-chamber view) was used to evaluate whether gas embolism occurred. Before the start of surgery, the four-chamber view was continuously monitored. RESULTS The number of gas embolisms in the 30%, 50%, and 100% groups was 36 (69.2%), 30 (55.6%), and 24 (44.4%), respectively. The incidence of gas embolism gradually decreased with increasing inhaled oxygen concentration (P = 0.031). CONCLUSION In hysteroscopic surgery, a higher oxygen concentration inhaled by patients may reduce the incidence of gas embolism, indicating that a higher inhaled oxygen concentration, especially 100%, could be recommended for patients during hysteroscopic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=53779, Registration number: ChiCTR2000033202).
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Affiliation(s)
- Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Jieshu Zhou
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Min Diao
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Hao Li
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Xuemei Lin
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
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Ku L, Lv H, Ma X. A rare congenital anomaly: unicuspid unicommissural aortic valve associated with stenosis and ascending aorta dilatation. Acta Cardiol 2024:1-2. [PMID: 38357962 DOI: 10.1080/00015385.2024.2313936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Leizhi Ku
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, PR China
| | - Hang Lv
- Department of Cardiac Function, Wuhan Asia General Hospital, Wuhan, PR China
| | - Xiaojing Ma
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, PR China
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10
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Lamichhane B, Lamichhane S, Paudel K, Pokhrel NB, Dhital S, Acharya SK. Culture-negative endocarditis with multifocal spread and flail mitral valve leaflet: a case report. Ann Med Surg (Lond) 2024; 86:1161-1165. [PMID: 38333264 PMCID: PMC10849347 DOI: 10.1097/ms9.0000000000001638] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Blood culture-negative infective endocarditis is the condition in which a causative organism cannot be identified after inoculation of at least three samples using standard blood-culture systems for 7 days. It has a low reported incidence of about 2.5-31%. Causes may be infectious or non-infectious; use of prior antibiotic therapy is usually the leading factor. Case presentation The authors present a case of true culture-negative endocarditis involving the mitral valve, with multiple foci of spread including brain, spleen, liver, and Intervertebral disc, which remained persistent despite treatment with intravenous broad-spectrum antibiotics on an inpatient and outpatient basis but eventually improved after upgrading alternative broad-spectrum antibiotic for an extended duration. The patient had complications in the form of a flail mitral valve with persistent mitral regurgitation, requiring mitra-clip placement. Discussion Positive blood culture is one of the major diagnostic criteria to establish infective endocarditis. Patients may have persistent negative cultures due to previous antibiotic use, the presence of fastidious organisms, or the use of inappropriate techniques or media. Involvement of a multidisciplinary team, use of multimodal investigations, and appropriate antibiotic stewardship are crucial. Extended duration of treatment and upgrading antibiotics can be helpful next steps in highly suspicious cases. With multifocal spread as in our case, it further becomes challenging to control and treat the infection as it is frequently connected with higher morbidity and mortality. Conclusion Blood culture-negative endocarditis is an entity that can present with early complications. It is diagnostically and therapeutically challenging to treat such patients. Multimodal approaches for early diagnosis and appropriate treatment are crucial owing to its high morbidity and mortality.
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Affiliation(s)
| | | | | | - Nishan B. Pokhrel
- Internal Medicine, Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Sandhya Dhital
- Internal Medicine, Kern Medical Center/Ross University School of Medicine, Castro Valley, FL
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11
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Polat F, Kaya Z, Yaylak B, Onuk T. Comparison of echocardiographic and clinical characteristics in embolic stroke and migraine patients with patent foramen ovale. Echocardiography 2024; 41:e15770. [PMID: 38379240 DOI: 10.1111/echo.15770] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND This single-center observational study aimed to compare the echocardiographic and clinical features in patients diagnosed with migraine and embolic stroke of undetermined source (ESUS) who presented with a known patent foramen ovale (PFO). METHODS Two-dimensional and color Doppler images were obtained using various transthoracic echocardiography views for both migraine and ESUS patients. Suspected PFO cases underwent further assessment through contrast echocardiography and transesophageal echocardiography (TEE). High-risk PFO characteristics were evaluated using TEE, and the Risk of Paradoxical Embolism (RoPe) score was calculated. RESULTS The study included 310 participants (age range: 18-60, 73.2% female), with 43.5% diagnosed with migraine and 56.5% with ESUS. Common comorbidities included diabetes (26.1%). High-velocity shunting through the interatrial septum was observed in 35.5% of patients. ESUS patients were older, with higher rates of diabetes and hypertension, while active smoking was more prevalent among migraine patients. Basic echocardiographic parameters were mostly similar, except for elevated pulmonary artery systolic pressure in ESUS. ESUS patients exhibited a greater occurrence of large microbubble passage through the interatrial septum and longer PFO lengths compared to migraine patients. However, the RoPe and High-risk PFO scores were similar between the groups. CONCLUSIONS ESUS patients, characterized by older age and higher rates of diabetes and hypertension, demonstrated increased pulmonary artery pressure, more significant microbubble crossings, and longer PFO lengths. Conversely, migraine patients had a higher prevalence of active smoking. Despite differing clinical profiles, the risk scores for PFO-related embolic events were comparable between the groups. These findings underscore potential distinctions between ESUS and migraine patients with PFO and their implications for management strategies.
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Affiliation(s)
- Fuat Polat
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, İstanbul, Turkey
| | - Zeynettin Kaya
- Department of Cardiology, Antalya ASV Yaşam Hospital, Antalya, Turkey
| | - Barış Yaylak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, İstanbul, Turkey
| | - Tolga Onuk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, İstanbul, Turkey
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12
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Godart F, Houeijeh A. PFO closure: How to simplify? Arch Cardiovasc Dis 2024; 117:167-168. [PMID: 38233309 DOI: 10.1016/j.acvd.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024]
Affiliation(s)
- François Godart
- Lille University Hospital Heart and Lung Institute, boulevard Pr.-Leclercq, 59037 Lille, France.
| | - Ali Houeijeh
- Institut Cœur Poumon, CHRU of Lille, Lille, France
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13
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Khanna S, Li C, Amarasekera AT, Bhat A, Chen HHL, Gan GCH, Tan TC. Echocardiographic parameters of cardiac structure and function in the diagnosis of acute myocarditis in adult patients: A systematic review and meta-analysis. Echocardiography 2024; 41:e15760. [PMID: 38345413 DOI: 10.1111/echo.15760] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) plays a key role in the initial work-up of myocarditis where the identification of pathologic structural and functional changes may assist in its diagnosis and management. The aim of this systematic review was to appraise the evidence for the utility of echocardiographic parameters of cardiac structure and function in the diagnosis of myocarditis in adult populations. METHODS A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing TTE parameters in adult patients with myocarditis (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of structural and functional TTE parameters were individually extracted and those with low heterogeneity were then meta-analyzed using a random-effects model for effect size, and assessed through standardized mean difference (SMD). RESULTS Available data from six studies (with a pooled total of 269 myocarditis patients and 240 controls) revealed that myocarditis can be reliably differentiated from healthy controls using echocardiographic measures of left ventricular (LV) size and systolic function, in particular LV end-diastolic diameter, LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) (p ≤ .01 for all). LV-GLS demonstrated the highest overall effect size, followed by LVEF and LVEDD (SMD: |0.46-1.98|). Two studies also demonstrated that impairment in LV-GLS was associated with adverse cardiovascular outcomes in this population, irrespective of LVEF. CONCLUSIONS LV-GLS demonstrated the greatest overall effect size and therefore ability to differentiate myocarditis populations from healthy controls. GLS was also shown to be a predictor of adverse cardiovascular outcomes, in this population. HIGHTLIGHTS What is already known on this subject? Myocarditis is a disease process that is often a diagnosis of exclusion, as it frequently mimics other acute cardiac pathologies. Transthoracic echocardiography is traditionally the initial imaging modality used for noninvasive structural assessment in populations with myocarditis. What might this study add? This study demonstrates that left ventricular (LV) global longitudinal strain, LV ejection fraction and LV end-diastolic diameter can differentiate between myocarditis patients and healthy controls. LV-GLS demonstrated the greatest overall effect size when comparing these two populations, in comparison to the other measures. How might this impact on clinical practice? This study demonstrates that assessment of myocardial deformation indices allows for sensitive discrimination between myocarditis patients from healthy controls. Routine assessment of LV-GLS may serve as an important diagnostic tool in the acute care setting.
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Affiliation(s)
- Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Cindy Li
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Anjalee T Amarasekera
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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14
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Ibrahim IA, Howladar MT, Alsaery TS, Anwar A, Ahmad W. Simultaneous Identification of Unroofed Coronary Sinus Atrial Septal Defect and Atrial Septal Defect Secundum Using Cardiac Computed Tomography Angiography. Cureus 2024; 16:e52575. [PMID: 38370993 PMCID: PMC10874617 DOI: 10.7759/cureus.52575] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Unroofed coronary sinus (UCS) represents a rare subtype of atrial septal defect (ASD), an adult congenital heart disease characterized by communication between the systemic and pulmonary circulations at the atrial level. This case report presents the unique occurrence of a large, unrepaired ASD secundum and an incidentally identified UCS type II in a 25-year-old female during a cardiac murmur assessment. The diagnosis of ASD secundum was initially made using transthoracic echocardiography (TTE) and was later confirmed with a transesophageal echocardiogram. The identification of the UCS was achieved through the utilization of cardiac computed tomography angiography (CCTA). Ultimately, the patient underwent a successful reroofing procedure using a bovine pericardial patch.
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Affiliation(s)
- Islam A Ibrahim
- Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, SAU
| | | | | | - Ashraf Anwar
- Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, SAU
| | - Waqar Ahmad
- Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, SAU
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15
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Askar M, Karaduman M, Coldur R, Askar S. Relationship of right ventricular functions with in-hospital and 1 year later mortality in patients hospitalized for COVID-19 pneumonia. Ann Thorac Med 2024; 19:96-104. [PMID: 38444992 PMCID: PMC10911235 DOI: 10.4103/atm.atm_172_23] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The aim of this study was to determine the association of right ventricular function with in-hospital mortality and mortality 1 year after discharge in patients hospitalized for COVID-19 pneumonia. METHODS The study was conducted in Van Yuzuncu Yil University Faculty of Medicine hospital between February 10, 2021 and August 10, 2022. A total of 156 patients hospitalized in intensive care and wards due to COVID-19 pneumonia were included in this study. Echocardiography was performed in all patients. RESULTS Among the demographic findings of the patients included in the study, male gender, patients hospitalized in the intensive care unit (ICU), patients receiving O2 support, and smokers were found to have higher mortality rates during hospitalization. At the end of 1 year, the mortality rate was higher in patients who were hospitalized in the ICU received O2 support and had diabetes mellitus. Among echocardiographic findings, those with a low left ventricular ejection fraction had higher early and 1-year mortality rates. Of the right ventricular functions, low fractional area change, high systolic pulmonary artery pressure (SPAP), shortened pulmonary acceleration time, low right ventricle systolic wave S' velocity, increased right atrium area, and inferior vena cava diameter were found to be associated with high mortality. Increased right atrial area and inferior vena cava diameter, increased SPAP, and shortened pulmonary acceleration time were found to be significant in 1-year mortality. The presence of pericardial effusion was associated with mortality during hospitalization but not with 1-year mortality. B-type natriuretic peptide, D-dimer, and hemoglobin levels were significantly correlated with both hospital mortality and 1-year mortality. CONCLUSIONS In the follow-up of COVID-19 pneumonia, right ventricular function is considered to be an important factor in early and late mortality. It could be helpful to establish a follow-up program for discharged patients from the parameters involved in mortality.
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Affiliation(s)
- Muntecep Askar
- Department of Cardiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Medeni Karaduman
- Department of Cardiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Rabia Coldur
- Department of Cardiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Selvi Askar
- Department of Chest Diseases, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
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16
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Ogugua FM, Mathew RO, Ternacle J, Rodin H, Pibarot P, Shroff GR. Impact of arteriovenous fistula on flow states in the evaluation of aortic stenosis among ESKD patients on dialysis. Echocardiography 2024; 41:e15728. [PMID: 38113338 DOI: 10.1111/echo.15728] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/20/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION An arteriovenous fistula (AVF) in patients with end-stage kidney disease (ESKD) can influence flow states. We sought to evaluate if assessment of aortic stenosis (AS) by transthoracic echocardiographic (TTE) differs in the presence of AVF compared to other dialysis accesses in patients on dialysis. METHODS We identified consecutive ESKD patients on dialysis and concomitant AS from a single center between January 2000 and March 2021. We analyzed TTE parameters of AS severity (velocities, gradients, aortic valve area [AVA]) and hemodynamics (cardiac output [CO], valvuloarterial impedance [Zva]) and compared AS parameters in patients with AVF versus other dialysis access. RESULTS The cohort included 94 patients with co-prevalent ESKD and AS; mean age 66 years, 71% male; 43% Black, 24% severe AS. Dialysis access: 53% AVF, 47% others. In the overall cohort, no significant differences were noted between AVF versus non-AVF in AVA/CO/Zva, but with notable subgroup differences. In mild AS, CO was significantly higher in AVF versus non-AVF (6.3 vs. 5.2 L/min; p = .04). In severe AS, Zva was higher in the AVF versus non-AVF (4.6 vs. 3.6 mm Hg/mL/m2 ). With increasing AS severity in the AVF group, CO decreased, coupled with increase in Zva, likely counterbalancing the net hemodynamic impact of the AVF. CONCLUSION Among ESKD patients with AS, TTE parameters of flow states and AS severity differed in those with AVF versus other dialysis accesses and varied with progression in severity of AS. Future longitudinal assessment of hemodynamic parameters in a larger cohort of co-prevalent ESRD and AS would be valuable.
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Affiliation(s)
- Fredrick M Ogugua
- Division of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Roy O Mathew
- Division of Cardiology, Loma Linda VA Health Care System, Loma Linda, California, USA
| | - Julien Ternacle
- Division of Cardiology, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
- Division of Cardiology, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Holly Rodin
- Division of Biostatistics, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Philippe Pibarot
- Division of Cardiology, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Gautam R Shroff
- Division of Biostatistics, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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17
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Grotberg JC, McDonald RK, Co IN. Point-of-Care Echocardiography in the Difficult-to-Image Patient in the ICU: A Narrative Review. Crit Care Explor 2024; 6:e1035. [PMID: 38222871 PMCID: PMC10786596 DOI: 10.1097/cce.0000000000001035] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES The objective of this narrative review was to address common obstacles encountered in the ICU to acquiring quality and interpretable images using point-of-care echocardiography. DATA SOURCES Detailed searches were performed using PubMed and Ovid Medline using medical subject headings and keywords on topics related to patient positioning, IV echo contrast, alternative subcostal views, right ventricular outflow tract (RVOT) hemodynamics, and point-of-care transesophageal echocardiography. Articles known to the authors were also selected based on expert opinion. STUDY SELECTION Articles specific to patient positioning, IV echo contrast, alternative subcostal views, RVOT hemodynamics, and point-of-care transesophageal echocardiography were considered. DATA EXTRACTION One author screened titles and extracted relevant data while two separate authors independently reviewed selected articles. DATA SYNTHESIS Impediments to acquiring quality and interpretable images in critically ill patients are common. Notably, body habitus, intra-abdominal hypertension, dressings or drainage tubes, postoperative sternotomies, invasive mechanical ventilation, and the presence of subcutaneous emphysema or lung hyperinflation are commonly encountered obstacles in transthoracic image acquisition in the ICU. Despite these obstacles, the bedside clinician may use obstacle-specific maneuvers to enhance image acquisition. These may include altering patient positioning, respiratory cycle timing, expanding the subcostal window to include multilevel short-axis views for use in the assessment of RV systolic function and hemodynamics, coronal transhepatic view of the inferior vena cava, and finally point-of-care transesophageal echocardiography. CONCLUSIONS Despite common obstacles to point-of-care echocardiography in critically ill patients, the beside sonographer may take an obstacle-specific stepwise approach to enhance image acquisition in difficult-to-image patients.
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Affiliation(s)
- John C Grotberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Rachel K McDonald
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Ivan N Co
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
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18
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Kandels J, Metze M, Hagendorff A, Stöbe S. Prognostic Relevance of Global Myocardial Work Index in Patients with Moderate Aortic Valve Stenosis. J Clin Med 2023; 12:7694. [PMID: 38137763 PMCID: PMC10743712 DOI: 10.3390/jcm12247694] [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: 10/18/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was to evaluate the prognostic value of the GWI in patients with moderate AS. METHODS AND RESULTS In this prospective study, 103 patients with moderate AS (mean age 72 ± 10 years; male: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without an aortic valve replacement (AVR). After a median follow-up of 30 ± 5 months, 37 patients (36%) were referred for an AVR. Survival without an AVR was 96% at 12 months and 80% at 30 months (>1951 mmHg%) versus 96% and 68% (≤1951 mmHg%). A GWI ≤ 1951 mmHg% did not predict the need for an AVR (hazard ratio 1.31 (95% CI, 0.63-2.72), p = 0.49). Furthermore, there was no significant correlation between the mean GWI (1644 ± 448 mmHg%) and mean aortic valve pressure gradient (24.2 mmHg ± 6.2, p = 0.615) or effective aortic orifice area (1.24 cm2 ± 0.11, p = 0.678). There was no difference between the AVR and non-AVR groups in the occurrence of clinical symptoms. CONCLUSION In contrast to patients with severe AS, a GWI ≤ 1951 mmHg% did not predict the need for an AVR. Further research is needed to improve the risk stratification in patients with moderate AS.
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Affiliation(s)
- Joscha Kandels
- Correspondence: ; Tel.: +49-341-97-12389; Fax: +49-341-97-12659
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19
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Zhang M, Liu HL, Li WH, Li MZ. The value of transthoracic echocardiography and chest X-ray in locating the tip of central venous catheter in dialysis patients: a comparative study with computed tomography imaging. Ren Fail 2023; 45:2290179. [PMID: 38059492 PMCID: PMC11001318 DOI: 10.1080/0886022x.2023.2290179] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
To determine the tip position of the central venous catheter (CVC) in patients with dialysis, the guidelines recommend that it be determined using chest radiography (CXR) after catheterization, without fluoroscopy. However, some researchers have proposed that transthoracic echocardiography (TTE) can replace CXR, but this has not been widely adopted. This study aimed to determine which of the two aforementioned methods is more suitable for locating the tip position of the CVC. This prospective study included 160 patients who underwent hemodialysis at our hospital from March 2021 to December 2022. After inserting the CVC through the internal jugular vein, we used transthoracic echocardiography and CXR to determine the tip of the CVC and compared the results with those of computed tomography (CT). In the comparison between TTE and CXR for locating the CVC tip, we obtained three main findings. (1) TTE was associated with fewer misdiagnosed cases than CXR. (2) TTE provided higher sensitivity (similar sensitivity in position 2), specificity, positive/negative predictive values, and accuracy than CXR. (3) When comparing the receiver operating characteristic curves of TTE and CXR, the area under the curve (95% confidence interval) for the former was larger. Additionally, we made anatomical discoveries: the "hyperechoic triangle" recognized by TTE was equivalent to the entrance of the superior vena cava into the right atrium shown by transesophageal transthoracic echocardiography. TTE is more suitable than CXR as the first examination for CVC tip localization, as it improves diagnostic accuracy and reduces X-ray radiation damage.
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Affiliation(s)
- Meng Zhang
- Graduate School of Chengde Medical College, Hebei Province, China
| | - Hui-Ling Liu
- Headquarters Department of Ultrasound, Affiliated Hospital of Chengde Medical College, Hebei Province, China
| | - Wei-Hong Li
- Headquarters Department of Ultrasound, Affiliated Hospital of Chengde Medical College, Hebei Province, China
| | - Mu-Zi Li
- Physical Examination Department, Chengde Shuangluan District People’s Hospital, Hebei Province, China
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Kurt D, Yılmaz E, Çamcı S, Aydın E, Çelik Ş. Incidence and Predictors of Left Ventricular Thrombus Formation After Acute Myocardial Infarction With ST-Segment Elevation. Cureus 2023; 15:e50495. [PMID: 38222227 PMCID: PMC10787315 DOI: 10.7759/cureus.50495] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Background and objective Our prospective study aimed to evaluate the frequency and risk factors of left ventricular thrombus (LVT) occurring after acute ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PCI). Methods Our study included 131 patients diagnosed with acute STEMI who were followed up and treated. The presence of the thrombus was determined by transthoracic echocardiography (TTE). Study patients were evaluated as cases of thrombus (+) and thrombus (-). The relationship of electrocardiographic measurements such as the number of leads with pathological Q waves, ST segment deviation score, QT dispersion, and echocardiographic measurements such as ejection fraction (EF), end-systolic and end-diastolic volumes, and wall motion score index (WMSI) with LVT was investigated. LVT risk factors were identified. Results The median age of the study patients was 59.7 ± 11.7 years, and 84.7% were male. The incidence of LVT was 17.6% (23 patients). While the anterior STEMI rate was 86.9% in the thrombus (+) group, it was 50.9% in the thrombus (-) group (p<0.001). While WMSI was 2.1 ± 0.44 in the thrombus (+) group, it was calculated as 1.40 ± 0.31 in the thrombus (-) group (p<0.001). In the thrombus (+) group, EF was found to be lower, end-systolic and end-diastolic volumes were higher, and the rate of moderate and severe mitral regurgitation and the rate of aneurysmatic segment detection were higher. LVT had a moderate correlation with WMSI (r: 0.613; p<0.001), the presence of an aneurysmatic segment (r: 0.549; p<0.001), and EF (r: -0.514; p<0.001). Presentation with anterior STEMI (odds ratio [OR]: 4.266; p<0.001), WMSI (OR: 7.971; p=0.012), the number of leads with pathological Q waves detected at discharge (OR: 3.651; p=0.009), the presence of an aneurysmatic segment (OR: 2.089, p=0.009), and EF (OR: 1.129, p=0.006) were identified as independent risk factors of the presence of LVT. The area under the curve for WMSI was found to be 0.910 (95% CI: 0.852-0.968). A WMSI cut-off of 1.56 identified LVT with 91% sensitivity and 70% specificity (Youden index: 0.617). Conclusion In the primary PCI era, LVT incidence after acute STEMI is still significant. Anterior STEMI, the number of leads with pathological Q waves detected at discharge, WMSI, aneurysm formation, and low EF are independent risk factors for LVT. Among these risk factors, the variable with the highest diagnostic power is WMSI.
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Affiliation(s)
- Devrim Kurt
- Cardiology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Emre Yılmaz
- Cardiology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Sencer Çamcı
- Cardiology, Bursa Postgraduate Hospital, Bursa, TUR
| | - Ertan Aydın
- Cardiology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Şükrü Çelik
- Cardiology, Trabzon Ahi Evran Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, TUR
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Xiang Q, Wei Y, Feng X, Chen S, Zhao Y. Initial establishment and validation of a predictive model for preeclampsia in twin pregnancies based on maternal characteristics and echocardiographic parameters. Acta Obstet Gynecol Scand 2023; 102:1566-1574. [PMID: 37533238 PMCID: PMC10577616 DOI: 10.1111/aogs.14651] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/22/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The primary objective of this study was to evaluate the association between maternal echocardiographic changes and the occurrence of preeclampsia (PE) in twin pregnancies. Additionally, we established and validated a prediction model for PE in twin pregnancies. MATERIAL AND METHODS The first part of this study was retrospective and included data from 854 twin pregnancies that received antenatal care at Peking University Third Hospital from April 2017 to April 2021 (training cohort). Overall, 159 women who underwent transthoracic echocardiography were included in the analysis. To build a predictive model, cardiac findings were compared between normotensive women and those with PE. The model was then validated in a prospective longitudinal cohort (test cohort) that included 109 women with twin pregnancies who underwent two consecutive transthoracic echocardiography examinations during the second and third trimesters. RESULTS Fifty-four normotensive women and 105 women with PE were analyzed in the retrospective cohort that was used to build the model in which later preeclampsia was associated with higher left ventricular mass index (>61 g/m2 ), interventricular septal thickness (>7.87 mm), left atrial anteroposterior diameter (>33.5 mm), mitral inflow late diastolic velocity (A) (>0.685 m/s), ratio of early diastolic velocity (E) and peak early diastolic myocardial velocity of the lateral mitral annulus (>6.5), and lower peak early diastolic myocardial velocity (<13.1 cm/s). The optimized PE prediction model based on the interventricular septal thickness, left atrial anteroposterior diameter, A, peak early diastolic myocardial velocity and pre-pregnancy bodyweight index was then established (area under the curve [AUC] = 0.840, 95% CI 0.778-0.903, P < 0.001). The model was tested in the prospective cohort including 87 normotensive women and 22 women with PE; the validation test showed that the prediction model in the second (AUC = 0.801) and third (AUC = 0.811) trimesters had high discriminative ability and calibration. CONCLUSIONS Maternal echocardiographic changes in twin pregnancies are associated with the development of preeclampsia. The model constructed, based on the echocardiographic parameters and body mass index, provides novel ideas for the prediction of PE.
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Affiliation(s)
- Qianqian Xiang
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
| | - Yuan Wei
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
| | - Xinheng Feng
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Shaomin Chen
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Yangyu Zhao
- Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Clinical Research Center of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
- National Center for Healthcare Quality Management in ObstetricsBeijingChina
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22
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Zhang R, Zhao F, Wang J, Qin Y, Wang T, Chu AA. Case Report: Integrated echocardiographic assessment guided Liwen procedure for treating obstructive hypertrophic cardiomyopathy with ventricular aneurysm. Front Cardiovasc Med 2023; 10:1278457. [PMID: 38028451 PMCID: PMC10646534 DOI: 10.3389/fcvm.2023.1278457] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease, with an estimated incidence of 0.2%-6%, and is the main cause of sudden cardiac death (SCD) in young athletes. Left ventricular apical aneurysm (LVAA) is a rare subtype of HCM, accounting for about 5% of HCM patients, and has a higher incidence of cardiovascular adverse events. In cases of hypertrophic obstructive cardiomyopathy with LVAA (HOCM-LVAA) that do not respond adequately to optimized medical therapy, the echocardiography-guided percutaneous intra-myocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) emerges as a promising and effective novel therapeutic approach. In this case report, we present for the first time a comprehensive application of echocardiographic techniques, including TTE, 2-D STE, and contrast enhancement, in the diagnosis, treatment, surgical guidance, and assessment of therapeutic outcomes in a case of HOCM-LVAA.
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Affiliation(s)
| | | | | | | | | | - Ai-Ai Chu
- Department of Echocardiography, First Clinical Medicine School, Gansu Province Hospital, Gansu University of Chinese Medicine, Lanzhou, China
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Visby L, Møgelvang R, Grund FF, Myhr KA, Hassager C, Vejlstrup N, Mattu R, Kristensen CB. The Influence of Food Intake and Preload Augmentation on Cardiac Functional Parameters: A Study Using Both Cardiac Magnetic Resonance and Echocardiography. J Clin Med 2023; 12:6781. [PMID: 37959245 PMCID: PMC10648012 DOI: 10.3390/jcm12216781] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: To investigate how food intake and preload augmentation affect the cardiac output (CO) and volumes of the left ventricle (LV) and right ventricle (RV) assessed using cardiac magnetic resonance (CMR) and trans-thoracic echocardiography (TTE). (2) Methods: Eighty-two subjects with (n = 40) and without (n = 42) cardiac disease were assessed using both CMR and TTE immediately before and after a fast infusion of 2 L isotonic saline. Half of the population had a meal during saline infusion (food/fluid), and the other half were kept fasting (fasting/fluid). We analyzed end-diastolic (EDV) and end-systolic (ESV) volumes and feature tracking (FT) using CMR, LV global longitudinal strain (GLS), and RV longitudinal strain (LS) using TTE. (3) Results: CO assessed using CMR increased significantly in both groups, and the increase was significantly higher in the food/fluid group: LV-CO (ΔLV-CO: +2.6 ± 1.3 vs. +0.7 ± 1.0 p < 0.001), followed by increased heart rate (HR) (ΔHR: +12 ± 8 vs. +1 ± 6 p < 0.001). LV and RV achieved increased stroke volume (SV) through different mechanisms. For the LV, through increased contractility, increased LV-EDV, decreased LV-ESV, increased LV-FT, and GLS were observed. For the RV, increased volumes, increased RV-EDV, increased RV-ESV, and at least for the fasting/fluid group, unchanged RV-FT and RV-LS were reported. (4) Conclusions: Preload augmentation and food intake have a significant impact on hemodynamic and cardiac functional parameters. This advocates for standardized recommendations regarding oral intake of fluid and food before cardiac assessment, for example, TTE, CMR, and right heart catheterization. We also demonstrate different approaches for the LV and RV to increase SV: for the LV by increased contractility, and for the RV by volume expansion.
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Affiliation(s)
- Lasse Visby
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Rasmus Møgelvang
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2100 Copenhagen, Denmark
- Cardiovascular Research Unit, University of Southern Denmark, Baagoees Allé 15, DK-5700 Svendborg, Denmark
| | - Frederik Fasth Grund
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Katrine Aagaard Myhr
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Christian Hassager
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2100 Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
| | - Raj Mattu
- Kettering General Hospital NHS Foundation Trust, University Hospitals Northamptonshire, Kettering NN1 5BD, Northamptonshire, UK
- University College London, Gower St., London WC1E 6BT, UK
| | - Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (F.F.G.)
- Department of Cardiology, Lund University Hospital, Entrégatan 7, SE-22242 Lund, Sweden
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24
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Nielsen AB, Skaarup KG, Djernæs K, Duus LS, Espersen C, Sørensen SK, Ruwald MH, Hansen ML, Worck RH, Johannessen A, Hansen J, Nardelli P, San José Estépar R, San José Estépar R, Biering-Sørensen T. Association Between Pulmonary Vascular Volume and Cardiac Structure and Function in Patients With Atrial Fibrillation. Am J Cardiol 2023; 205:182-189. [PMID: 37604065 DOI: 10.1016/j.amjcard.2023.07.119] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
Pulmonary vascular abnormalities, quantified from computed tomography scans, have frequently been observed in patients with pulmonary diseases. However, little is known about pulmonary vascular changes in patients with cardiac disease. Thus, we aimed to examine the cardiopulmonary relation in patients with atrial fibrillation (AF) by comparing pulmonary vascular volume (PVV) to echocardiographic measures and AF severity. A total of 742 patients (median age 63 years, 70% men) who underwent ablation for AF were included. Preprocedural cardiac computed tomography was used to measure the total and small-vessel PVV, along with the pulmonary artery to aorta ratio and the degree of emphysema. The association between PVV and echocardiographic parameters was evaluated using a multivariable linear regression analysis. Lower total and small-vessel PVV were associated with more impaired measures of cardiac structure and function, including but not limited to left ventricular ejection fraction and peak atrial longitudinal strain. Patients with reduced total and small-vessel PVV had higher odds of having persistent AF than paroxysmal AF in the unadjusted logistic regression analyses. However, after clinical and echocardiographic adjustments, only reduced small-vessel PVV remained independently associated with persistent AF (odds ratio 1.90, 95% confidence interval 1.26 to 2.87, p = 0.002). In conclusion, pulmonary vascular remodeling is associated with persistent AF and with more impaired measures of cardiac structure and function, providing further insights into heart-lung interactions in this patient group.
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Affiliation(s)
- Anne Bjerg Nielsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | - Kasper Djernæs
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Lisa Steen Duus
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline Espersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Samuel Kiil Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Martin Huth Ruwald
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - René Husted Worck
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Arne Johannessen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Jim Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ahmed Abdi I, Karataş M, Öcal L, Abdirahman Ahmed S, Sheikh Hassan M, Atilla K, Farah Yusuf Mohomud M. Pattern of rheumatic heart disease among patients attending at a tertiary care hospital in Somalia: first report from Somalia. Am J Cardiovasc Dis 2023; 13:345-353. [PMID: 38026112 PMCID: PMC10658047] [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] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 07/05/2023] [Indexed: 12/01/2023]
Abstract
Rheumatic heart disease (RHD) is the leading cause of valvular heart disease in underdeveloped nations. It remains a significant public health issue in Sub-Saharan African countries. This study aimed to determine the pattern, severity, and complications of RHD in Somalia. This was a retrospective cross-sectional study of all patients diagnosed with rheumatic heart disease. A total of 8526 echocardiographic examinations were done in our center over a two-year study period from January 2020 to December 2021. Patients with congenital cardiac disease, post-operative cases, myxomatous and old age degenerative disease were all excluded. Of 433 patients, 286 (66.1%) were female, and the mean age was 46.5 ± 20.3. The isolated mitral valve (MV) affected 222 (51.3%). Dual involvement of mitral and aortic valve (AV) was present in 190 (44%). Overall isolated or combined valve involvement, mitral regurgitation (MR) was the most common valve lesion 345 (79.7%), followed by mitral stenosis (MS) 160 (37%). According to the severity of lesions, severe MR was 230 (53.1%) patients, followed by severe MS (n=129, 29.8%). The most common complication of RHD depicted in our study were secondary pulmonary hypertension and enlarged left atrium, 23.8% (n=103) and 19.6% (n=85), respectively. In conclusion, in our study majority of RHD patients were females. Both isolated and in combination, MV was the most commonly affected, and mitral regurgitation was the most common valvular lesion. In our study high percentage of patients already had complications at the time of diagnosis.
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Affiliation(s)
- Ishak Ahmed Abdi
- Cardiology Department, Mogadishu Somali Turkish Training and Research HospitalMogadishu, Somalia
| | - Mesut Karataş
- Cardiology Department, Mogadishu Somali Turkish Training and Research HospitalMogadishu, Somalia
| | - Lütfi Öcal
- Cardiology Department, Mogadishu Somali Turkish Training and Research HospitalMogadishu, Somalia
| | - Said Abdirahman Ahmed
- Cardiology Department, Mogadishu Somali Turkish Training and Research HospitalMogadishu, Somalia
| | - Mohamed Sheikh Hassan
- Neurology Department, Mogadishu Somali Turkish Training and Research HospitalMogadishu, Somalia
| | - Koyuncu Atilla
- Cardiology Department, Mogadishu Somali Turkish Training and Research HospitalMogadishu, Somalia
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26
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Pedgaonkar RA, Singh NG, Dhananjaya M, Nagaraja PS, Nagesh KS, Prabhakar V. Comparison of noninvasive cardiac output monitoring by electrical cardiometry with transthoracic echocardiography in postoperative paediatric cardiac surgical patients - A prospective observational study. Ann Card Anaesth 2023; 26:380-385. [PMID: 37861570 PMCID: PMC10691584 DOI: 10.4103/aca.aca_9_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 10/21/2023] Open
Abstract
Aim The present study was conducted to validate cardiac output (CO) and cardiac index (CI) obtained from electrical cardiometry (EC) ICON ® with transthoracic echocardiography (TTE) in postoperative pediatric cardiac surgical patients. Materials and Methods A prospective observational study was conducted in 25 pediatric patients with age < 10 years who underwent elective cardiac surgery. Data Analysis BlandAltman plot was constructed for interchangeability and Polar plot was constructed to know trending ability. Results A total of 250 datasets were analyzed. Spearman's correlation coefficient for CO between ICON ® and TTE showed good positive correlation (r = 0.850, 95% confidence interval 0.81 to 0.881, P <.0001). Moderate positive correlation was observed between ICON ® and TTE for CI (r = 0.60, 95% confidence interval 0.515 to 0.674, P <.0001). Linear regression equations for CO and CI between ICON ® and TTE were: y = 0.5230 + 0.8078 X (R2 = 0.6597, P <.001) and y = 1.8350 + 0.5869 X (R2 = 0.3985, P <.001) [y- ICON ®; X - TTE], respectively. BlandAltman plot for CO between ICON ® and TTE showed a bias of 0.3012 with limits of agreement (LOA) being -0.69 to 1.3 and for CI bias was 0.6939 with LOA-2.1 to 3.5. Polar plot analysis showed an angular bias of 8.1750, with radial LOA being -13.74° to 30.08° for CO and angular bias of 6.6931, with radial LOA being -15.69° to 29.07° for CI. Conclusion ICON ® monitor-derived parameters are not interchangeable with the values derived from TTE. However, the ICON ® monitor demonstrated a good trending ability for both CO and CI.
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Affiliation(s)
- Raj A. Pedgaonkar
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - Naveen G. Singh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - Manasa Dhananjaya
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - PS Nagaraja
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - KS Nagesh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - V Prabhakar
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
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27
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Karande S, Vaideeswar P, More T. How often are heart diseases correctly diagnosed antemortem in children with fatal illnesses? A retrospective review of medical and autopsy records. J Postgrad Med 2023; 69:224-226. [PMID: 37787265 PMCID: PMC10846810 DOI: 10.4103/jpgm.jpgm_608_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/04/2023] Open
Abstract
This retrospective study analyzed the concordance level between clinical and autopsy diagnosis of heart diseases over six years. Utilizing the Goldmann classification, the concordance rate was found to be 38.1%. Major discrepancies (Class I and II) were found in 39% cases and minor (Class III and IV) in 22.9% cases.
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Affiliation(s)
- S Karande
- Department of Pediatrics), Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - P Vaideeswar
- Department of Pathology (Cardiovascular & Thoracic Division), Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
| | - T More
- Department of Pediatrics), Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai, Maharashtra, India
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28
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Hou S, Han Z, Wang H, Sun M. Multiple cardiac myxomas and cutaneous pigmentation revealing carney complex. J Clin Ultrasound 2023; 51:1332-1334. [PMID: 37434534 DOI: 10.1002/jcu.23519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Suyun Hou
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Zhengyang Han
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Honghu Wang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Mengjiao Sun
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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29
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Tang Y, Peng S, Yao HL, Liu Z, Zhang L, Zhong C, She C, Liu W, Tang Y, Fu Q, Zhang Y. Left atrial function index predicts poor outcomes in acute myocardial infarction patients treated with percutaneous coronary intervention. Front Cardiovasc Med 2023; 10:1043775. [PMID: 37727308 PMCID: PMC10505662 DOI: 10.3389/fcvm.2023.1043775] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/11/2023] [Indexed: 09/21/2023] Open
Abstract
Background and aims The left atrial function index (LAFI) is an index that combines the left atrial emptying fraction, adjusted left atrial volume and stroke volume. The prognostic value of LAFI in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI) is unknown. This study aims to determine whether LAFI predicts prognosis in AMI patients treated with PCI. Methods Patients with newly diagnosed AMI who were treated with PCI at Hunan Provincial People's Hospital from March 2020 to October 2021 were prospectively enrolled. All patients underwent transthoracic echocardiography (TTE) at baseline and follow-up. The endpoint events included rehospitalization due to unstable angina, nonfatal myocardial infarction, rehospitalization due to heart failure and cardiovascular death. Results A total of 368 patients with AMI (92 women; mean age, 61.45 ± 11.91 years) were studied with a median follow-up of 14 ± 6.58 months. Sixty-nine patients had endpoint events. Patients who presented with events had a significantly lower LAFI than patients without events (34.25 ± 12.86 vs. 48.38 ± 19.42, P < 0.0001). Multivariate Cox analysis demonstrated that LAFI (HR = 0.97 [95% CI: 0.95; 0.99]; P = 0.012) and the Killip classification (HR = 1.51 [95% CI: 1.03; 2.22]; P = 0.034) were independently predictive of endpoint events. Kaplan-Meier survival curves showed that patients with LAFI ≤ 40.17 cm/ml/m2 had higher events than patients with LAFI > 40.17 cm/ml/m2 (HR = 8.53 [95% CI: 4.74; 15.35]; P < 0.0001). Conclusion LAFI is a strong and independent predictor of adverse events and can be used for risk stratification in patients with AMI treated with PCI.
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Affiliation(s)
- Yijin Tang
- Department of Cardiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Siling Peng
- Department of Cardiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hui-ling Yao
- Department of General Medicine, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, China
| | - Zhibin Liu
- Department of Cardiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Liang Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
| | - Changqing Zhong
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
| | - Chang She
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
| | - Wei Liu
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
| | - Yi Tang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
| | - Qinghua Fu
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
| | - Yi Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
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30
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Jeong J, Chao CJ, Arsanjani R, Kim K, Pelkey MN, Chen YC, Ramzan RN, Elbahnasawy M, Sleem M, Ayoub C, Farina JMM, Grogan M, Kane GC, Patel BN, Oh JK, Banerjee I. Challenges and solutions of echocardiography generalization for deep learning: a study in patients with constrictive pericarditis. J Med Imaging (Bellingham) 2023; 10:054502. [PMID: 37840850 PMCID: PMC10569796 DOI: 10.1117/1.jmi.10.5.054502] [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: 02/28/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose The inherent characteristics of transthoracic echocardiography (TTE) images such as low signal-to-noise ratio and acquisition variations can limit the direct use of TTE images in the development and generalization of deep learning models. As such, we propose an innovative automated framework to address the common challenges in the process of echocardiography deep learning model generalization on the challenging task of constrictive pericarditis (CP) and cardiac amyloidosis (CA) differentiation. Approach Patients with a confirmed diagnosis of CP or CA and normal cases from Mayo Clinic Rochester and Arizona were identified to extract baseline demographics and the apical 4 chamber view from TTE studies. We proposed an innovative preprocessing and image generalization framework to process the images for training the ResNet50, ResNeXt101, and EfficientNetB2 models. Ablation studies were conducted to justify the effect of each proposed processing step in the final classification performance. Results The models were initially trained and validated on 720 unique TTE studies from Mayo Rochester and further validated on 225 studies from Mayo Arizona. With our proposed generalization framework, EfficientNetB2 generalized the best with an average area under the curve (AUC) of 0.96 (± 0.01 ) and 0.83 (± 0.03 ) on the Rochester and Arizona test sets, respectively. Conclusions Leveraging the proposed generalization techniques, we successfully developed an echocardiography-based deep learning model that can accurately differentiate CP from CA and normal cases and applied the model to images from two sites. The proposed framework can be further extended for the development of echocardiography-based deep learning models.
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Affiliation(s)
- Jiwoong Jeong
- Arizona State University, School of Computing and Augmented Intelligence, Tempe, Arizona, United States
| | - Chieh-Ju Chao
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Reza Arsanjani
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | - Kihong Kim
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Melissa N. Pelkey
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Yi-Chieh Chen
- Mayo Clinic Health System Austin, Department of Pharmacy, Austin, Minnesota, United States
| | - Raheel N. Ramzan
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | | | - Mohamed Sleem
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | - Chadi Ayoub
- Mayo Clinic, Department of Cardiology, Scottsdale, Arizona, United States
| | | | - Martha Grogan
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Garvan C. Kane
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Bhavik N. Patel
- Mayo Clinic, Department of Radiology, Scottsdale, Arizona, United States
| | - Jae K. Oh
- Mayo Clinic, Department of Cardiology, Rochester, Minnesota, United States
| | - Imon Banerjee
- Arizona State University, School of Computing and Augmented Intelligence, Tempe, Arizona, United States
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31
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Hanson RS, Venegas OG, Alverson LA, Abrams BA, Kertai MD. Embracing Scrutiny: The Importance of Critical Evaluation and Transparency in Research. Semin Cardiothorac Vasc Anesth 2023; 27:149-152. [PMID: 37449721 DOI: 10.1177/10892532231189788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Ross S Hanson
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Ollin G Venegas
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Lindsey A Alverson
- Department of Critical Care Medicine, Providence Sacred Heart Medical Center, Spokane, WA, USA
| | - Benjamin A Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Schilling J, Lin JP, Mankad SV, Krishnam MS, Ning M, Patel PM, Kim CK, Kapoor R, Di Tullio MR, Jung J, Kim JK, Fisher MJ. The 2022 FASEB Virtual Catalyst Conference on the Cardiac Interatrial Septum and Stroke Risk, December 7, 2022. FASEB J 2023; 37:e23122. [PMID: 37606555 DOI: 10.1096/fj.202300897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/09/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
There is emerging evidence that the cardiac interatrial septum has an important role as a thromboembolic source for ischemic strokes. There is little consensus on treatment of patients with different cardiac interatrial morphologies or pathologies who have had stroke. In this paper, we summarize the important background, diagnostic, and treatment considerations for this patient population as presented during the Federation of American Societies for Experimental Biology (FASEB) Virtual Catalytic Conference on the Cardiac Interatrial Septum and Stroke Risk, held on December 7, 2022. During this conference, many aspects of the cardiac interatrial septum were discussed. Among these were the embryogenesis of the interatrial septum and development of anatomic variants such as patent foramen ovale and left atrial septal pouch. Also addressed were various mechanisms of injury such as shunting physiologies and the consequences that can result from anatomic variants, as well as imaging considerations in echocardiography, computed tomography, and magnetic resonance imaging. Treatment options including anticoagulation and closure were addressed, as well as an in-depth discussion on whether the left atrial septal pouch is a stroke risk factor. These issues were discussed and debated by multiple experts from neurology, cardiology, and radiology.
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Affiliation(s)
- Jonathan Schilling
- Department of Medicine, University of California, Irvine, California, USA
| | - Jeannette P Lin
- Department of Cardiology, University of California, Los Angeles, California, USA
| | - Sunil V Mankad
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayil S Krishnam
- Department of Radiology, Stanford University, Stanford, California, USA
| | - MingMing Ning
- Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pranav M Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Ruchi Kapoor
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York, USA
| | - Jinman Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Jin Kyung Kim
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Mark J Fisher
- Departments of Neurology, Anatomy & Neurobiology, and Pathology & Laboratory Medicine, University of California, Irvine, California, USA
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Kholdani CA, Choudhary G, Furfaro DM, Markson LJ, Manning WJ, Strom JB. Echocardiographic Progression of Peak Tricuspid Regurgitant Velocity Among Medicare Beneficiaries. JACC Adv 2023; 2:100579. [PMID: 37854952 PMCID: PMC10583835 DOI: 10.1016/j.jacadv.2023.100579] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Peak tricuspid regurgitant velocity (TRV) on transthoracic echocardiography (TTE) is a commonly obtained parameter and robust predictor of subsequent adverse clinical outcomes. OBJECTIVES The purpose of this study was to determine the predictors and clinical significance of TRV progression. METHODS We retrospectively linked consecutive outpatient TTE reports from our institution to 2005 to 2017 Medicare claims. Individuals with prior tricuspid surgery, endocarditis, tricuspid stenosis, missing TRV values, TTEs performed during inpatient hospitalization, or <2 TTEs were excluded. RESULTS A total of 4,572 patients (mean age 67.8 ± 11.9 years, 50.4% female) received 13,273 TTEs over a median follow-up of 7.4 (IQR: 4.5-6.9) years. TRV increased by a mean of 0.23 (95% CI: 0.22 to 0.23 m/s/y, P < 0.001) (range, 0.01-0.80 m/s/y). Older age, depressed left ventricular ejection fraction, diabetes, hypertension, hyperlipidemia, atrial fibrillation, heart failure, and chronic kidney disease were associated with faster progression (all P < 0.05). Accounting for 23 demographic, clinical, and TTE variables, faster TRV progression was associated with a stepwise increased risk of all-cause mortality (TRV progression quartile 4 vs 1; adjusted HR: 2.17; 95% CI: 1.74-2.71; P < 0.001). Those with regression of TRV (n = 384 [8.4%]) had a lower mortality risk (adjusted HR: 0.40; 95% CI: 0.28-0.57; P < 0.001). CONCLUSIONS In this large, multidecade study of Medicare beneficiaries with serial TTEs performed in the outpatient setting, the mean rate of TRV progression was 0.23 m/s/y. Older age, left heart disease, and adverse metabolic features were associated with faster progression. Faster progression was associated with a graded risk for all-cause mortality.
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Affiliation(s)
- Cyrus A. Kholdani
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Gaurav Choudhary
- Lifespan Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - David M. Furfaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence J. Markson
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Warren J. Manning
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jordan B. Strom
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Gao S, Zhang S, Wang Z, Wu M, Gu C, Bai R, Liu M, Tian Z, Zhang S. Long-Term Prognosis of Different Subtypes of Left Ventricular Noncompaction Cardiomyopathy Patients: A Retrospective Study in China. J Cardiovasc Dev Dis 2023; 10:369. [PMID: 37754798 PMCID: PMC10531838 DOI: 10.3390/jcdd10090369] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
Left ventricular noncompaction (LVNC) is a heterogeneous cardiomyopathy that can be classified into different subtypes based on morphologic and functional features. However, the prognosis of the dilated and isolated subtypes of non-pediatric LVNC remains unknown. We retrospectively studied 101 patients with LVNC diagnosed at Peking Union Medical College Hospital from 2006 to 2022 using the Jenni criteria of transthoracic echocardiography. The patients were grouped into those with dilated LVNC (n = 64) or isolated LVNC (n = 37), and 88 patients (54 with dilated LVNC and 34 with isolated LVNC) were followed up successfully. The primary outcome was major adverse cardiovascular events (a composite of cardiovascular mortality, heart failure, severe ventricular arrhythmia, and systolic embolism). The median follow-up time was 5.24 years. The incidence of major adverse cardiovascular events was 43.2%; patients with dilated LVNC had a higher risk (adjusted hazard ratio, 4.43; 95% confidence interval, 1.24-15.81; p = 0.02) than those with isolated LVNC. None of the isolated LVNC patients had cardiovascular deaths or severe ventricular arrhythmias. The risk of systemic embolism was similar between patients with dilated and isolated LVNC. Our findings indicate that transthoracic echocardiography is a useful tool for classifying LVNC into subtypes with distinct clinical outcomes. Dilated LVNC is associated with a poor prognosis, while the isolated subtype is probably a physiological condition.
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Affiliation(s)
- Shiqi Gao
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Shuyuan Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Zeyuan Wang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Ming Wu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Chengying Gu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Ruilian Bai
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Meixi Liu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Zhuang Tian
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
| | - Shuyang Zhang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China; (S.G.); (S.Z.); (Z.W.); (M.W.); (C.G.); (R.B.); (M.L.)
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Petkovic A, Menkovic N, Petrovic O, Bilbija I, Radovanovic NN, Stanisavljevic D, Putnik S, Maksimovic R, Ivanovic B. The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis. J Clin Med 2023; 12:5482. [PMID: 37685577 PMCID: PMC10488865 DOI: 10.3390/jcm12175482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/18/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a rare disease with a high mortality rate and rising incidence, requiring timely and precise diagnosis in order to choose appropriate therapy. Imaging of morphologic lesions is an integrative part of diagnosis. Artifacts and the patient's habitus make echocardiography difficult to visualize advanced-form IE. Cardiac computed tomography (CCT) constantly shows an additive diagnostic value due to high resolution of cardiac anatomy. Conjecturally, joint application of both diagnostic tests improves overall sensitivity and specificity in diagnosing IE. METHODS Patients with definite IE underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and CCT. We analyzed valvular and paravalvular IE lesions in all three imaging methods and compared them to surgical or autopsy findings. We calculated sensitivity, specificity, diagnostic accuracy, and positive and negative predictive value of both imaging tests individually and jointly used. RESULTS We examined 78 patients, male to female ratio 2:1, mean age 52.29 ± 16.62. We analyzed 85 valves, 70 native valves, 13 prosthetic valves, and 2 corrected valves due to Ozaki procedure, along with a central shunt and 4 pacemaker leads. As a single test, the sensitivity and specificity of CCT, TTE, and TEE for valvular lesions were 91.6/20%, 65.5/57.9%, and 60/84%, and paravalvular lesions were 100/0%, 46/10.5%, and 14.7/100%. When combined together, sensitivity and specificity for valvular lesions rose to 96.6/0% and paravalvular lesions to 100/0%. We also analyzed the diagnostic performance for each test in single and mutual application, per specific IE lesion. CONCLUSION In the individual application, CCT in comparison to TTE and TEE shows better diagnostic performance in detection of valvular and paravalvular lesions. In joint application, there is a statistically significant difference in performance compared to their single use, especially in prosthetic valves and invasive forms of IE native valves.
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Affiliation(s)
- Ana Petkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.P.); (N.M.)
| | - Nemanja Menkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (A.P.); (N.M.)
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ilija Bilbija
- Department for Cardiac Surgery, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (S.P.)
| | - Nikola N. Radovanovic
- Pacemaker Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Svetozar Putnik
- Department for Cardiac Surgery, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (S.P.)
| | - Ruzica Maksimovic
- Center of Radiology, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branislava Ivanovic
- Cardiology Clinic, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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Vinogradsky AV, Hayashi H, Kirschner M, Ning Y, Kurlansky P, Yuzefpolskaya M, Colombo P, Sayer G, Uriel N, Naka Y, Takeda K. Preoperative Left Ventricular Diastolic Dimension Index Is Associated With Outcomes After HeartMate 3 Implantation. Eur J Cardiothorac Surg 2023:ezad287. [PMID: 37589647 DOI: 10.1093/ejcts/ezad287] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE We investigated the association between indexed left ventricular diastolic dimension and clinical outcomes after HeartMate 3 implantation. METHODS We retrospectively reviewed patients implanted with the HeartMate 3 at our center between November 2014 and September 2021. Left ventricular diastolic dimension was assessed via preoperative transthoracic echocardiography and left ventricular diastolic dimension index was calculated as left ventricular diastolic dimension/body surface area. The primary outcome was a composite of death or readmission due to right heart failure or stroke. The cut-off left ventricular diastolic dimension index value most closely associated with outcomes was determined by receiver-operating characteristic curve and restricted cubic spline analyses. RESULTS Left ventricular diastolic dimension index measurements were available for 252 of 253 (99.6%) patients. Using a left ventricular diastolic dimension index cut-off value of 33.5 mm/m2, the cohort was divided: left ventricular diastolic dimension index ≤ (n = 131) or > (n=121) 33.5 mm/m2. While there were no significant differences in age, INTERMACS level, and preoperative hemodynamics between groups, patients with smaller left ventricular diastolic dimension index were more likely to have a larger body surface area (2.1 vs 1.9 m2, P<0.001), ischemic cardiomyopathy (64 [49%] vs 40 [33%], P=0.01), and smaller left atrium volume index (40.5 [32.3-54.0] mL/m2 vs. 54.0 [43.0-66.8] mL/m2, P<0.001). Smaller left ventricular diastolic dimension index patients had significantly worse survival (74% vs 88%, log-rank P=0.009) and freedom from adverse events (55% vs 73%, log-rank P=0.005) at 3-year follow-up. Smaller left ventricular diastolic dimension index was independently associated with the composite outcome (Hazard ratio 2.24, P=0.002). CONCLUSIONS Smaller preoperative left ventricular diastolic dimension index is associated with worse outcomes in patients undergoing HeartMate 3 implantation.
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Affiliation(s)
- Alice V Vinogradsky
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Hideyuki Hayashi
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Kirschner
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Paolo Colombo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Luo Y, Ye X, Zhang L, Yang Y, Liang Q. A rare case of cardiogenic shock caused by takotsubo syndrome associated with SARS-CoV-2 infection: The value of echocardiography in the diagnosis and monitoring of the efficacy of extracorporeal membrane oxygenation. Echocardiography 2023; 40:866-874. [PMID: 37229563 DOI: 10.1111/echo.15594] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly invades the respiratory system, but may also cause various cardiovascular complications. We report a rare case of myocarditis associated with SARS-CoV-2 infection. A 61-year-old man was admitted to the hospital with a positive nucleic acid test for SARS-CoV-2. A sudden increase in troponin level (up to .144 ng/mL) was observed on the 8th day after admission. He developed symptoms of heart failure and progressed rapidly to cardiogenic shock. Echocardiography on the same day showed reduced left ventricular ejection fraction, reduced cardiac output, and segmental ventricular wall motion abnormalities. Takotsubo cardiomyopathy associated with SARS-CoV-2 infection was considered based on the typical echocardiography findings. We immediately started veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment. The patient was successfully withdrawn from VA-ECMO after 8 days following recovery of ejection fraction to 65% and all indicators qualifying the withdrawal criteria. Echocardiography plays an important role in dynamic monitoring of cardiac changes in such cases and can help determine the timing of extracorporeal membrane oxygenation treatment and withdrawal.
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Affiliation(s)
- Yiran Luo
- Department of Cardiology Cardiac Function Room, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xianwei Ye
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Lu Zhang
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yang Yang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou, Zunyi, China
| | - Qin Liang
- Department of Cardiology Cardiac Function Room, Guizhou Provincial People's Hospital, Guiyang, China
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Minkin R, Hopson R, Ramasubbu K, Gharanei M, Weingarten JA. Pulmonary hypertension predicts higher mortality in patients admitted with severe COVID-19 infection. SAGE Open Med 2023; 11:20503121231187755. [PMID: 37519945 PMCID: PMC10372496 DOI: 10.1177/20503121231187755] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Patients with underlying conditions are predicted to have worse outcomes with COVID-19. A strong association between baseline cardiovascular disease and COVID-19-related mortality has been shown by a number of studies. In the current retrospective study, we aim to identify whether patients with pulmonary hypertension have worse outcomes compared with patients without pulmonary hypertension. Methods Data from patients of ⩾18 years of age with COVID was retrospectively collected and analyzed (n = 679). Patients who underwent transthoracic echocardiography, at the discretion of the medical team, were identified and the transthoracic echocardiography was reviewed for the presence of pulmonary hypertension. Patient health parameters and outcomes were measured and statistically analyzed. Results Of 679 consecutive patients identified with a diagnosis of COVID-19, 57 underwent transthoracic echocardiography, 32 of which were found to have pulmonary hypertension. Patients who underwent transthoracic echocardiography had a significantly higher intensive care unit admission rate (73.7% versus 25.4%, p < 0.001) and increased presence of acute respiratory distress syndrome (63.2% versus 21.6%, p > 0.001). These patients had longer intensive care unit length of stay, longer mechanical ventilation time, longer hospital length of stay, and a significantly higher mortality rate when compared to those not undergoing transthoracic echocardiography (59.7% versus 32.3%, p < 0.001). Among patients who underwent transthoracic echocardiography, those with pulmonary hypertension had significantly higher mortality compared to those without pulmonary hypertension (80% versus 43.8%, p < 0.01). Conclusion COVID-19 in patients with pulmonary hypertension was associated with high in-hospital mortality even when adjusted for confounding factors. A number of mechanisms have been proposed for the worse outcomes in patients with pulmonary hypertension and right ventricular dysfunction, including right ventricle overload and indirect pro-inflammatory cytokine storm. Further, large-scale studies are required to evaluate the impact of right ventricular dysfunction in COVID-19 patients and to elucidate the associated mechanisms.
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Affiliation(s)
- Ruth Minkin
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Roger Hopson
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Mayel Gharanei
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Gong T, Zhang F, Feng L, Zhu X, Deng D, Ran T, Li L, Kong L, Sun L, Ji X. Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study. Front Cardiovasc Med 2023; 10:1078038. [PMID: 37554364 PMCID: PMC10405080 DOI: 10.3389/fcvm.2023.1078038] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) is a common congenital cardiovascular malformation, and improvements in the diagnostic process for surgical decision-making are important. We sought to compare the diagnostic accuracy of transthoracic echocardiography (TTE) with computed tomographic angiography (CTA) to diagnose CoA. METHODS We retrospectively reviewed 197 cases of CoA diagnosed by TTE and CTA and confirmed at surgery from July 2009 to August 2019. RESULTS The surgical findings confirmed that 19 patients (9.6%) had isolated CoA and 178 (90.4%) had CoA combined with other congenital cardiovascular malformations. The diagnostic accuracy of CoA by CTA was significantly higher than that of TTE (χ2 = 6.52, p = 0.01). In contrast, the diagnostic accuracy of TTE for associated cardiovascular malformations of CoA was significantly higher than that of CTA (χ2 = 15.36, p < 0.0001). Infants and young children had more preductal type of CoA, and PDA was the most frequent cardiovascular lesion associated with CoA. The pressure gradient was significantly decreased after the first operation, similar at 6 months, 1 year, and 3 years follow-ups by TTE. CONCLUSIONS CTA is more accurate as a clinical tool for diagnosing CoA; however, TTE with color Doppler can better identify associated congenital cardiovascular malformations. Therefore, combining TTE and CTA would benefit clinical evaluation and management in patients suspected of CoA. TTE was valuable for post-operation follow-up and clinical management.
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Affiliation(s)
- Ting Gong
- Department of Ultrasound, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Feiyan Zhang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Lingxin Feng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhu
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Deng
- School of Medical Imaging, Changsha Medical University, Changsha, China
| | - Tingting Ran
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liling Li
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kong
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Xiaojuan Ji
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
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Apostolou F, Ioannides M, Mitsis A, Koutsofti C, Deltas C, Avraamides P. Case report: Aborted sudden cardiac death as a first presentation of severe mitral annulus disjunction-a case series and review of the literature. Front Cardiovasc Med 2023; 10:1171226. [PMID: 37547253 PMCID: PMC10400284 DOI: 10.3389/fcvm.2023.1171226] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Mitral annulus disjunction (MAD) is defined as a systolic displacement between the ventricular myocardium and the posterior mitral annulus supporting the posterior mitral leaflet. This structural abnormality is associated with the loss of mechanical annular function manifested as an abnormal systolic excursion of the leaflet hinge point into the left atrium but with maintained electrical function, separating the left atrium and ventricle electrophysiologically. The mitro-aortic fibrous continuity limits MAD anteriorly, between the aortic cusps and the anterior leaflet of the mitral valve. Consequently, MAD has been observed only at the insertion of the posterior leaflet. It can extend preferentially at the central posterior scallop. The first diagnostic modality aiding the diagnosis is transthoracic echocardiography (TTE), although in some cases adjunctive cardiac imaging modality might be suggested. MAD carries a strong association with malignant ventricular arrhythmogenesis and a profound predisposition for sudden cardiac death (SCD). In this context, a thorough investigation of this morphological and functional abnormality is vital in estimating the risk assessment and stratification for optimal management and elimination of the risk of the patient for SCD. Based on the current scientific data and literature, we will discuss the diagnosis, clinical implications, risk stratification, and therapeutic management of MAD.
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Affiliation(s)
- Fay Apostolou
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Marios Ioannides
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Andreas Mitsis
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Constantina Koutsofti
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus,Nicosia, Cyprus
| | - Constantinos Deltas
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus,Nicosia, Cyprus
- School of Medicine, University of Cyprus, Nicosia, Cyprus
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Hakgör A, Ceren Tokgöz Demircan H, Keskin B, Tanyeri S, Kültürsay B, Tosun A, Yaşar Akbal Ö, Külahçıoğlu Ş, Karagöz A, Türkday Derebey S, Bayram Z, Çağan Efe S, Doğan C, Halil Tanboğa İ, Özdemir N, Kaymaz C. A Novel Composed Index to Evaluate the Right Ventricle Free-Wall Adaptation Against Ventricular Wall Stress in Acute Pulmonary Embolism. Anatol J Cardiol 2023; 27:423-431. [PMID: 37288851 PMCID: PMC10339144 DOI: 10.14744/anatoljcardiol.2023.2677] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/27/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. METHODS Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). RESULTS This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P =.001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. CONCLUSIONS Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality.
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Affiliation(s)
- Aykun Hakgör
- Department of Cardiology, Medipol Mega University Hospital, İstanbul, Turkey
| | - Hacer Ceren Tokgöz Demircan
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Sevim Türkday Derebey
- Department of Cardiology, University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
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Kurnick A, Burkhanova U, Friedman A, John S, Bukharovich I. A Rare Case of Massive Left Atrial Myxoma Presenting as Syncope. Cureus 2023; 15:e41249. [PMID: 37529806 PMCID: PMC10388804 DOI: 10.7759/cureus.41249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
We report a rare case of a large left atrial myxoma that manifested as syncope in a patient who presented to the hospital following a syncopal episode. Our patient had a history of hypertension and anemia with reported two months of dyspnea on exertion. He was found to have a large left atrial myxoma. Atrial myxomas are the most common benign primary cardiac tumors. Patients may be asymptomatic or experience shortness of breath, palpitations, syncope, or sudden death. Cases of syncope caused by left atrial myxoma have been rarely documented. Our case report adds to the growing literature documenting this phenomenon. Larger observational studies are needed to properly define the incidence of left atrial myxoma causing syncope.
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Affiliation(s)
- Adam Kurnick
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Umida Burkhanova
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Adam Friedman
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
- Department of Cardiology, Kings County Hospital, Brooklyn, USA
| | - Inna Bukharovich
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
- Department of Cardiology, Kings County Hospital, Brooklyn, USA
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Batool S, Taj IA, Ghafoor M. Ejection Fraction Estimation from Echocardiograms Using Optimal Left Ventricle Feature Extraction Based on Clinical Methods. Diagnostics (Basel) 2023; 13:2155. [PMID: 37443550 DOI: 10.3390/diagnostics13132155] [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: 05/16/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Echocardiography is one of the imaging systems most often utilized for assessing heart anatomy and function. Left ventricle ejection fraction (LVEF) is an important clinical variable assessed from echocardiography via the measurement of left ventricle (LV) parameters. Significant inter-observer and intra-observer variability is seen when LVEF is quantified by cardiologists using huge echocardiography data. Machine learning algorithms have the capability to analyze such extensive datasets and identify intricate patterns of structure and function of the heart that highly skilled observers might overlook, hence paving the way for computer-assisted diagnostics in this field. In this study, LV segmentation is performed on echocardiogram data followed by feature extraction from the left ventricle based on clinical methods. The extracted features are then subjected to analysis using both neural networks and traditional machine learning algorithms to estimate the LVEF. The results indicate that employing machine learning techniques on the extracted features from the left ventricle leads to higher accuracy than the utilization of Simpson's method for estimating the LVEF. The evaluations are performed on a publicly available echocardiogram dataset, EchoNet-Dynamic. The best results are obtained when DeepLab, a convolutional neural network architecture, is used for LV segmentation along with Long Short-Term Memory Networks (LSTM) for the regression of LVEF, obtaining a dice similarity coefficient of 0.92 and a mean absolute error of 5.736%.
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Affiliation(s)
- Samana Batool
- Electrical Engineering, Capital University of Science and Technology, Islamabad Expressway, Kahuta Road, Islamabad 44000, Pakistan
| | - Imtiaz Ahmad Taj
- Electrical Engineering, Capital University of Science and Technology, Islamabad Expressway, Kahuta Road, Islamabad 44000, Pakistan
| | - Mubeen Ghafoor
- School of Computer Science, University of Lincoln, Brayford Way, Brayford, Pool, Lincoln LN6 7TS, UK
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Ran T, Feng L, Li M, Yi Q, Zhu X, Ji X. Clinical analysis and medium-term follow-up of simultaneous interventional therapy for compound congenital heart disease in children: a single-center retrospective study. Front Pediatr 2023; 11:1193136. [PMID: 37425280 PMCID: PMC10325865 DOI: 10.3389/fped.2023.1193136] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective This study aimed to explore the safety and efficacy of simultaneous interventional therapy for compound congenital heart disease (CCHD) in children. Methods In total, 155 children with CCHD who received simultaneous interventional therapy at the Children's Hospital of Chongqing Medical University between January 2007 and December 2021 were included in study. Data on clinical manifestations, transthoracic echocardiography, electrocardiogram, and follow-up were retrospectively analyzed. Results The most common type of CCHD was atrial septal defect (ASD) combined with ventricular septal defect (VSD), accounting for 32.3% of the patients. Simultaneous interventional therapy was successfully administered to 151 children (97.4%). The pulmonary gradient of patients with pulmonary stenosis decreased from 47.3 ± 21.9 mmHg to 15.2 ± 12.2 mmHg (P < 0.05) immediately after the procedure. One patient had failed PBPV as he had residual PS >40 mmHg post procedure. The right ventricular dimension and left ventricular end-diastolic dimension significantly decreased in the first month after the procedure in patients with ASD combined with VSD. Twenty-five (16.1%) patients had mild residual shunt, which spontaneously disappeared in more than half of these patients 6 months after the procedure. The major adverse events were minimal (n = 4, 2.58%), including one patient requiring drug treatment for complete atrioventricular block and three patients receiving surgical treatment because of cardiac erosion, anterior tricuspid valve chordae rupture, and hemolysis, respectively. Conclusions ASD combined with VSD is the most common type of CCHD in children, and simultaneous interventional therapy for CCHD in children is safe and effective with satisfactory results. Ventricular remodeling can be reversed in patients with ASD combined with VSD 1 month after the procedure. Most adverse events associated with interventional therapy are mild and manageable.
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Affiliation(s)
- Tingting Ran
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lingxin Feng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mi Li
- Department of Cardiovascular Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhu
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaojuan Ji
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
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Serban A, Dadarlat-Pop A, Achim A, Gavan D, Pepine D, Rancea R, Tomoaia R. Diagnosis of Left-Sided Mechanical Prosthetic Valve Thrombosis: A Pictorial Review. J Pers Med 2023; 13:967. [PMID: 37373956 DOI: 10.3390/jpm13060967] [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: 03/14/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Although transcatheter valve therapy is rapidly evolving, surgical valve replacement is still required in many patients with severe left-side valve stenosis or regurgitation, the mechanical bi-leaflet heart valve being the standard prosthesis type in younger patients. Moreover, the prevalence of valvular heart disease is steadily increasing, especially in industrialized countries, and the problem of lifelong efficient anticoagulation of these patients remains fundamental, especially in the context where vitamin K antagonists continue to be the current standard of anticoagulation despite a level of oscillating anticoagulation. In this setting, avoiding prosthetic valve thrombosis after surgery is the number one objective for both the patient and the responsible physicians. Although rare, this complication is life threatening, with the sudden onset of acute cardiac failure such as acute pulmonary edema, cardiogenic shock, or sudden cardiac death and inadequate anticoagulation remaining the leading cause of prosthesis thrombosis, along with other risk factors. The availability of multimodal imaging techniques enables and encompasses to a full extent the diagnosis of mechanical valve thrombosis. The gold-standard diagnostic methods are transthoracic and transesophageal echocardiography. Moreover, 3D ultrasound has undoubted value in giving a more accurate description of the thrombus's extension. When transthoracic and transesophageal echocardiography are uncertain, the multidetector computer tomography examination is an important complementary imaging method. Fluoroscopy is also an excellent tool for evaluating the mobility of prosthetic discs. Each method complements the other to differentiate an acute mechanical valve thrombosis from other prosthetic valve pathologies such as pannus formation or infective endocarditis and aids the physician in accurately establishing the treatment method (surgical or pharmaceutical) and its optimal timing. The aim of this pictorial review was to discuss from an imagistic perspective the mechanical prosthetic aortic and mitral valve thrombosis and to provide an overview of the essential role of non-invasive exploration in the treatment of this severe complication.
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Affiliation(s)
- Adela Serban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandra Dadarlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Dana Gavan
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Diana Pepine
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Raluca Rancea
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
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Ukita K, Egami Y, Nohara H, Kawanami S, Sugae H, Kawamura A, Nakamura H, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Predictors and outcomes of tricuspid regurgitation improvement after radiofrequency catheter ablation for persistent atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:1360-1366. [PMID: 37149757 DOI: 10.1111/jce.15919] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/12/2023] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). METHODS We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow-up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one-grade improvement of TR) and non-improvement of TR: IM group and Non-IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all-cause death) more than 12 months after the RFCA. RESULTS IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event-free survival than Non-IM group. CONCLUSIONS Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes.
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Affiliation(s)
- Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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Henriquez E, Fatima N, Sayabugari R, Nasim MH, Noorayingarath H, Bai K, Garcia A, Habib A, Patel TP, Shaikh F, Razzaq W, Abdin ZU, Gupta I. Transesophageal Echocardiography vs. Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Endocarditis. Cureus 2023; 15:e39996. [PMID: 37416006 PMCID: PMC10321677 DOI: 10.7759/cureus.39996] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Infective endocarditis is an infection of the inner layers of the heart, seen often in intravenous drug users and patients with valvular lesions or prosthetic heart valves. This entity has high mortality and morbidity. The most common causative microorganism is Staphylococcus aureus. In this comprehensive literature review, we focused on both Staphylococcus aureus infections, i.e., methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, demographics, use of transthoracic echocardiogram and/or transesophageal echocardiogram for diagnostics, and treatments. Although clinical criteria are relevant, transesophageal echocardiogram plays a vital role in establishing and identifying the presence of infective endocarditis and its local complications, with higher sensitivity in patients with prosthetic valves. The antibiotic selection posed a great challenge for clinicians due to antibiotic resistance and the aggressive nature of Staphylococcus aureus. Early diagnosis of infective endocarditis, when suspected, and effective management by a multispecialty team can improve the outcome for the patients.
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Affiliation(s)
- Elvis Henriquez
- Internal Medicine, University of Medical Sciences, Las Tunas, CUB
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | | | | | - Karoona Bai
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | | | - Ayesha Habib
- Internal Medicine, Punjab Medical College, Faisalabad, PAK
| | | | - Fouziya Shaikh
- Internal Medicine, Krishna Institute of Medical Sciences, Karad, IND
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Medicine, District Head Quarters Hospital, Faisalabad, PAK
| | - Ishita Gupta
- Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, IND
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Patnaik R, Krishna B, Sampath S. Correlation of Common Carotid Artery Blood Flow Parameters With Transthoracic Echocardiographic Cardiac Output for Assessing Fluid Responsiveness After Passive Leg Raising (PLR) Test in Critically Ill Patients. Cureus 2023; 15:e40229. [PMID: 37435241 PMCID: PMC10332793 DOI: 10.7759/cureus.40229] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction The passive leg raising (PLR) test is a simple, non-invasive method of knowing fluid responsiveness by acting as an internal-fluid challenge. The PLR test coupled with a non-invasive assessment of stroke volume would be the ideal method to assess fluid responsiveness. This study aimed to determine the correlation between transthoracic echocardiographic cardiac output (TTE-CO) and common carotid artery blood flow (CCABF) parameters in determining fluid responsiveness with the PLR test. Methods We performed a prospective observational study on 40 critically ill patients. Patients were evaluated with a 7-13 MHz linear transducer probe for CCABF parameters calculated using time-averaged mean velocity (TAmean) and with a 1-5 MHz cardiac probe equipped with tissue doppler imaging (TDI) for TTE-CO calculated using left ventricular outflow tract velocity time integral (LVOT VTI) with an apical five-chamber view. Two separate PLR tests (five minutes apart) were done within 48 hours of ICU admission. The first PLR test was to assess the effects on TTE-CO. The second PLR test was performed to assess the effects on CCABF parameters. Patients were designated as fluid responders (FR) if changes in TTE-CO (Δ TTE-CO) ≥ 10 %. Results A positive PLR test was observed in 33% of patients. A strong correlation was present between absolute values of TTE-CO calculated using LVOT VTI and the absolute values of CCABF calculated using TAmean (r=0.60, p<0.05). However, a weak correlation was found between Δ TTE-CO and changes in CCABF (Δ CCABF) during the PLR test (r=0.05, p<0.74). A positive PLR test response could not be detected by Δ CCABF (area under the curve (AUC): 0.59 ± 0.09). Conclusions We found a moderate correlation between TTE-CO and CCABF at baseline. However, Δ TTE-CO had a very poor correlation with Δ CCABF, during the PLR test. Considering this, CCABF parameters may not be recommended as a means to detect fluid responsiveness with PLR tests in critically ill patients.
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Affiliation(s)
- Rohit Patnaik
- Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Bhuvana Krishna
- Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, IND
| | - Sriram Sampath
- Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, IND
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Chotalia M, Patel JM, Bangash MN, Parekh D. Cardiovascular Subphenotypes in ARDS: Diagnostic and Therapeutic Implications and Overlap with Other ARDS Subphenotypes. J Clin Med 2023; 12:jcm12113695. [PMID: 37297890 DOI: 10.3390/jcm12113695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a highly heterogeneous clinical condition. Shock is a poor prognostic sign in ARDS, and heterogeneity in its pathophysiology may be a barrier to its effective treatment. Although right ventricular dysfunction is commonly implicated, there is no consensus definition for its diagnosis, and left ventricular function is neglected. There is a need to identify the homogenous subgroups within ARDS, that have a similar pathobiology, which can then be treated with targeted therapies. Haemodynamic clustering analyses in patients with ARDS have identified two subphenotypes of increasingly severe right ventricular injury, and a further subphenotype of hyperdynamic left ventricular function. In this review, we discuss how phenotyping the cardiovascular system in ARDS may align with haemodynamic pathophysiology, can aid in optimally defining right ventricular dysfunction and can identify tailored therapeutic targets for shock in ARDS. Additionally, clustering analyses of inflammatory, clinical and radiographic data describe other subphenotypes in ARDS. We detail the potential overlap between these and the cardiovascular phenotypes.
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Affiliation(s)
- Minesh Chotalia
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
| | - Jaimin M Patel
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
| | - Mansoor N Bangash
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
| | - Dhruv Parekh
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
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Kandels J, Metze M, Hagendorff A, Stöbe S. Impact of Aortic Valve Regurgitation on Doppler Echocardiographic Parameters in Patients with Severe Aortic Valve Stenosis. Diagnostics (Basel) 2023; 13:diagnostics13111828. [PMID: 37296679 DOI: 10.3390/diagnostics13111828] [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: 04/05/2023] [Revised: 05/06/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Diagnosing severe aortic stenosis (AS) depends on flow and pressure conditions. It is suspected that concomitant aortic regurgitation (AR) has an impact on the assessment of AS severity. The aim of this study was to analyze the impact of concomitant AR on Doppler-derived guideline criteria. We hypothesized that both transvalvular flow velocity (maxVAV) and the mean pressure gradient (mPGAV) will be affected by AR, whereas the effective orifice area (EOA) and the ratio between maximum velocity of the left ventricular outflow tract and transvalvular flow velocity (maxVLVOT/maxVAV) will not. Furthermore, we hypothesized that EOA (by continuity equation), and the geometric orifice area (GOA) (by planimetry using 3D transesophageal echocardiography, TEE), will not be affected by AR. METHODS AND RESULTS In this retrospective study, 335 patients (mean age 75.9 ± 9.8 years, 44% male) with severe AS (defined by EOA < 1.0 cm2) who underwent a transthoracic and transesophageal echocardiography were analyzed. Patients with a reduced left ventricular ejection fraction (LVEF < 53%) were excluded (n = 97). The remaining 238 patients were divided into four subgroups depending on AR severity, and they were assessed using pressure half time (PHT) method: no, trace, mild (PHT 500-750 ms), and moderate AR (PHT 250-500 ms). maxVAV, mPGAV and maxVLVOT/maxVAV were assessed in all subgroups. Among the four subgroups (no (n = 101), trace (n = 49), mild (n = 61) and moderate AR (n = 27)), no differences were obtained for EOA (no AR: 0.75 cm2 ± 0.15; trace AR: 0.74 cm2 ± 0.14; mild AR: 0.75 cm2 ± 0.14; moderate AR: 0.75 cm2 ± 0.15, p = 0.998) and GOA (no AR: 0.78 cm2 ± 0.20; trace AR: 0.79 cm2 ± 0.15; mild AR: 0.82 cm2 ± 0.19; moderate AR: 0.83 cm2 ± 0.14, p = 0.424). In severe AS with moderate AR, compared with patients without AR, maxVAV (p = 0.005) and mPGAV (p = 0.022) were higher, whereas EOA (p = 0.998) and maxVLVOT/maxVAV (p = 0.243) did not differ. The EOA was smaller than the GOA in AS patients with trace (0.74 cm2 ± 0.14 vs. 0.79 cm2 ± 0.15, p = 0.024), mild (0.75 cm2 ± 0.14 vs. 0.82 cm2 ± 0.19, p = 0.021), and moderate AR (0.75 cm2 ± 0.15 vs. 0.83 cm2 ± 0.14, p = 0.024). In 40 (17%) patients with severe AS, according to an EOA < 1.0 cm2, the GOA was ≥ 1.0 cm2. CONCLUSION In severe AS with moderate AR, the maxVAV and mPGAV are significantly affected by AR, whereas the EOA and maxVLVOT/maxVAV are not. These results highlight the potential risk of overestimating AS severity in combined aortic valve disease by only assessing transvalvular flow velocity and the mean pressure gradient. Furthermore, in cases of borderline EOA, of approximately 1.0 cm2, AS severity should be verified by determining the GOA.
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Affiliation(s)
- Joscha Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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