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Skaff AM, Lambert AN, Alsoufi B. Ventricular dysfunction in a low birthweight, premature neonate. J Thorac Cardiovasc Surg 2024; 167:1147-1151. [PMID: 37295644 DOI: 10.1016/j.jtcvs.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Adam M Skaff
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, Ky
| | - A Nicole Lambert
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, Ky
| | - Bahaaldin Alsoufi
- Department of Cardiothoracic Surgery, University of Louisville and Norton Children's Hospital, Louisville, Ky.
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Shiraga T, Makimoto H, Kohlmann B, Magnisali CE, Imai Y, Itani Y, Makimoto A, Schölzel F, Bejinariu A, Kelm M, Rana O. Improving Valvular Pathologies and Ventricular Dysfunction Diagnostic Efficiency Using Combined Auscultation and Electrocardiography Data: A Multimodal AI Approach. Sensors (Basel) 2023; 23:9834. [PMID: 38139680 PMCID: PMC10748155 DOI: 10.3390/s23249834] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Simple sensor-based procedures, including auscultation and electrocardiography (ECG), can facilitate early diagnosis of valvular diseases, resulting in timely treatment. This study assessed the impact of combining these sensor-based procedures with machine learning on diagnosing valvular abnormalities and ventricular dysfunction. Data from auscultation at three distinct locations and 12-lead ECGs were collected from 1052 patients undergoing echocardiography. An independent cohort of 103 patients was used for clinical validation. These patients were screened for severe aortic stenosis (AS), severe mitral regurgitation (MR), and left ventricular dysfunction (LVD) with ejection fractions ≤ 40%. Optimal neural networks were identified by a fourfold cross-validation training process using heart sounds and various ECG leads, and their outputs were combined using a stacking technique. This composite sensor model had high diagnostic efficiency (area under the receiver operating characteristic curve (AUC) values: AS, 0.93; MR, 0.80; LVD, 0.75). Notably, the contribution of individual sensors to disease detection was found to be disease-specific, underscoring the synergistic potential of the sensor fusion approach. Thus, machine learning models that integrate auscultation and ECG can efficiently detect conditions typically diagnosed via imaging. Moreover, this study highlights the potential of multimodal artificial intelligence applications.
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Affiliation(s)
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
- Data Science Center/Cardiovascular Center, Jichi Medical University, Shimotsuke-City 329-0498, Japan
| | - Benita Kohlmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
| | - Christofori-Eleni Magnisali
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
| | - Yoshie Imai
- Mitsubishi Electric Inc., Kamakura 247-0056, Japan
| | - Yusuke Itani
- Mitsubishi Electric Inc., Kamakura 247-0056, Japan
| | - Asuka Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
| | - Fabian Schölzel
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
| | - Alexandru Bejinariu
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
- CARID—Cardiovascular Research Institute Düsseldorf, 40225 Düsseldorf, Germany
| | - Obaida Rana
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (B.K.); (O.R.)
- CARID—Cardiovascular Research Institute Düsseldorf, 40225 Düsseldorf, Germany
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3
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Marcoux E, Sosnowski D, Ninni S, Mackasey M, Cadrin-Tourigny J, Roberts JD, Olesen MS, Fatkin D, Nattel S. Genetic Atrial Cardiomyopathies: Common Features, Specific Differences, and Broader Relevance to Understanding Atrial Cardiomyopathy. Circ Arrhythm Electrophysiol 2023; 16:675-698. [PMID: 38018478 DOI: 10.1161/circep.123.003750] [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] [Indexed: 11/30/2023]
Abstract
Atrial cardiomyopathy is a condition that causes electrical and contractile dysfunction of the atria, often along with structural and functional changes. Atrial cardiomyopathy most commonly occurs in conjunction with ventricular dysfunction, in which case it is difficult to discern the atrial features that are secondary to ventricular dysfunction from those that arise as a result of primary atrial abnormalities. Isolated atrial cardiomyopathy (atrial-selective cardiomyopathy [ASCM], with minimal or no ventricular function disturbance) is relatively uncommon and has most frequently been reported in association with deleterious rare genetic variants. The genes involved can affect proteins responsible for various biological functions, not necessarily limited to the heart but also involving extracardiac tissues. Atrial enlargement and atrial fibrillation are common complications of ASCM and are often the predominant clinical features. Despite progress in identifying disease-causing rare variants, an overarching understanding and approach to the molecular pathogenesis, phenotypic spectrum, and treatment of genetic ASCM is still lacking. In this review, we aim to analyze the literature relevant to genetic ASCM to understand the key features of this rather rare condition, as well as to identify distinct characteristics of ASCM and its arrhythmic complications that are related to specific genotypes. We outline the insights that have been gained using basic research models of genetic ASCM in vitro and in vivo and correlate these with patient outcomes. Finally, we provide suggestions for the future investigation of patients with genetic ASCM and improvements to basic scientific models and systems. Overall, a better understanding of the genetic underpinnings of ASCM will not only provide a better understanding of this condition but also promises to clarify our appreciation of the more commonly occurring forms of atrial cardiomyopathy associated with ventricular dysfunction.
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Affiliation(s)
- Edouard Marcoux
- Research Center, Montreal Heart Institute, Université de Montréal. (E.M., D.S., S. Ninni, M.M., S. Nattel)
- Faculty of Pharmacy, Université de Montréal. (E.M.)
| | - Deanna Sosnowski
- Research Center, Montreal Heart Institute, Université de Montréal. (E.M., D.S., S. Ninni, M.M., S. Nattel)
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada (D.S., M.M., S. Nattel)
| | - Sandro Ninni
- Research Center, Montreal Heart Institute, Université de Montréal. (E.M., D.S., S. Ninni, M.M., S. Nattel)
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, France (S. Ninni)
| | - Martin Mackasey
- Research Center, Montreal Heart Institute, Université de Montréal. (E.M., D.S., S. Ninni, M.M., S. Nattel)
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada (D.S., M.M., S. Nattel)
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal. (J.C.-T.)
| | - Jason D Roberts
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Canada (J.D.R.)
| | - Morten Salling Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (M.S.O.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst (D.F.)
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington (D.F.)
- Department of Cardiology, St Vincent's Hospital, Darlinghurst, NSW, Australia (D.F.)
| | - Stanley Nattel
- Research Center, Montreal Heart Institute, Université de Montréal. (E.M., D.S., S. Ninni, M.M., S. Nattel)
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal. (S. Nattel.)
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada (D.S., M.M., S. Nattel)
- Institute of Pharmacology. West German Heart and Vascular Center, University Duisburg-Essen, Germany (S. Nattel)
- IHU LYRIC & Fondation Bordeaux Université de Bordeaux, France (S. Nattel)
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4
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Soulaidopoulos S, Xintarakou A, Vogiatzakis N, Doundoulakis I, Arsenos P, Archontakis S, Antoniou CK, Drakopoulou M, Kordalis A, Skiadas I, Tsiachris D, Dilaveris P, Sideris S, Xydis P, Tsioufis K, Gatzoulis KA. Atrial fibrillation: An early marker of ventricular myocardial dysfunction. Kardiol Pol 2023; 82:86-89. [PMID: 37997827 DOI: 10.33963/v.kp.97492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Stergios Soulaidopoulos
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Xintarakou
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vogiatzakis
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Doundoulakis
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Arsenos
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Maria Drakopoulou
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Kordalis
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Skiadas
- State Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | | | - Polychronis Dilaveris
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Skevos Sideris
- State Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Xydis
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A Gatzoulis
- 1st Department of Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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5
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Bove T, Grootjans E, Naessens R, Martens T, De Wolf D, Vandekerckhove K, Panzer J, De Groote K, De Backer J, Demulier L, François K. Long-term follow-up of atrioventricular valve function in Fontan patients: effect of atrioventricular valve surgery. Eur J Cardiothorac Surg 2023; 64:ezad305. [PMID: 37682065 DOI: 10.1093/ejcts/ezad305] [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: 02/17/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between atrioventricular valve and ventricular function in Fontan survivors, including the effect of atrioventricular valve surgery. METHODS Analysis focused on transplant-free survival and the need for atrioventricular valve surgery in single ventricle patients after Fontan completion. Longitudinal echocardiographic examination of long-term valve and ventricular function was performed. RESULTS Fontan completion was performed in 113 patients, having a right univentricular morphology in 33.6%, a left ventricle morphology in 62.8% and ambiguous in 3.6%. Perioperative mortality was 2.7% (n = 3). Within a median follow-up of 16.3 years (interquartile range 10.6-23.6), transplant-free survival was 96.1 ± 1.9% and 90.4 ± 5.8% at 10-25 years. Twenty AV valve procedures were performed in 14 (12.4%) children, respectively, pre-Fontan (n = 10), per-Fontan (n = 8) and post-Fontan (n = 2), resulting in a cumulative incidence of AV valve surgery is 5.7 ± 2.2% and 12.3 ± 3.2% at 1-5 years. Atrio-ventricular valve function deteriorated over time [hazard ratio (HR) 1.112, 95% confidence interval (CI) 1.089-1.138, P < 0.001], without difference for valve morphology (P = 0.736) or ventricular dominance (P = 0.484). AV valve dysfunction was greater in patients requiring AV valve surgery (HR 20.383, 95% CI 6.223-36.762, P < 0.001) but showed a comparable evolution since repair to those without valve surgery (HR 1.070, 95% CI 0.987-1.160, P = 0.099). Progressive time-related ventricular dysfunction was observed (HR 1.141, 95% CI 1.097-1.182, P < 0.001), significantly less in left ventricle-dominance (HR 0.927, 95% CI 0.860-0.999, P = 0.047) but more after AV valve surgery (HR 1.103, 95% CI 1.014-1.167, P = 0.022). CONCLUSIONS In a homogeneously treated Fontan population, 25-year transplant-free survival is encouraging. Atrio-ventricular valve surgery was necessary in 12.4%, resulting mostly in a durable valve function. However, a slow time-related decline of atrioventricular valve function as of ventricular function is worrisome, evoking a role for additional heart failure therapy.
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Affiliation(s)
- Thierry Bove
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Eva Grootjans
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Romanie Naessens
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Thomas Martens
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | | | - Joseph Panzer
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Laurent Demulier
- Department of Adult Congenital Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
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6
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Stack KO, Schluger C, Roberts AL, Lawrence K, Balsara S, Hunt M, Kaplinski M, Gardner MM, Ravishankar C, Rossano J, Goldberg DJ, Mahle M, O'Connor MJ, Mascio CE, Gaynor JW, Burstein D. Impact of Ventricular Dysfunction and Atrioventricular Valve Regurgitation on Pre-Fontan Attrition. Ann Thorac Surg 2023; 116:778-785. [PMID: 37429514 DOI: 10.1016/j.athoracsur.2023.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND There is a significant incidence of pre-Fontan attrition-defined as failure to undergo Fontan completion-after superior cavopulmonary connection. This study investigated the impact of at least moderate ventricular dysfunction (VD) and atrioventricular valve regurgitation (AVVR) on pre-Fontan attrition. METHODS This single-center retrospective cohort study included all infants who underwent Norwood palliation from 2008 to 2020 and subsequently underwent superior cavopulmonary connection. Pre-Fontan attrition was defined as death, listing for heart transplantation before Fontan completion, or unsuitability for Fontan completion. The study's secondary outcome was transplant-free survival. RESULTS Pre-Fontan attrition occurred in 34 of 267 patients (12.7%). Isolated VD was not associated with attrition. However, patients with isolated AVVR had 5 times the odds of attrition (odds ratio, 5.4; 95% CI 1.8-16.2), and patients with both VD and AVVR had 20 times the odds of attrition (odds ratio, 20.1; 95% CI 7.7-52.8) compared with patients without VD or AVVR. Only patients with both VD and AVVR had significantly worse transplant-free survival compared with patients without VD or AVVR (hazard ratio, 7.7; 95% CI 2.8-21.6). CONCLUSIONS The additive effect of VD and AVVR is a powerful contributor to pre-Fontan attrition. Future research investigating therapies that can mitigate the degree of AVVR may help improve Fontan completion rates and long-term outcomes.
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Affiliation(s)
- Kathryn O Stack
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Charlotte Schluger
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy L Roberts
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kendall Lawrence
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sheri Balsara
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mallory Hunt
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Kaplinski
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Monique M Gardner
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Cardiac Critical Care, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chitra Ravishankar
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Rossano
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David J Goldberg
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marlene Mahle
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher E Mascio
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle Burstein
- Division of Pediatric Cardiology, Department of Pediatrics, Larner College of Medicine at University of Vermont, Burlington, Vermont
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7
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Cetta F, Stephens EH. Attrition Before Fontan vs Creating a Bad Fontan: The Dilemma. Ann Thorac Surg 2023; 116:785-786. [PMID: 37541562 DOI: 10.1016/j.athoracsur.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Frank Cetta
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55902.
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8
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Akgöl G, Gülkesen A, Uslu EY, Alkan G, Bolayır HA, Gelen MA, Uslu MF. Can myocardial dysfunction be detected in patients with rheumatoid arthritis with no cardiac symptoms? Eur Rev Med Pharmacol Sci 2023; 27:4399-4405. [PMID: 37259720 DOI: 10.26355/eurrev_202305_32445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The aim of our study was to investigate the role of tissue Doppler and Myocardial Performance Index (MPI) in evaluating cardiac involvement in patients with rheumatoid arthritis (RA) with no cardiac symptoms, to determine whether these measurements differ between healthy controls and RA patients, and whether they can be used to determine the risk of cardiovascular disease and predict prognosis. PATIENTS AND METHODS 50 RA patients fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA criteria and 50 healthy volunteering controls were included in the study. All patients and controls were assessed using electrocardiography (ECG), echocardiography, conventional Doppler echocardiography and tissue Doppler echocardiography. MPI values were calculated. In addition, RA patients were compared after being divided into two subgroups: seropositive and seronegative RA. Disease activity levels of the patients were determined based on Disease Activity Score in 28 Joints (DAS28). RESULTS The control group and RA group were compared in terms of PR interval, left atrial diameter, E/A, E/e', and MPI values. Comparisons between the groups yielded statistically significant differences in left atrial diameter, E/A, E/e', and MPI values and no significant difference in PR intervals. These parameters were also compared between seropositive and seronegative patients. Left atrial diameter was significantly higher in seronegative patients than in seropositive patients. There was no significant difference in the other values. DAS28 scores had no correlation with cardiac parameters. CONCLUSIONS Early detection of ventricular dysfunction in RA may be useful in clinical practice when predicting prognosis and optimizing treatment. The present study found that RA patients had impaired tissue Doppler measurements and MPI results compared to controls. MPI and tissue Doppler may be useful in early detection of ventricular dysfunction.
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Affiliation(s)
- G Akgöl
- Department of Physical Medicine and Rehabilitation, Firat University, Elazig, Turkey.
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9
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Candanedo Ocaña F, Martín Toro MA, Camacho Jurado FJ, Martín Hidalgo M, González Pérez PJ, Herruzo Rojas MS, Morales Ponce FJ. Left bundle branch block and severe ventricular dysfunction due to flecainide toxicity: a case report. Emergencias 2023; 35:159-160. [PMID: 37038953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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10
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Rowland EM, Riemer K, Lichtenstein K, Tang MX, Weinberg PD. Non-invasive Assessment by B-Mode Ultrasound of Arterial Pulse Wave Intensity and Its Reduction During Ventricular Dysfunction. Ultrasound Med Biol 2023; 49:473-488. [PMID: 36335055 DOI: 10.1016/j.ultrasmedbio.2022.09.016] [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] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Arterial pulse waves contain clinically useful information about cardiac performance, arterial stiffness and vessel tone. Here we describe a novel method for non-invasively assessing wave properties, based on measuring changes in blood flow velocity and arterial wall diameter during the cardiac cycle. Velocity and diameter were determined by tracking speckles in successive B-mode images acquired with an ultrafast scanner and plane-wave transmission. Blood speckle was separated from tissue by singular value decomposition and processed to correct biases in ultrasound imaging velocimetry. Results obtained in the rabbit aorta were compared with a conventional analysis based on blood velocity and pressure, employing measurements obtained with a clinical intra-arterial catheter system. This system had a poorer frequency response and greater lags but the pattern of net forward-traveling and backward-traveling waves was consistent between the two methods. Errors in wave speed were also similar in magnitude, and comparable reductions in wave intensity and delays in wave arrival were detected during ventricular dysfunction. The non-invasive method was applied to the carotid artery of a healthy human participant and gave a wave speed and patterns of wave intensity consistent with earlier measurements. The new system may have clinical utility in screening for heart failure.
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Affiliation(s)
- Ethan M Rowland
- Department of Bioengineering, Imperial College London, London, UK
| | - Kai Riemer
- Department of Bioengineering, Imperial College London, London, UK
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, UK
| | - Peter D Weinberg
- Department of Bioengineering, Imperial College London, London, UK.
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11
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Rudiktyo E, Yonas E, Cramer MJ, Siswanto BB, Doevendans PA, Soesanto AM. Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation. Glob Heart 2023; 18:15. [PMID: 36936249 PMCID: PMC10022539 DOI: 10.5334/gh.1192] [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: 09/20/2022] [Accepted: 02/16/2023] [Indexed: 03/19/2023] Open
Abstract
Background Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established. Purpose Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR. Methods The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation. Results The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3). Conclusions Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Emir Yonas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Maarten J. Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bambang B. Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A. Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Central Military Hospital Utrecht, the Netherlands
- Netherlands Heart Institute Utrecht the Netherlands
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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12
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Pola K, Bergström E, Töger J, Rådegran G, Arvidsson PM, Carlsson M, Arheden H, Ostenfeld E. Increased biventricular hemodynamic forces in precapillary pulmonary hypertension. Sci Rep 2022; 12:19933. [PMID: 36402861 PMCID: PMC9675772 DOI: 10.1038/s41598-022-24267-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Precapillary pulmonary hypertension (PHprecap) is a condition with elevated pulmonary vascular pressure and resistance. Patients have a poor prognosis and understanding the underlying pathophysiological mechanisms is crucial to guide and improve treatment. Ventricular hemodynamic forces (HDF) are a potential early marker of cardiac dysfunction, which may improve evaluation of treatment effect. Therefore, we aimed to investigate if HDF differ in patients with PHprecap compared to healthy controls. Patients with PHprecap (n = 20) and age- and sex-matched healthy controls (n = 12) underwent cardiac magnetic resonance imaging including 4D flow. Biventricular HDF were computed in three spatial directions throughout the cardiac cycle using the Navier-Stokes equations. Biventricular HDF (N) indexed to stroke volume (l) were larger in patients than controls in all three directions. Data is presented as median N/l for patients vs controls. In the RV, systolic HDF diaphragm-outflow tract were 2.1 vs 1.4 (p = 0.003), and septum-free wall 0.64 vs 0.42 (p = 0.007). Diastolic RV HDF apex-base were 1.4 vs 0.87 (p < 0.0001), diaphragm-outflow tract 0.80 vs 0.47 (p = 0.005), and septum-free wall 0.60 vs 0.38 (p = 0.003). In the LV, systolic HDF apex-base were 2.1 vs 1.5 (p = 0.005), and lateral wall-septum 1.5 vs 1.2 (p = 0.02). Diastolic LV HDF apex-base were 1.6 vs 1.2 (p = 0.008), and inferior-anterior 0.46 vs 0.24 (p = 0.02). Hemodynamic force analysis conveys information of pathological cardiac pumping mechanisms complementary to more established volumetric and functional parameters in precapillary pulmonary hypertension. The right ventricle compensates for the increased afterload in part by augmenting transverse forces, and left ventricular hemodynamic abnormalities are mainly a result of underfilling rather than intrinsic ventricular dysfunction.
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Affiliation(s)
- Karin Pola
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Elsa Bergström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johannes Töger
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, and Skåne University Hospital, Section of Heart Failure and Valvular Disease, Lund University, Lund, Sweden
| | - Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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13
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Çamci S, Yilmaz E, Yakarişik M. The effect of L-thyroxine treatment on ventricular dysfunction and pulmonary arterial stiffness in patients with subclinical hypothyroidism. Eur Rev Med Pharmacol Sci 2022; 26:7036-7045. [PMID: 36263551 DOI: 10.26355/eurrev_202210_29887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE In our study, we aimed at evaluating the change in biventricular functions and pulmonary arterial stiffness (PAS) in patients with subclinical hypothyroidism (SH) in whom euthyroidism was achieved with L-thyroxine therapy. PATIENTS AND METHODS 70 SH patients and 75 healthy volunteers were included in our study consecutively. Baseline demographic and echocardiographic data of the participants were recorded. The data obtained in the control evaluation 6 months after the euthyroidism were achieved in the SH group patients started on L-thyroxine treatment and then compared with the baseline measurements. RESULTS The mean age of patients in the SH group was 44.1 ± 9.4 years and 47.1% were women. Euthyroidism in SH patients was achieved with a mean daily L-thyroxine treatment of 59 µg/day for a mean of 16.1 ± 4.5 weeks. Positive changes in metabolic and hormonal profiles were achieved after L-thyroxine treatment in SH patients. It was determined that left ventricular and right ventricular isovolumetric relaxation and myocardial performance index were higher in SH patients compared to the control group, and these measurements were observed to decrease significantly with L-thyroxine treatment (p < 0.05 for each). While PAS was 16.9 ± 3.1 kHz/ms in the control group, it was 25.2 ± 5.3 kHz/ms in the SH group (p < 0.05). After L-thyroxine treatment, PAS measurements decreased to 17.2 ± 3.2 kHz/ms (p < 0.05) in the SH group and showed a positive change. Thyroid-stimulating hormone (TSH) change (Δ TSH) with Δ E/A ratio (r: -0.407, p < 0.001), right ventricular myocardial performance index (Δ RV MPI) change (r: 0.404, p < 0.001) and PAS change (Δ PAS) (r: 0.458, p < 0.001) found to be correlated. CONCLUSIONS SH is associated with dysfunction in the biventricular and pulmonary vascular bed. Biventricular functions and PAS change positively in SH patients with L-thyroxine treatment.
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Affiliation(s)
- S Çamci
- Department of Cardiology, Department of Internal Medicine, Faculty of Medicine, Giresun University, Giresun, Turkey.
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14
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Ridjab DA, Ivan I, Budiman F, Tenggara R. Evaluation of subclinical ventricular systolic dysfunction assessed using global longitudinal strain in liver cirrhosis: A systematic review, meta-analysis, and meta-regression. PLoS One 2022; 17:e0269691. [PMID: 35671306 PMCID: PMC9173645 DOI: 10.1371/journal.pone.0269691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Global longitudinal strain (GLS) can identify subclinical myocardial dysfunction in patients with cirrhosis. This systematic review aims to provide evidence of a possible difference in GLS values between patients with cirrhosis and patients without cirrhosis. Studies from inception to August 11, 2021, were screened and included based on the inclusion criteria. The Newcastle Ottawa Scale was used to assess the quality of nonrandomized studies. Meta-analyses were conducted with subsequent sensitivity and subgroup analyses according to age, sex, cirrhosis etiology, and severity. Publication bias was evaluated using Begg’s funnel plot, Egger’s test, and rank correlation test with subsequent trim-and-fill analysis. The systematic database search yielded 20 eligible studies. Random effect showed a significant reduction of left ventricular (LV) GLS (MD:-1.43;95%; 95%CI,-2.79 to -0.07; p = 0.04; I2 = 95% p<0.00001) and right ventricular (RV) GLS (MD:-1.95; 95%CI,-3.86 to -0.05, p = 0.04; I2 = 90%, p<0.00001) in the group with cirrhosis. A sensitivity test on subgroup analysis based on the study design showed a -1.78% lower LV-GLS in the group with cirrhosis (I2 = 70%, p = 0.0003). Meta-regression analysis showed that the severity of cirrhosis was significantly related to GLS reduction. This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors. The study protocol was registered at PROSPERO (CRD42020201630). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guidelines.
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Affiliation(s)
- Denio A. Ridjab
- Department of Medical Education Unit, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- * E-mail:
| | - Ignatius Ivan
- Fifth Year Medical Student, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Fanny Budiman
- Fifth Year Medical Student, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Riki Tenggara
- Department of Internal Medicine, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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15
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Arvind B, Devagourou V, Saxena A. Unique Association of Aortopulmonary Window With Anomalous Origin of Left Coronary Artery From Pulmonary Artery in an Infant: A Blessing in Disguise? World J Pediatr Congenit Heart Surg 2021; 13:401-403. [PMID: 34931907 DOI: 10.1177/21501351211060033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortopulmonary window (APW) seen in association with anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is extremely uncommon. When faced with this combination, ALCAPA usually goes undetected since most of the clinical and echocardiographic features of ALCAPA, including ventricular dysfunction are absent due to co-existent pulmonary hypertension. Herein we report a 5-month-old child with a large APW in whom a preoperative computed tomography angiogram facilitated the diagnosis of ALCAPA. The case is described for its rarity and the challenges faced during management. Also, it is extremely crucial that this coronary anomaly is identified and corrected during surgery, since failure to do so results in unforeseen postoperative ventricular dysfunction.
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Affiliation(s)
- Balaji Arvind
- Department of Cardiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, 28730All India Institute of Medical Sciences, New Delhi, India
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16
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Affiliation(s)
- David G Tingay
- Neonatal ResearchMurdoch Children's Research InstituteParkville, Australia
- NeonatologyThe Royal Children's HospitalParkville, Australia
- Department of PaediatricsUniversity of MelbourneMelbourne, Australia
| | - John P Kinsella
- Department of PediatricsUniversity of Colorado School of MedicineAurora, Coloradoand
- Children's Hospital ColoradoAurora, Colorado
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17
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Diarte-Añazco EMG, Méndez-Lara KA, Pérez A, Alonso N, Blanco-Vaca F, Julve J. Novel Insights into the Role of HDL-Associated Sphingosine-1-Phosphate in Cardiometabolic Diseases. Int J Mol Sci 2019; 20:ijms20246273. [PMID: 31842389 PMCID: PMC6940915 DOI: 10.3390/ijms20246273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023] Open
Abstract
Sphingolipids are key signaling molecules involved in the regulation of cell physiology. These species are found in tissues and in circulation. Although they only constitute a small fraction in lipid composition of circulating lipoproteins, their concentration in plasma and distribution among plasma lipoproteins appears distorted under adverse cardiometabolic conditions such as diabetes mellitus. Sphingosine-1-phosphate (S1P), one of their main representatives, is involved in regulating cardiomyocyte homeostasis in different models of experimental cardiomyopathy. Cardiomyopathy is a common complication of diabetes mellitus and represents a main risk factor for heart failure. Notably, plasma concentration of S1P, particularly high-density lipoprotein (HDL)-bound S1P, may be decreased in patients with diabetes mellitus, and hence, inversely related to cardiac alterations. Despite this, little attention has been given to the circulating levels of either total S1P or HDL-bound S1P as potential biomarkers of diabetic cardiomyopathy. Thus, this review will focus on the potential role of HDL-bound S1P as a circulating biomarker in the diagnosis of main cardiometabolic complications frequently associated with systemic metabolic syndromes with impaired insulin signaling. Given the bioactive nature of these molecules, we also evaluated its potential of HDL-bound S1P-raising strategies for the treatment of cardiometabolic disease.
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Affiliation(s)
- Elena M. G. Diarte-Añazco
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain;
| | - Karen Alejandra Méndez-Lara
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain;
- Correspondence: (K.A.M.-L.); (F.B.-V.); (J.J.)
| | - Antonio Pérez
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain;
- Centro de Investigación Biomédica en Red (CIBER) de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, 28029 Madrid, Spain;
- Servei d’Endocrinologia, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08041 Barcelona, Spain
| | - Núria Alonso
- Centro de Investigación Biomédica en Red (CIBER) de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, 28029 Madrid, Spain;
- Servei d’Endocrinologia, Hospital Universitari Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain
| | - Francisco Blanco-Vaca
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain;
- Centro de Investigación Biomédica en Red (CIBER) de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, 28029 Madrid, Spain;
- Servei de Bioquímica, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08041 Barcelona, Spain
- Correspondence: (K.A.M.-L.); (F.B.-V.); (J.J.)
| | - Josep Julve
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, and Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona), Spain;
- Centro de Investigación Biomédica en Red (CIBER) de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, 28029 Madrid, Spain;
- Correspondence: (K.A.M.-L.); (F.B.-V.); (J.J.)
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18
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19
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Chopra VK, Mittal S, Bansal M, Singh B, Trehan N. Clinical profile and one-year survival of patients with heart failure with reduced ejection fraction: The largest report from India. Indian Heart J 2019; 71:242-248. [PMID: 31543197 PMCID: PMC6796637 DOI: 10.1016/j.ihj.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/25/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND India has one of the largest population of heart failure (HF) patients in the world; yet only limited information is available about HF in India. METHODS This observational study was performed at Medanta- The Medicity, a large, tertiary-care institute in the National Capital Region of India. Records of HF patients with reduced left ventricular ejection fraction (LVEF) registered at Medanta HF clinic during the period early 2014 to mid-2017 were reviewed. Disease characteristics and one-year mortality details were collected. RESULTS Mean age of the subjects (n = 5590) was 59.1 ± 11.8 years with 83.0% males. Mean LVEF was 30.0 ± 6.6%. Coronary artery disease (CAD) was the dominant cause of HF, accounting for 77.8% of the total population. Most patients received guideline-directed medical therapy with a beta blocker being prescribed to 81.8% subjects. The one-year all-cause mortality was 17.6%. On multivariate analysis, age, usage of loop diuretics and ivabradine, and serum creatinine were independently associated with one-year mortality, whereas rheumatic etiology had an inverse association. CONCLUSIONS This represents the largest single-center data of HF patients reported so far and the largest study describing clinical outcomes from HF patients in India. Our patients were younger, had high proportion of CAD, and there was higher usage of beta-blockers. Despite this, the one-year mortality was substantial. Given the enormous magnitude of HF burden in India and the paucity of information on this subject, these findings should be of help in identifying key problem areas and potential solutions for management of HF in India.
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Affiliation(s)
| | - Sanjay Mittal
- Clinical Cardiology and Research, Medanta - The Medicity, Gurgaon, India
| | | | - Balbir Singh
- Cardiac Electrophysiology, Medanta - The Medicity, Gurgaon, India
| | - Naresh Trehan
- Cardiothoracic Surgery, Medanta - The Medicity, Gurgaon, India
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20
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Wagner J, Agostoni P, Arena R, Belardinelli R, Dumitrescu D, Hager A, Myers J, Rauramaa R, Riley M, Takken T, Schmidt-Trucksäss A. The Role of Gas Exchange Variables in Cardiopulmonary Exercise Testing for Risk Stratification and Management of Heart Failure with Reduced Ejection Fraction. Am Heart J 2018; 202:116-126. [PMID: 29933148 DOI: 10.1016/j.ahj.2018.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/18/2018] [Indexed: 01/14/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is common in the developed world and results in significant morbidity and mortality. Accurate risk assessment methods and prognostic variables are therefore needed to guide clinical decision making for medical therapy and surgical interventions with the ultimate goal of decreasing risk and improving health outcomes. The purpose of this review is to examine the role of cardiopulmonary exercise testing (CPET) and its most commonly used ventilatory gas exchange variables for the purpose of risk stratification and management of HFrEF. We evaluated five widely studied gas exchange variables from CPET in HFrEF patients based on nine previously used systematic criteria for biomarkers. This paper provides clinicians with a comprehensive and critical overview, class recommendations and evidence levels. Although some CPET variables met more criteria than others, evidence supporting the clinical assessment of variables beyond peak V̇O2 is well-established. A multi-variable approach also including the V̇E-V̇CO2 slope and EOV is therefore recommended.
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Affiliation(s)
- Jonathan Wagner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy & Department of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Romualdo Belardinelli
- Department of Cardiovascular Sciences, Cardiac Rehabilitation Lancisi, Ancona, Italy
| | - Daniel Dumitrescu
- Herzzentrum der Universitaet zu Koeln, Klinik III fuer Innere Medizin, Cologne, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technical University of Munich, Germany
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System and Stanford University, Palo Alto, CA
| | - Rainer Rauramaa
- Foundation for Research in Health, Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Marshall Riley
- Department of Medicine, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Tim Takken
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
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21
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Li JG, Xu H. Should Beta-Blockers Be Routinely Prescribed for Myocardial Infarction Without Heart Failure or Ventricular Dysfunction? J Am Coll Cardiol 2017; 70:1685-1686. [PMID: 28935047 DOI: 10.1016/j.jacc.2017.07.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
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22
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Martin AP, Skinner JR. Ventricular extrasystoles and ventricular dysfunction: Too close for comfort? Heart Rhythm 2016; 13:2149-2150. [PMID: 27496585 DOI: 10.1016/j.hrthm.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew P Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand; Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Child Health, University of Auckland, Auckland, New Zealand.
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23
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Nitta CH, Osmond DA, Herbert LM, Beasley BF, Resta TC, Walker BR, Jernigan NL. Role of ASIC1 in the development of chronic hypoxia-induced pulmonary hypertension. Am J Physiol Heart Circ Physiol 2014; 306:H41-52. [PMID: 24186095 PMCID: PMC3920158 DOI: 10.1152/ajpheart.00269.2013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 03/29/2013] [Accepted: 10/30/2013] [Indexed: 11/22/2022]
Abstract
Chronic hypoxia (CH) associated with respiratory disease results in elevated pulmonary vascular intracellular Ca(2+) concentration, which elicits enhanced vasoconstriction and promotes vascular arterial remodeling and thus has important implications in the development of pulmonary hypertension (PH). Store-operated Ca(2+) entry (SOCE) contributes to this elevated intracellular Ca(2+) concentration and has also been linked to acute hypoxic pulmonary vasoconstriction (HPV). Since our laboratory has recently demonstrated an important role for acid-sensing ion channel 1 (ASIC1) in mediating SOCE, we hypothesized that ASIC1 contributes to both HPV and the development of CH-induced PH. To test this hypothesis, we examined responses to acute hypoxia in isolated lungs and assessed the effects of CH on indexes of PH, arterial remodeling, and vasoconstrictor reactivity in wild-type (ASIC1(+/+)) and ASIC1 knockout (ASIC1(-/-)) mice. Restoration of ASIC1 expression in pulmonary arterial smooth muscle cells from ASIC1(-/-) mice rescued SOCE, confirming the requirement for ASIC1 in this response. HPV responses were blunted in lungs from ASIC1(-/-) mice. Both SOCE and receptor-mediated Ca(2+) entry, along with agonist-dependent vasoconstrictor responses, were diminished in small pulmonary arteries from control ASIC(-/-) mice compared with ASIC(+/+) mice. The effects of CH to augment receptor-mediated vasoconstrictor and SOCE responses in vessels from ASIC1(+/+) mice were not observed after CH in ASIC1(-/-) mice. In addition, ASIC1(-/-) mice exhibited diminished right ventricular systolic pressure, right ventricular hypertrophy, and arterial remodeling in response to CH compared with ASIC1(+/+) mice. Taken together, these data demonstrate an important role for ASIC1 in both HPV and the development of CH-induced PH.
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Affiliation(s)
- Carlos H Nitta
- Vascular Physiology Group, Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Smirnova EA, Terekhina OL, Matzievski DD, Antipova TA, Kobozeva LP, Michunskaya AB, Pozdnyakov OM, Kruglov SV, Bakhtina LY. [Effect of the alloxane diabetes on the cardio-vascular system function and lipid peroxidation in rats of different genetic strains]. Patol Fiziol Eksp Ter 2014:37-43. [PMID: 25051682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We have previously shown that the innate increased activity of the NO- system, typical for the August rats, increases vulnerability to alloxane diabetes (ALD). The purpose of this study was to investigate the effect of ALD on the cardiovascular system and lipid peroxidation in rats with different activity of NO-system. The August rats and Wistar rats treated with alloxan (125 mg/kg, s/c, once) were studied 3.5 months after. In August-ALD the double production significantly decreased to a greater extent (by 35%) than in Wistar-ALD (by 17%) compared with the control. As in August-ALD and in Wistar-ALD was observed the similar fall of the relaxation (-dp/dt) of the left ventricle (by 45-49%), but not the contraction rate (+dp/dt). LPO activation in the heart and liver, as well as NO-system (level of nitrates and nitrites in the blood plasma) in August rats were more pronounced than in Wistar rats. The hsp32 level in August rats fell significantly more (by 93% ) than in Wistar rats (by 61%). Pathological changes in the microvasculature of the mesostenium were identical in compared rats. Thus, more pronounced cardiac dysfunction in August-ALD, compared with Wistar-ALD, associated with greater activation of lipid peroxidation and NO-system.
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25
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Miguez AC, Francisco JC, Barberato SH, Simeoni R, Précoma D, do Amaral VF, Rodrigues E, Olandoski M, de Noronha L, Greca FH, de Carvalho KAT, Faria-Neto JR, Guarita-Souza LC. The functional effect of soybean extract and isolated isoflavone on myocardial infarction and ventricular dysfunction: the soybean extract on myocardial infarction. J Nutr Biochem 2012; 23:1740-8. [PMID: 22717376 DOI: 10.1016/j.jnutbio.2011.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/11/2011] [Accepted: 05/25/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Myocardial infarction is a public health problem. Functional food is an alternative treatment for cardiovascular diseases. OBJECTIVE The objective was to analyze the functional and anatomopathological post-myocardial-infarction effects of soybean extract (SE) and isoflavone (IF). METHODS Myocardial infarction was induced in adult Wistar rats. After 5 days, an echocardiogram was performed to determine heart rate (HR), ejection fraction (EF), systolic volume (LVESV) and diastolic volume (LVEDV). Animals with ventricular dysfunction (EF<45%) were selected for study. The animals were divided into three groups: control (n=14), SE (n=15) and IF (n=12). The IF group received 120 mg/kg/day isolated IF, and the SE group received 12.52 g/day. After 30 days, a new echocardiogram was performed. A histological exam was carried out to determine the collagen. Activity of biochemical markers [arginase, lactate dehydrogenase (LDH) and malate dehydrogenase] was measured. RESULTS The animals of the control, IF and SE groups showed a reduction in EF after the infarction (P=.432, P=.017 and P=.320, respectively). An increase of LVESV and LVEDV was observed in all groups (P=.009, P=.001 and P=.140; and P=.003, P=.008 and P=.205, respectively). A reduction of HR was found in the SE group (P=.020). There was a greater activity of LDH in the SE group. A smaller quantity of mature collagen was found in the region proximal to the myocardial infarction in the SE group. CONCLUSION A protective effect in the SE group was observed 30 days after the myocardial infarction.
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Affiliation(s)
- Ana C Miguez
- Experimental Laboratory of the Center for Biological and Health Sciences, Pontifical Catholic University of Parana (PUCPR), Brazil
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Abstract
Mechanical circulatory support is an essential issue in the management of patients with end-stage cardiac failure. The aim of this study is to evaluate the efficacy of temporary support with a centrifugal blood pump as bridge to heart function recovery or bridge to transplantation. Heart recovery is achieved by improving ventricular mechanical working conditions with proper modifications of preload and afterload. This article assesses the advantages of a novel 'cardiac chambers' cannulation setting versus the traditional one, in the case of biventricular or isolated right ventricular failure. The study was conducted using a numerical computer model based on the work by Guyton, Sagawa, Westerhof, and Noordergraaf. Simulation of the planned trials was achieved by changing the model parameters, the pump angular velocity, and the inflow and outflow settings.
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Affiliation(s)
- G Arpesella
- Heart and Lung Transplantation Program, Policlinico S Orsola-Malpighi, Bologna University, Bologna, Italy
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Abstract
Progress in the medical and surgical management of patients with carcinoid disease has resulted in improved symptoms and survival. Carcinoid heart disease remains a major cause of morbidity and mortality among patients with malignant carcinoid syndrome. Limited medical treatment options are available for patients with symptomatic carcinoid heart disease. At the Mayo Clinic (Rochester, MN), we have taken an aggressive approach to severe valvular dysfunction from carcinoid heart disease. Patients with severe carcinoid heart disease currently are referred for cardiac operation when they develop cardiac symptoms, ventricular dysfunction, or (rarely) in anticipation of hepatic surgery. Surgical outcome depends on patient age and functional class at the time of cardiac surgery. Despite metastatic disease that limits longevity, cardiac surgical survivors usually demonstrate dramatic improvement in functional capacity. Cardiac surgery should be considered early for patients with symptomatic carcinoid heart disease and controlled carcinoid symptoms. An experienced medical, surgical, and anesthetic team approach to the patient with carcinoid heart disease is critical in order to provide state of the art management.
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Anderson MB, Gratz E, Wong RK, Benali K, Kung RTV. Improving outcomes in patients with ventricular assist devices transferred from outlying to tertiary care hospitals. J Extra Corpor Technol 2007; 39:43-8. [PMID: 17486873 PMCID: PMC4680681] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In this retrospective study, the implant course and outcome of patients with ventricular assist devices (VADs) transferred from outlying "spoke" hospitals and converted nonsurgically to a device designed for ambulation at tertiary care "hub" hospitals are evaluated. Factors affecting the crucial decision to transfer and to convert devices have not previously been characterized. Data from 50 patients at 26 US hub institutions were voluntarily submitted to a VAD data registry at ABIOMED, between December 2003 and December 2005. The patients were transferred from 40 spokes on the BVS 5000 Blood Pump and converted to the AB5000 Ventricle (both ABIOMED) at hubs. Comparisons were made on implant indications, time-course, and end-organ function at the time of conversion between surviving patients and patients that had died. Patients who were transferred and converted had a survival to recovery or to next therapy rate of 42%. Eighteen of the surviving patients were still alive 30 days after the explant: 61% were weaned, 33% were transplanted, and 5.6% received a destination device. Average implant-to-transfer time was 1.5 vs. 2.0 days for 30-day survivors and expired patients, respectively, whereas support time from transfer to conversion was 4.8 vs. 4 days, respectively. At the time of device conversion, a total bilirubin below a threshold level of 3.5 mg/dL was predictive of 30-day survival (n = 26, p = .03, odds ratio = 2.73, 95% confidence interval: 1.22-6.16). Patients who survived 30 days were supported longer than those who died (35 vs. 21.1 days, p = .026). At least 18 patients recovered sufficiently on the AB5000 Ventricle to tolerate extubation and 11 patients were able to ambulate. Liver function after implant both at the spoke and before conversion at the hub may be a good indicator of patient survivability. Patients transferred from the BVS 5000 Blood Pump benefited from easy, safe conversion to the AB5000 Ventricle, which provided them with additional support time and afforded the opportunity to recover native heart function.
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Affiliation(s)
- Mark B Anderson
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
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Berkowitz MJ, Picard MH, Harkness S, Sanborn TA, Hochman JS, Slater JN. Echocardiographic and angiographic correlations in patients with cardiogenic shock secondary to acute myocardial infarction. Am J Cardiol 2006; 98:1004-8. [PMID: 17027560 DOI: 10.1016/j.amjcard.2006.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2005] [Revised: 05/01/2006] [Accepted: 05/01/2006] [Indexed: 11/26/2022]
Abstract
In patients with cardiogenic shock (CS) complicating acute myocardial infarction, echocardiographic and angiographic findings are used to aid diagnosis, determine prognosis, and guide management. The purpose of this analysis from the Should we emergently revascularize Occluded Coronary arteries for Cardiogenic ShocK (SHOCK) trial is to identify relations between the angiographic and echocardiographic features of patients with CS. Such an analysis of the correlations between echocardiographic and angiographic findings in patients with CS may provide insights into the etiology and treatment of CS. In 302 randomized patients, an echocardiogram and an angiogram before revascularization were available in 127 patients. Although the median ejection fraction derived by echocardiography and left ventricular angiography was identical (30%), the positive correlation was weak (R2 = 0.209, p = 0.019). Patients with a larger number of diseased vessels had worse mitral regurgitation (MR) by echocardiography (p = 0.005). There was a significant but weak association between left ventricular angiographic MR grade and echocardiographic MR severity (R2 = 0.162, p = 0.015), but there was no association between culprit vessel and degree of MR. In conclusion, worse coronary artery disease is associated with more severe MR. Echocardiography and angiography are valuable and result in similar estimated ejection fractions in a large cohort, but there is wide variation between the techniques in patients.
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Affiliation(s)
- M Joshua Berkowitz
- Cardiovascular Clinical Research Center, New York University School of Medicine, New York, New York, USA.
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30
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Brower GL, Gardner JD, Forman MF, Murray DB, Voloshenyuk T, Levick SP, Janicki JS. The relationship between myocardial extracellular matrix remodeling and ventricular function. Eur J Cardiothorac Surg 2006; 30:604-10. [PMID: 16935520 DOI: 10.1016/j.ejcts.2006.07.006] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 07/10/2006] [Accepted: 07/13/2006] [Indexed: 11/18/2022] Open
Abstract
Elevations in myocardial stress initiate structural remodeling of the heart in an attempt to normalize the imposed stress. This remodeling consists of cardiomyocyte hypertrophy and changes in the amount of collagen, collagen phenotype and collagen cross-linking. Since fibrillar collagen is a relatively stiff material, a decrease in collagen can result in a more compliant ventricle while an increase in collagen or collagen cross-linking results in a stiffer ventricle. If continued elevations in wall stress exceed the ability of the heart to compensate, then the ventricular wall thickness is disproportionately reduced compared to chamber volume and diastolic and systolic dysfunction ensues. This review describes the structural organization of collagen within the myocardium, discusses its effect on ventricular function and considers whether therapy aimed at reducing fibrosis is efficacious in heart failure. The evidence indicates that chamber stiffness can clearly be affected by alterations in both collagen quantity and quality, with the effect of changes in collagen concentration being modified by the extent of collagen cross-linking. The limited evidence available regarding the effects of collagen on systolic function indicates that pharmacological attempts to reduce interstitial collagen have a negative impact. Accordingly, a shift in treatment strategies directed more specifically at affecting collagen cross-linking, rather than reducing the concentration of collagen, may be warranted in the prevention of the adverse impact of collagen alterations on myocardial remodeling.
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Affiliation(s)
- Gregory L Brower
- Department of Cell and Developmental Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29208, USA
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Zhong JQ, Zhang W, Gao H, Li Y, Zhong M, Li D, Zhang C, Zhang Y. Changes in connexin 43, metalloproteinase and tissue inhibitor of metalloproteinase during tachycardia-induced cardiomyopathy in dogs. Eur J Heart Fail 2006; 9:23-9. [PMID: 16828340 DOI: 10.1016/j.ejheart.2006.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 02/28/2006] [Accepted: 04/25/2006] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To study changes in connexin, metalloproteinase and tissue inhibitor of metalloproteinase levels during tachycardia-induced cardiomyopathy (TIC). METHODS Canine models of TIC were established by rapid right atrial pacing at 350-400 beats per min for 8 weeks in 11 dogs, six dogs acted as a sham operation group. Echocardiography, left ventricular pressure and its first derivation with time (positive and negative maximum, dp/dtmax, -dp/dtmax), and intracardiac electrograms were recorded before and after rapid pacing at 1, 4 and 8 weeks. Data were acquired in sinus rhythm. Ultrastructural changes in left ventricular tissue were observed by transmission electron microscope. Connexin 43 (Cx43) levels in the left ventricular myocardium were measured by confocal laser microscopy. The relative abundance of matrix metalloproteinase (MMP-2) and tissue inhibitor of metalloproteinase (TIMP-2) were studied by immunoblotting. RESULT AND CONCLUSIONS (1) Ventricular dilatation and systolic dysfunction occurred after 1 week of rapid right atrial pacing. (2) There was structural damage to the myofibrils, mitochondria, and the sarcoplasmic reticulum with intercalated disk discontinuity. (3) Levels of Cx43 decreased significantly and gap junction remodelling occurred during TIC. (4) TIC may result from several mechanisms, such as ultrastructural changes or gap junction and matrix remodelling.
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Affiliation(s)
- Jing-quan Zhong
- Cardiology Department, Qilu Hospital of Shandong University, 107 Wen Hua Xi Lu, Jinan 250012, Shandong Province, China
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Chamorro C, Romera MA, Silva JA, Valdivia M, Ortega A. [Can heart donation exclusion factors be overcome?]. Rev Esp Cardiol 2006; 59:232-7. [PMID: 16712747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES A shortage of heart donors is limiting the expansion of transplant programs. Our aims were to investigate the impact of different heart donation exclusion factors and to examine ways of increasing the donor pool. PATIENTS AND METHOD We carried out a retrospective descriptive study of individuals donating organs at a university hospital over a ten-year period. Males under 50 years of age and females under 55 years were regarded as potential heart donors. We recorded the etiology of brain death, initial heart donation exclusion factors, and later reasons for rejection. RESULTS We studied 130 organ donors, 69 of whom were regarded as potential heart donors. Thirty-nine actually became heart donors (i.e., 30% of all donors and 56.5% of those of a suitable age). Thirteen were excluded because of a history of heart disease; the majority died from ischemic or hemorrhagic stroke, excluding rupture of an aneurysm or arteriovenous malformation (P< .005). Another 11 donors were excluded because of ventricular dysfunction, which was probably secondary to brain death in 10 patients. Ventricular dysfunction accounted for 30% of cases of heart donation exclusion. A comparison of donor subgroups showed that the incidence of ventricular dysfunction did not vary according to the cause of brain death. Among 27 elderly potential donors, 70% died of stroke and 85% had a diagnosis of, or risk factors for, heart disease. CONCLUSIONS Ventricular dysfunction accounted for 30% of cases of heart donation exclusion. Prevention or reversal of this condition could increase the heart donor pool.
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Affiliation(s)
- Carlos Chamorro
- Servicio de Medicina Intensiva y Coordinación de Trasplantes, Hospital Universitario de Puerta de Hierro, Madrid, España.
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Matesanz R, Valentín M. [Cardiac transplantation in Spain. Have we reached our peak?]. Rev Esp Cardiol 2006; 59:193-6. [PMID: 16712741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
Vascular stiffening of the large arteries is a common feature of aging and is exacerbated by many common disorders such as hypertension, diabetes, and renal disease. This change influences the phasic mechanical stresses imposed on the blood vessels that in turn is important to regulating smooth muscle tone, endothelial function, and vascular health. In addition, the heart typically adapts to confront higher and later systolic loads by both hypertrophy and ventricular systolic stiffening. This creates altered coupling between heart and vessel that importantly affects cardiovascular reserve function. In this overview, I discuss the notion of a coupling disease in which stiffness of both heart and arteries interact to limit performance and generate clinical symptoms. This involves changes in the mechanical interaction of both systems, changes in signaling within the arteries themselves, and alterations in coronary flow regulation. Lastly, I briefly review recent development in de-stiffening strategies that may pave the way to treat this syndrome and its clinical manifestations.
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Affiliation(s)
- David A Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Baltimore, MD 21205, USA.
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Affiliation(s)
- Theodorus A M Kaandorp
- Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
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36
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Müller FU, Lewin G, Baba HA, Bokník P, Fabritz L, Kirchhefer U, Kirchhof P, Loser K, Matus M, Neumann J, Riemann B, Schmitz W. Heart-directed expression of a human cardiac isoform of cAMP-response element modulator in transgenic mice. J Biol Chem 2004; 280:6906-14. [PMID: 15569686 DOI: 10.1074/jbc.m407864200] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The transcriptional activation mediated by cAMP-response element (CRE) and transcription factors of the CRE-binding protein (CREB)/CRE modulator (CREM) family represents an important mechanism of cAMP-dependent gene regulation possibly implicated in detrimental effects of chronic beta-adrenergic stimulation in end-stage heart failure. We studied the cardiac role of CREM in transgenic mice with heart-directed expression of CREM-IbDeltaC-X, a human cardiac CREM isoform. Transgenic mice displayed atrial enlargement with atrial and ventricular hypertrophy, developed atrial fibrillation, and died prematurely. In vivo hemodynamic assessment revealed increased contractility of transgenic left ventricles probably due to a selective up-regulation of SERCA2, the cardiac Ca(2+)-ATPase of the sarcoplasmic reticulum. In transgenic ventricles, reduced phosphorylation of phospholamban and of the CREB was associated with increased activity of serine-threonine protein phosphatase 1. The density of beta(1)-adrenoreceptor was increased, and messenger RNAs encoding transcription factor dHAND and small G-protein RhoB were decreased in transgenic hearts as compared with wild-type controls. Our results indicate that heart-directed expression of CREM-IbDeltaC-X leads to complex cardiac alterations, suggesting CREM as a central regulator of cardiac morphology, function, and gene expression.
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Affiliation(s)
- Frank U Müller
- Institute of Pharmacology and Toxicology, University of Münster, Domagkstrasse 12, D-48149 Münster, Germany.
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Camilletti J, Erriest J, Campisi R, Pedroni P, Giachello F, Arregui V, Illanes L, Mele A. [Use of Gated-SPECT with with 99mTC-MIBI in the evaluation of the prognostic significance of ventricular arrhythmias during a stress test]. Rev Esp Med Nucl 2004; 23:27-32. [PMID: 14718148 DOI: 10.1016/s0212-6982(04)72242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
UNLABELLED The presence of ventricular complex cardiac arrhythmias in coronary patients, both at rest or during physical exercise, is considered a risk factor for future coronary events or sudden death during long time follow up. The meaning of ventricular complex arrhythmias (VCA) in patients with normal ventricular function and without myocardium ischemia has still not been explained. This study aimed to evaluate if patients with normal ventricular function and no evidence of cardiac ischemia (determined by means of Gated SPECT) who developed VCA during stress test show an increase in cardiac events on later monitoring. PATIENTS AND METHODS All patients were studied by means of an ergometric exercise test using a standard Bruce protocol and Gated SPECT with Methoxyisobutyl Isonitrile-99mTechnetium (99mTC-MIBI). Sixty-seven (67) patients with normal ventricular function and no evidence of cardiac ischemia were included. RESULTS 13 patients had VCA and 54 had no ventricular arrhythmias during stress test. During the follow up of 681.3 +/- 469 days, none of the 13 patients had sudden death, angina pectoris or myocardium infarction. CONCLUSIONS In our sample, the appearance of VCA during stress test in patients without myocardium ischemia and normal ventricular function was not associated with an increase of cardiac events during the monitoring which was carried out.
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Affiliation(s)
- J Camilletti
- Instituto de Cardiología La Plata, La Plata, República Argentina
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Abstract
INTRODUCTION Congenital infections can cause severe brain damage. As a result, it is very important to identify them early in their course so that treatment can be administered to the mother, if possible. The role of imaging is to determine the presence, if any, and the extent of brain damage in the infected fetus. Although MRI is most commonly used as an adjunct to sonography, when clinical suspicion is high in the setting of a normal ultrasound or to better define abnormalities detected by ultrasound, MRI is routinely used in toxoplasmosis seroconversion to definitively rule out brain lesions, even when the ultrasound scan is considered normal. MRI is also used serially throughout the pregnancy to check for the development of brain abnormalities; medical treatment results in excellent clinical outcome if the brain is normal. DISCUSSION This article describes the indications, techniques, and findings that will allow proper use of fetal MRI in the setting of congenital infections.
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Affiliation(s)
- A James Barkovich
- Neuroradiology, Room L371, University of California, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
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Abstract
Isolated cardiac metastasis from a primary liposarcoma of noncardiac origin is a rare occurrence. A patient who presented with biventricular failure and constrictive hemodynamics years after successful resection of a primary liposarcoma of the thigh is described. Extensive cardiac encasement by tumor was suspected on diagnostic imaging. Hemodynamic instability and multiorgan failure necessitated urgent exploratory sternotomy. The patient died intraoperatively. Extensive metastatic sarcoma limited to the heart was confirmed during surgical procedure. This case suggests that in clinical and pathological investigation of a cardiac mass, knowledge of previous extracardiac involvement with soft tissue sarcoma is essential.
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Affiliation(s)
- Douglas S Lee
- Department of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Macmillan CSA, Grant IS, Andrews PJD. Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management? Intensive Care Med 2002; 28:1012-23. [PMID: 12185419 DOI: 10.1007/s00134-002-1382-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2002] [Indexed: 11/26/2022]
Abstract
Cardiac injury and pulmonary oedema occurring after acute neurological injury have been recognised for more than a century. Catecholamines, released in massive quantities due to hypothalamic stress from subarachnoid haemorrhage (SAH), result in specific myocardial lesions and hydrostatic pressure injury to the pulmonary capillaries causing neurogenic pulmonary oedema (NPO). The acute, reversible cardiac injury ranges from hypokinesis with a normal cardiac index, to low output cardiac failure. Some patients exhibit both catastrophic cardiac failure and NPO, while others exhibit signs of either one or other, or have subclinical evidence of the same. Hypoxia and hypotension are two of the most important insults which influence outcome after acute brain injury. However, despite this, little attention has hitherto been devoted to prevention and reversal of these potentially catastrophic medical complications which occur in patients with SAH. It is not clear which patients with SAH will develop important cardiac and respiratory complications. An active approach to investigation and organ support could provide a window of opportunity to intervene before significant hypoxia and hypotension develop, potentially reducing adverse consequences for the long-term neurological status of the patient. Indeed, there is an argument for all SAH patients to have echocardiography and continuous monitoring of respiratory rate, pulse oximetry, blood pressure and electrocardiogram. In the event of cardio-respiratory compromise developing i.e. cardiogenic shock and/or NPO, full investigation, attentive monitoring and appropriate intervention are required immediately to optimise cardiorespiratory function and allow subsequent definitive management of the SAH.
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Affiliation(s)
- C S A Macmillan
- University of Dundee, Department of Anaesthesia, Ninewells Hospital, Dundee DD1 9SY, UK.
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Daubert JC, Leclercq C. Upgrading from ventricular to physiological pacing: is it worth it? Eur Heart J 2002; 23:437-41. [PMID: 11863345 DOI: 10.1053/euhj.2001.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Calvert CA, Wall M. Effect of severity of myocardial failure on heart rate variability in Doberman pinschers with and without echocardiographic evidence of dilated cardiomyopathy. J Am Vet Med Assoc 2001; 219:1084-8. [PMID: 11700705 DOI: 10.2460/javma.2001.219.1084] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether heart rate variability (HRV) is reduced in Doberman Pinschers with dilated cardiomyopathy. DESIGN Case series. ANIMALS 62 overtly healthy Doberman pinschers. PROCEDURE Heart rate variability was analyzed in time and frequency domains from data obtained during 24-hour ambulatory electrocardiographic Holter recordings in 41 overtly healthy Doberman pinschers with normal echocardiograms and 21 overtly healthy Doberman pinschers with abnormal echocardiograms. RESULTS Heart rate variability usually was greater during night versus day, and 2 dogs with the most severe myocardial failure had reduced HRV. CONCLUSIONS AND CLINICAL RELEVANCE Reduced HRV was detected only in Doberman Pinschers with the most severe myocardial failure. Thus, HRV in less severely affected dogs is not reduced, or the normal sinus arrhythmia of dogs renders HRV relatively insensitive. Analysis of HRV did not provide additional information relative to the severity of left ventricular dysfunction or risk of sudden death from that which could be derived from echocardiography, analysis of Holter recordings, and signal-averaged electrocardiography.
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Affiliation(s)
- C A Calvert
- Department of Small Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens 30602, USA
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Abstract
BACKGROUND Although angiotensin-converting enzyme (ACE) inhibitor therapy has been shown to improve clinical outcomes of patients with systolic dysfunction, it has been underused or prescribed in inadequate dosages by physicians in the treatment of congestive heart failure. Our goal was to evaluate whether integration of a clinical guideline within a continuous quality improvement program would improve care for patients with congestive heart failure caused by systolic dysfunction. METHODS All patients of a private community medical group who were admitted to the hospital with congestive heart failure were studied prospectively for 21 months. An internally developed congestive heart failure practice guideline was presented to the group's physicians. The guidelines were available in the hospital computer system and were reinforced at monthly quality improvement meetings. Performance data were reviewed quarterly with the physicians. RESULTS Rates of classifying systolic vs diastolic dysfunction remained unchanged during the study. Use of ACE inhibitor therapy at the time of discharge improved substantially for patients with systolic dysfunction. Quarterly admissions of patients with systolic dysfunction declined 49% throughout the study period. No improvement was noted in the documentation of specific discharge instructions. CONCLUSIONS Use of a disease management guideline, ongoing physician education, and feedback of peer performance data to physicians significantly improved the quality and efficiency of care provided to patients with congestive heart failure in an independent, primary care medical group.
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Affiliation(s)
- L A Civitarese
- Preferred Primary Care Physicians, Pittsburgh, PA 15220, USA
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Abstract
Experience accumulated from several large trials strongly suggest that beta-blockers should be used for the management of congestive heart failure (CHF). Beta-blockade should be added to conventional therapy such as diuretics, ACE inhibitors, and digoxin, as this was the approach used in the major trials. It is appropriate to treat patients with mild, moderate and, when stable, severe CHF. The benefits obtained include improvements in left ventricular function, reductions in symptoms and morbidity, improvement of quality of life, and delay of clinical progression, reflected by a reduced need for hospitalization and a reduction in mortality. Beta-blockers are much better tolerated, when used appropriately in selected patients, than was previously supposed.
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Affiliation(s)
- J G Cleland
- MRC Clinical Research Initiative in Heart Failure, University of Glasgow, Scotland
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45
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Boyd O. Perioperative cardiovascular optimization: importance and relevance for anaesthesia. Br J Hosp Med (Lond) 1997; 57:219-23. [PMID: 9176603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- O Boyd
- St George's Hospital, London
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Pennell DJ, Firmin DN, Burger P, Yang GZ, Manzara CC, Ell PJ, Swanton RH, Walker JM, Underwood SR, Longmore DB. Assessment of magnetic resonance velocity mapping of global ventricular function during dobutamine infusion in coronary artery disease. Br Heart J 1995; 74:163-70. [PMID: 7546996 PMCID: PMC483993 DOI: 10.1136/hrt.74.2.163] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is a versatile technique for examination of the cardiovascular system but only recently has assessment of myocardial ischaemia in coronary artery disease (CAD) become possible, for example by demonstrating abnormalities of regional ventricular contraction during stress. Global ventricular function during stress was assessed by MRI of aortic flow, which has not been previously attempted. DESIGN Variables measured by MRI reflecting the effect of ischaemia on global ventricular function during dobutamine stress were correlated with thallium-201 myocardial perfusion tomography. PATIENTS 10 normal controls and 25 patients with CAD. SETTING Tertiary cardiac referral centre. METHODS Novel MRI sequences and analysis systems were used to measure the following variables during staged dobutamine infusion to 20 micrograms/kg/min: stroke volume, cardiac output, cardiac power output, peak flow, peak flow acceleration, aortic back flow, and flow wave velocity. Heart rate, blood pressure, double product, and maximum tolerated dobutamine dose were also measured. Multiple regression analysis was used to compare changes during stress with 201TI tomography. RESULTS All parameters except for stroke volume and diastolic blood pressure increased in the controls. In the patients with CAD a significant relation was shown between the extent of reversible ischaemia and the change in peak flow acceleration (P < 0.00001), peak flow (P = 0.002), cardiac power output (P = 0.036), maximum dobutamine dose (P = 0.039), and systolic blood pressure (P = 0.04). Peak flow acceleration accounted for 58.4% of the variation in reversible ischaemia, and after allowing for this, only cardiac power output remained independently predictive adding a further 4.2% to the model (adjusted r2 = 0.626). A decrease in peak flow acceleration with an increase in dobutamine infusion indicated moderate or severe ischaemia (chi 2 = 10.2, P = 0.017). CONCLUSION MRI may be used to assess variables of aortic flow during stress, which includes acceleration with high temporal resolution. Peak flow acceleration was the most sensitive indicator of the effect of ischaemia on global ventricular function.
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Affiliation(s)
- D J Pennell
- Magnetic Resonance Unit, Royal Brompton Hospital, London
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Abstract
MR imaging allows functional evaluation of the ventricles of the entire heart because it evaluates cardiac anatomy three-dimensionally. Such evaluation is independent of chamber size and shape, and virtually independent of mathematical assumptions. Applying standard measurements of volume and function in children who have undergone multi-staged Fontan operations, we have shown diminished ventricular volumes and mass, and decreased cardiac indices, in post-Fontan procedure. These variations may be predictive of ultimate outcome in these complex patients.
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Affiliation(s)
- K E Fellows
- Department of Radiology, Children's Hospital of Philadelphia, PA, USA
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Hathaway DK, el-Gebely S, Cardoso SS, Elmer DS, Gaber AO. Autonomic cardiac dysfunction in diabetic transplant recipients succumbing to sudden cardiac death. Transplantation 1995; 59:634-7. [PMID: 7878771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- D K Hathaway
- College of Nursing, University of Tennessee, Memphis 38163
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