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Sun Q, Güven B, Wagg CS, Almeida de Oliveira A, Silver H, Zhang L, Chen B, Wei K, Ketema EB, Karwi QG, Persad KL, Vu J, Wang F, Dyck JRB, Oudit GY, Lopaschuk GD. Mitochondrial fatty acid oxidation is the major source of cardiac adenosine triphosphate production in heart failure with preserved ejection fraction. Cardiovasc Res 2024; 120:360-371. [PMID: 38193548 DOI: 10.1093/cvr/cvae006] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is a prevalent disease worldwide. While it is well established that alterations of cardiac energy metabolism contribute to cardiovascular pathology, the precise source of fuel used by the heart in HFpEF remains unclear. The objective of this study was to define the energy metabolic profile of the heart in HFpEF. METHODS AND RESULTS Eight-week-old C57BL/6 male mice were subjected to a '2-Hit' HFpEF protocol [60% high-fat diet (HFD) + 0.5 g/L of Nω-nitro-L-arginine methyl ester]. Echocardiography and pressure-volume loop analysis were used for assessing cardiac function and cardiac haemodynamics, respectively. Isolated working hearts were perfused with radiolabelled energy substrates to directly measure rates of fatty acid oxidation, glucose oxidation, ketone oxidation, and glycolysis. HFpEF mice exhibited increased body weight, glucose intolerance, elevated blood pressure, diastolic dysfunction, and cardiac hypertrophy. In HFpEF hearts, insulin stimulation of glucose oxidation was significantly suppressed. This was paralleled by an increase in fatty acid oxidation rates, while cardiac ketone oxidation and glycolysis rates were comparable with healthy control hearts. The balance between glucose and fatty acid oxidation contributing to overall adenosine triphosphate (ATP) production was disrupted, where HFpEF hearts were more reliant on fatty acid as the major source of fuel for ATP production, compensating for the decrease of ATP originating from glucose oxidation. Additionally, phosphorylated pyruvate dehydrogenase levels decreased in both HFpEF mice and human patient's heart samples. CONCLUSION In HFpEF, fatty acid oxidation dominates as the major source of cardiac ATP production at the expense of insulin-stimulated glucose oxidation.
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Affiliation(s)
- Qiuyu Sun
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Berna Güven
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Faculty of Pharmacy, Department of Pharmacology, Ankara University, Ankara, Turkey
| | - Cory S Wagg
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Amanda Almeida de Oliveira
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Heidi Silver
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Liyan Zhang
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Brandon Chen
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
| | - Kaleigh Wei
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
| | - Ezra B Ketema
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Qutuba G Karwi
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, Canada
| | - Kaya L Persad
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Jennie Vu
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Faqi Wang
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gary D Lopaschuk
- Cardiovascular Research Centre, University of Alberta, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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Bahrami HSZ, Jørgensen PG, Hove JD, Dixen U, Biering-Sørensen T, Rossing P, Jensen MT. Prognostic value of myocardial performance index in individuals with type 1 and type 2 diabetes: Thousand&1 and Thousand&2 studies. Eur Heart J Cardiovasc Imaging 2023; 24:1555-1562. [PMID: 37638773 DOI: 10.1093/ehjci/jead178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/15/2023] [Indexed: 08/29/2023] Open
Abstract
AIMS Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in type 1 (T1D) and type 2 diabetes (T2D). Despite diabetes affects the myocardium, risk prediction models do not include myocardial function parameters. Myocardial performance index (MPI) reflects left ventricular function. The prognostic value of MPI has not been evaluated in large-scale diabetes populations. METHODS AND RESULTS We evaluated two prospective cohort studies: Thousand&1 (1093 individuals with T1D) and Thousand&2 (1030 individuals with T2D). Clinical data, including echocardiography, were collected at baseline. We collected follow-up data from national registries. We defined major adverse cardiovascular events (MACE) as incident events of hospital admission for acute coronary syndrome, heart failure, stroke, or all-cause mortality. For included individuals (56% male, 54 ± 15 years, MPI 0.51 ± 0.1, 63% T1D), follow-up was 100% after median of 5.3 years (range: 4.8-6.3). MPI was associated with MACE (HR 1.2, 95%CI 1.0-1.3, P = 0.012, per 0.10-unit increase) and heart failure (HR 1.3, 95%CI 1.1-1.6, P = 0.005, per 0.10-unit increase) after adjusting for clinical and echocardiographic variables. MPI predicted MACE and heart failure better in T1D than T2D (P = 0.031 for interaction). MPI added discriminatory power to the Steno T1 Risk Engine, based on clinical characteristics, in predicting MACE [area under the curve (AUC) from 0.77 to 0.79, P = 0.030] and heart failure (AUC from 0.77 to 0.83, P = 0.009) in T1D. CONCLUSION MPI is independently associated with MACE and heart failure in T1D but not T2D and improves prediction in T1D. Echocardiographic assessment in T1D may enhance risk prediction.
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Affiliation(s)
- Hashmat Sayed Zohori Bahrami
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Peter Godsk Jørgensen
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Cardiology, Copenhagen University Hospital, Herlev & Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Jens Dahlgaard Hove
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Peter Rossing
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
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Stendahl JC, Liu Z, Boutagy NE, Parajuli N, Lu A, Alkhalil I, Lin BA, Duncan JS, Sinusas AJ. Multiaxial pressure-strain analysis of regional myocardial work in the setting of graded coronary stenoses and dobutamine stress. Am J Physiol Heart Circ Physiol 2023; 325:H492-H509. [PMID: 37417870 PMCID: PMC10538990 DOI: 10.1152/ajpheart.00735.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
We present a detailed analysis of regional myocardial blood flow and work to better understand the effects of coronary stenoses and low-dose dobutamine stress. Our analysis is based on a unique open-chest model in anesthetized canines that features invasive hemodynamic monitoring, microsphere-based blood flow analysis, and an extensive three-dimensional (3-D) sonomicrometer array that provides multiaxial deformational assessments in the ischemic, border, and remote vascular territories. We use this model to construct regional pressure-strain loops for each territory and quantify the loop subcomponent areas that reflect myocardial work contributing to the ejection of blood and wasted work that does not. We demonstrate that reductions in coronary blood flow markedly alter the shapes and temporal relationships of pressure-strain loops, as well as the magnitudes of their total and subcomponent areas. Specifically, we show that moderate stenoses in the mid-left anterior descending coronary artery decrease regional midventricle myocardial work indices and substantially increase indices of wasted work. In the midventricle, these effects are most pronounced along the radial and longitudinal axes, with more modest effects along the circumferential axis. We further demonstrate that low-dose dobutamine can help to restore or even improve function, but often at the cost of increased wasted work. This detailed, multiaxial analysis provides unique insight into the physiology and mechanics of the heart in the presence of ischemia and low-dose dobutamine, with potential implications in many areas, including the detection and characterization of ischemic heart disease and the use of inotropic support for low cardiac output.NEW & NOTEWORTHY Our unique experimental model assesses cardiac pressure-strain relationships along multiple axes in multiple regions. We demonstrate that moderate coronary stenoses decrease regional myocardial work and increase wasted work and that low-dose dobutamine can help to restore myocardial function, but often with further increases in wasted work. Our findings highlight the significant directional variation of cardiac mechanics and demonstrate potential advantages of pressure-strain analyses over traditional, purely deformational measures, especially in characterizing physiological changes related to dobutamine.
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Affiliation(s)
- John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Zhao Liu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nabil E Boutagy
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, United States
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nripesh Parajuli
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Allen Lu
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Imran Alkhalil
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Ben A Lin
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
| | - James S Duncan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut, United States
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Khot N, Joshi S, Malwade S, Chavan S, Mane SV, Agarkhedkar S, Arora A. A Comprehensive Echocardiographic Assessment of Neonatal Right Ventricular Function in Neonatal Intensive Care Unit Babies. Cureus 2023; 15:e37166. [PMID: 37153277 PMCID: PMC10162581 DOI: 10.7759/cureus.37166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background The right ventricle (RV) in the fetus is the predominant chamber, accounting for about 60% of the total cardiac output. The majority of the RV outflow volume is diverted from the pulmonary artery via the ductus arteriosus to the descending aorta. After birth, the RV undergoes extensive structural and functional modifications. The RV undergoes an improper transition from fetal to neonatal circulation in sick neonatal intensive care unit (NICU) babies. Functional echocardiography is now commonly being used in most NICUs as it is a noninvasive and bedside investigation that gives an immediate evaluation of hemodynamics and can be taken into consideration as an extension of clinical assessment to study a critically unwell neonate. Therefore, a study of RV functions in NICU neonates will help in better understanding the neonatal cardiopulmonary response to different diseases. Thus, this study aimed to assess RV functions in neonates getting admitted to the NICU of a tertiary care institute. Methodology This observational, cross-sectional study was approved by the Research & Recognition Committee of Dr. D. Y. Patil Vidyapeeth, Pune. In total, 35 cases of term neonates admitted to the NICU at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune who fulfilled the inclusion criteria were enrolled in this study after obtaining consent from their parents. Two-dimensional echocardiography was performed by a trained pediatric cardiologist, and the findings were substantiated by a neonatologist trained in echocardiography. Results Our study found a strong association between tricuspid inflow velocity and neonates with sepsis. Similarly, a significant association was observed between abnormal tricuspid Inflow velocity (E/A and E/E') and neonates requiring inotropic support. Conclusions Data on the normal values of different echocardiographic parameters of the systolic and diastolic function of the RV during the neonatal phase of life are currently limited. Our data offer preliminary insights into this topic. Early echocardiography and intervention are advisable, especially in neonates with sepsis and requiring inotropic support.
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Affiliation(s)
- Nikita Khot
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Santosh Joshi
- Pediatric Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sanjay Chavan
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Shailaja V Mane
- Pediatric Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sharad Agarkhedkar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Amodini Arora
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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Nag P, Chowdhury SR, Behera SK, Das M, Narayan P. Levosimendan or Milrinone for Ventricular Septal Defect Repair With Pulmonary Arterial Hypertension. J Cardiothorac Vasc Anesth 2023; 37:972-979. [PMID: 36906394 DOI: 10.1053/j.jvca.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Both milrinone and levosimendan have been used in patients undergoing surgical closure of ventricular septal defects (VSD) with pulmonary artery hypertension (PAH); however, the evidence base for their use is limited. In the present study, the authors sought to compare the role of levosimendan and milrinone in the prevention of low-cardiac-output syndrome in the early postoperative period. DESIGN A prospective, randomized, controlled trial. SETTING At a tertiary-care center. PARTICIPANTS Children between 1 month and 12 years presenting with VSD and PAH between 2018 and 2020. INTERVENTIONS A total of 132 patients were randomized into the following 2 groups: Group L (levosimendan group) and Group M (milrinone group). MEASUREMENTS AND MAIN RESULTS In addition to conventional hemodynamic parameters, the authors also included a myocardial performance index assessment to compare the groups. The levosimendan group had significantly lower mean arterial pressure while coming off cardiopulmonary bypass, after shifting to intensive therapy unit, as well as at 3 and 6 hours postoperatively. The duration of ventilation (29.6 ± 13.9 hours v 23.2 ± 13.3 hours; p = 0.012), as well as postoperative intensive care unit stay, were significantly prolonged in the levosimendan group (5.48 ± 1.2 v 4.7 ± 1.3 days, p = 0.003). There were 2 (1.6%) in-hospital deaths in the entire cohort, 1 in each arm. There was no difference in the myocardial performance index of the left or right ventricle. CONCLUSIONS In patients undergoing surgical repair for VSD with PAH, levosimendan does not confer any additional benefit compared to milrinone. Both milrinone and levosimendan appear to be safe in this cohort.
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Affiliation(s)
- Prachi Nag
- Department of Cardiac Anesthesia, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Saibal Roy Chowdhury
- Department of Cardiac Anesthesia, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Sukanta Kumar Behera
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Mrinalendu Das
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
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Chan N, Hanna M, Maurer MS. The Wiggers Diagram: Hemodynamic Changes in Cardiac Amyloidosis. J Card Fail 2023; 29:217-219. [PMID: 35839927 DOI: 10.1016/j.cardfail.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Nicholas Chan
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland Ohio
| | - Mazen Hanna
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland Ohio
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York.
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Sokolov AA, Egunov OA, Krivoshchekov EV, Cetta F. Does the right ventricle size influence the left ventricle size and function in children with Ebstein anomaly? Echocardiography 2022; 39:1601-1607. [PMID: 36447127 DOI: 10.1111/echo.15496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Patients with Ebstein anomaly (EA) have a variety of clinical manifestation. The assessment of structural and geometric characteristics of the heart is important for optimal management. METHODS We retrospectively analyzed echocardiography database from 2009 to 2020. We evaluate patients in two groups: patients with EA were in Group 1 and children without cardiovascular pathology were in Group 2. All children in both groups underwent echocardiography according to American Society of Echocardiography recommendations. The shape of the heart chambers and their function were studied in both groups. RESULTS There were 153 in Group 1 and 2000 children without cardiovascular disease in Group 2. It was shown that in children with EA, the shape of the ventricle became less spherical, which was accompanied by a decrease in myocardial mass, and the ejection fraction was reduced 34% of patients. The functional volume (non-atrialized part) of the right ventricle in patients with EA was reduced, and its contractility was preserved in 62% of cases. Preservation of the contractile properties of the right ventricle in most cases was associated with higher systolic pressure in its cavity. CONCLUSION TAPSE, TESV, and the velocity of the annulus fibrous ring movement according to tissue dopplerography in patients with EA do not allow us to assess the contractility of the right ventricle. The myocardial performance index (MPI) characterizes a decrease in the functional volume of the right ventricle.
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Affiliation(s)
- Alexander A Sokolov
- Department of Functional and Laboratory Diagnostics, Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Oleg A Egunov
- Cardiovascular Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Evgeny V Krivoshchekov
- Cardiovascular Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Frank Cetta
- Division of Pediatric Cardiology and Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Huang H, He H, Qin Y, Du J, Song J. Independent prognostic value of left ventricular mass index in patients with light-chain amyloidosis. Acta Cardiol 2022; 77:815-821. [PMID: 36196999 DOI: 10.1080/00015385.2022.2118414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Echocardiographic-determined left ventricular mass index (LVMI) provides quantitative information on left-ventricular structure. However, its prognostic value on light-chain (AL) amyloidosis has not been clearly defined. METHODS We included 99 patients with newly diagnosed AL amyloidosis between July 2013 and March 2022. Clinical features and echocardiographic parameters were collected. RESULTS LVMI ≥113.4 g/m2 was predictive for overall survival (OS) and progression-free survival (PFS) with respective hazard ratios (HRs) of 2.87 (95% CI: 1.04-7.79) and 2.91 (95% CI: 1.25-6.68). Patients in the LVMI-high group had higher NT-proBNP, cTnT, and FLC-diff levels. They were more likely to be cardiac involved and have increased mean left ventricular wall thickness, decreased left ventricular ejection fraction, and higher proportion of patients with pericardial effusion. In subgroup analysis, LVMI-high group was associated with a reduced OS [HR: 4.74 (95% CI: 1.26-17.77)] and PFS [HR: 7.16 (95% CI: 2.10-24.40)] in patients with cardiac amyloidosis (CA). Besides, LVMI-high was associated with a reduced OS [HR: 3.58 (95% CI: 1.17-11.02)] and PFS [HR: 4.79 (95% CI: 1.77-12.94), p = 0.00] among patients staged of II or III (Mayo 2004), as well as reduced OS [HR: 22.65 (95% CI: 1.66-299.31)] and PFS [HR: 18.73 (95% CI: 2.36-148.35)] among patients staged of III or IV (Mayo 2012). CONCLUSIONS LVMI is a reliable prognostic indicator of survival. A cut-off of LVMI (113.4 g/m2) was prognostic for OS and PFS. Importantly, LVMI was able to identify a subset of patients with poorer prognosis in the context of CA or in the late stages according to the biomarker staging systems.
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Affiliation(s)
- Hejing Huang
- Department of Ultrasound, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Haiyan He
- Department of Hematology, The Myeloma & Lymphoma Center, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Juan Du
- Department of Hematology, The Myeloma & Lymphoma Center, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Jialin Song
- Department of Ultrasound, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
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Ardahanli I, Akhan O, Sahin E, Akgun O, Gurbanov R. Myocardial performance index increases at long-term follow-up in patients with mild to moderate COVID-19. Echocardiography 2022; 39:620-625. [PMID: 35294060 PMCID: PMC9111876 DOI: 10.1111/echo.15340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background The long‐term cardiovascular effects of Coronavirus disease‐2019 (COVID‐19) are not yet well known. Myocardial performance index (MPI) is a non‐invasive, inexpensive and reproducible echocardiographic parameter that reflects systolic and diastolic cardiac functions. The aim of the study was to compare MPI with a healthy control group in patients with mild or moderate COVID‐19 infection who subsequently had unexplained cardiac symptoms. Methods The study included 200 patients aged 18–70 years who were diagnosed with COVID‐19 infection at least 2 months ago and defined cardiac symptoms in their follow‐up. Patients with mild or moderate symptoms, no history of hospitalization, and no other pathology that could explain cardiac symptoms were included in the study. As the control group, 182 healthy volunteers without COVID‐19 were evaluated. Echocardiographic examination was performed on the entire study group. Isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), and ejection time (ET) were measured by tissue Doppler imaging. MPI was calculated with the IVCT+IVRT/ET formula. Results The mean age of the study group was 44.24 ± 13.49 years. In the patient group the MPI was significantly higher (.50 ± .11 vs .46 ± .07, p < .001), IVRT was longer (69.67 ± 15.43 vs 65.94 ± 12.03 ms, p = . 008), and ET was shorter (271.09 ± 36.61 vs 271.09 ± 36.61 ms, p = .028). IVCT was similar between groups (63.87 ± 13.66 vs. 63.21 ± 10.77 ms, p = .66). Mitral E and mitral A wave, E’, A’, and E/A were similar in both groups. Conclusions Our study showed that conventional diastolic function parameters were not affected in patients who survived COVID‐19 with mild symptoms but had symptoms in the long term. However, MPI measurements showed left ventricular dysfunction. To our knowledge, this is the first echocardiographic follow‐up study to evaluate left ventricular systolic and diastolic functions with MPI in COVID‐19 patients. We think that when cardiac involvement assessment is required in patients who have survived COVID‐19, MPI should be measured alongside other echocardiographic measurements.
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Affiliation(s)
- Isa Ardahanli
- Department of Cardiology, Seyh Edebali University Faculty of Medicine, Bilecik, Turkey
| | - Onur Akhan
- Department of Cardiology, Bilecik Training and Research Hospital, Bilecik, Turkey
| | - Ebru Sahin
- Department of Cardiology, Bilecik Training and Research Hospital, Bilecik, Turkey
| | - Onur Akgun
- Department of Cardiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Rafig Gurbanov
- Department of Bioengineering, Bilecik Seyh Edebali University, Bilecik, Turkey
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10
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Sirico A, Raffone A, Maruotti GM, Travaglino A, Paciullo C, Diterlizzi A, Mollo A, Rizzo G, Zullo F, Lanzone A. Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN 2021; 44:e99-e107. [PMID: 34425601 DOI: 10.1055/a-1499-7265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The myocardial performance index (MPI) has been proposed to evaluate cardiac dysfunction in newborns from diabetic mothers. Although MPI is routinely assessed in newborns, its role in the evaluation of fetuses from women with hyperglycemia in pregnancy (HIP) is still under evaluation. We aimed to evaluate the differences in third trimester fetal MPI in pregnant women with hyperglycemia compared to healthy controls. MATERIALS AND METHODS Seven electronic databases were searched for all studies assessing women with HIP who underwent evaluation of fetal left MPI during pregnancy compared to a control group. The summary measures were reported as mean differences (MD) in the mean fetal left MPI between women with HIP and healthy controls, with a 95 % confidence interval (CI). A post hoc subgroup analysis based on the type of HIP - pregestational diabetes, GDM, or gestational impaired glucose tolerance (GIGT) - was performed as an additional analysis. RESULTS 14 studies assessing 1326 fetuses (580 from women with HIP and 746 from controls) were included. Women with HIP had a significantly higher mean left fetal MPI compared to controls (MD 0.08; 95 %CI: 0.05 to 0.11; p < 0.00 001). Subgroup analysis according to the type of HIP concurred with the overall analysis for women with DM (MD 0.07; 95 %CI: 0.01 to 0.13; p = 0.02) and for women with GDM (MD 0.012; 95 %CI: 0.07 to 0.17; p < 0.00 001) but not for women with GIGT (MD -0.01, 95 % CI -0.28 to 0.27; p = 0.96). CONCLUSION Fetal left MPI is increased in pregnancies with HIP appearing as a potential marker of cardiac dysfunction.
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Affiliation(s)
- Angelo Sirico
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carmela Paciullo
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alice Diterlizzi
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re - University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Lanzone
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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11
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging. Circ Cardiovasc Imaging 2021; 14:e000029. [PMID: 34196223 DOI: 10.1161/hci.0000000000000029] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, NY
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, NY
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - James C Moon
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | | | - C Cristina Quarta
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Jamieson M Bourque
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Molecular Medicine, University of Pavia, Italy
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12
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Gonçalves LDS, Sales LP, Saito TR, Campos JC, Fernandes AL, Natali J, Jensen L, Arnold A, Ramalho L, Bechara LRG, Esteca MV, Correa I, Sant'Anna D, Ceroni A, Michelini LC, Gualano B, Teodoro W, Carvalho VH, Vargas BS, Medeiros MHG, Baptista IL, Irigoyen MC, Sale C, Ferreira JCB, Artioli GG. Histidine dipeptides are key regulators of excitation-contraction coupling in cardiac muscle: Evidence from a novel CARNS1 knockout rat model. Redox Biol 2021; 44:102016. [PMID: 34038814 PMCID: PMC8144739 DOI: 10.1016/j.redox.2021.102016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 12/04/2022] Open
Abstract
Histidine-containing dipeptides (HCDs) are abundantly expressed in striated muscles. Although important properties have been ascribed to HCDs, including H+ buffering, regulation of Ca2+ transients and protection against oxidative stress, it remains unknown whether they play relevant functions in vivo. To investigate the in vivo roles of HCDs, we developed the first carnosine synthase knockout (CARNS1−/−) rat strain to investigate the impact of an absence of HCDs on skeletal and cardiac muscle function. Male wild-type (WT) and knockout rats (4 months-old) were used. Skeletal muscle function was assessed by an exercise tolerance test, contractile function in situ and muscle buffering capacity in vitro. Cardiac function was assessed in vivo by echocardiography and cardiac electrical activity by electrocardiography. Cardiomyocyte contractile function was assessed in isolated cardiomyocytes by measuring sarcomere contractility, along with the determination of Ca2+ transient. Markers of oxidative stress, mitochondrial function and expression of proteins were also evaluated in cardiac muscle. Animals were supplemented with carnosine (1.8% in drinking water for 12 weeks) in an attempt to rescue tissue HCDs levels and function. CARNS1−/− resulted in the complete absence of carnosine and anserine, but it did not affect exercise capacity, skeletal muscle force production, fatigability or buffering capacity in vitro, indicating that these are not essential for pH regulation and function in skeletal muscle. In cardiac muscle, however, CARNS1−/− resulted in a significant impairment of contractile function, which was confirmed both in vivo and ex vivo in isolated sarcomeres. Impaired systolic and diastolic dysfunction were accompanied by reduced intracellular Ca2+ peaks and slowed Ca2+ removal, but not by increased markers of oxidative stress or impaired mitochondrial respiration. No relevant increases in muscle carnosine content were observed after carnosine supplementation. Results show that a primary function of HCDs in cardiac muscle is the regulation of Ca2+ handling and excitation-contraction coupling.
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Affiliation(s)
- Lívia de Souza Gonçalves
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil; Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Lucas Peixoto Sales
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil; Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Tiemi Raquel Saito
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil; Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | - Alan Lins Fernandes
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil; Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - José Natali
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil
| | - Leonardo Jensen
- Laboratório de Hipertensão do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Alexandre Arnold
- Laboratório de Hipertensão do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Lisley Ramalho
- Institute of Biomedical Sciences, University of Sao Paulo, Brazil
| | | | - Marcos Vinicius Esteca
- Laboratory of Cell and Tissue Biology, Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Brazil
| | - Isis Correa
- Laboratório de Hipertensão do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Diogo Sant'Anna
- Laboratório de Hipertensão do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Alexandre Ceroni
- Departamento de Fisiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, Brazil
| | | | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil; Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Walcy Teodoro
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | | | | | - Igor Luchini Baptista
- Laboratory of Cell and Tissue Biology, Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Brazil
| | - Maria Cláudia Irigoyen
- Laboratório de Hipertensão do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Craig Sale
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, Nottingham Trent University, UK
| | | | - Guilherme Giannini Artioli
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Divisão de Reumatologia, Universidade de São Paulo, SP, Brazil; Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil.
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13
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Abu-Halima M, Wagner V, Becker LS, Ayesh BM, Abd El-Rahman M, Fischer U, Meese E, Abdul-Khaliq H. Integrated microRNA and mRNA Expression Profiling Identifies Novel Targets and Networks Associated with Ebstein's Anomaly. Cells 2021; 10:cells10051066. [PMID: 33946378 PMCID: PMC8146150 DOI: 10.3390/cells10051066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
Little is known about abundance level changes of circulating microRNAs (miRNAs) and messenger RNAs (mRNA) in patients with Ebstein’s anomaly (EA). Here, we performed an integrated analysis to identify the differentially abundant miRNAs and mRNA targets and to identify the potential therapeutic targets that might be involved in the mechanisms underlying EA. A large panel of human miRNA and mRNA microarrays were conducted to determine the genome-wide expression profiles in the blood of 16 EA patients and 16 age and gender-matched healthy control volunteers (HVs). Differential abundance level of single miRNA and mRNA was validated by Real-Time quantitative PCR (RT-qPCR). Enrichment analyses of altered miRNA and mRNA abundance levels were identified using bioinformatics tools. Altered miRNA and mRNA abundance levels were observed between EA patients and HVs. Among the deregulated miRNAs and mRNAs, 76 miRNAs (49 lower abundance and 27 higher abundance, fold-change of ≥2) and 29 mRNAs (25 higher abundance and 4 lower abundance, fold-change of ≥1.5) were identified in EA patients compared to HVs. Bioinformatics analysis identified 37 pairs of putative miRNA-mRNA interactions. The majority of the correlations were detected between the lower abundance level of miRNA and higher abundance level of mRNA, except for let-7b-5p, which showed a higher abundance level and their target gene, SCRN3, showed a lower abundance level. Pathway enrichment analysis of the deregulated mRNAs identified 35 significant pathways that are mostly involved in signal transduction and cellular interaction pathways. Our findings provide new insights into a potential molecular biomarker(s) for the EA that may guide the development of novel targeting therapies.
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Affiliation(s)
- Masood Abu-Halima
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany; (M.A.E.-R.); (H.A.-K.)
- Correspondence:
| | - Viktoria Wagner
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
- Center for Clinical Bioinformatics, Saarland University, 66123 Saarbrücken, Germany
| | - Lea Simone Becker
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
| | - Basim M. Ayesh
- Department of Laboratory Medical Sciences, Alaqsa University, Gaza 4051, Palestine;
| | - Mohammed Abd El-Rahman
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany; (M.A.E.-R.); (H.A.-K.)
| | - Ulrike Fischer
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
| | - Eckart Meese
- Institute of Human Genetics, Saarland University, 66421 Homburg, Germany; (V.W.); (L.S.B.); (U.F.); (E.M.)
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, 66421 Homburg, Germany; (M.A.E.-R.); (H.A.-K.)
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14
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Kim SM, Ye SY. Evaluation of the Fetal Left Ventricular Myocardial Performance Index (MPI) by Using an Automated Measurement of Doppler Signals in Normal Pregnancies. Diagnostics (Basel) 2021; 11:diagnostics11020358. [PMID: 33672746 PMCID: PMC7924560 DOI: 10.3390/diagnostics11020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022] Open
Abstract
The myocardial performance index is widely used as an indicator of the heart’s performance. However, due to the subjective nature of ultrasonic testing, there are differences in the measurements among inspectors, requiring a quantitative and objective assessment. In this study, an automated program was developed to quantitatively evaluate the myocardial performance index (MPI) and the cardiac time intervals in the left ventricle for each trimester. One hundred and thirty-three pregnant women who visited the hospital for prenatal examinations were studied, and skilled inspectors obtained left ventricular blood flow waveforms from 47 fetuses in the 12 weeks, 54 fetuses in the 22 weeks, and 32 fetuses in the 31 weeks of pregnancy using a pulse Doppler mode of ultrasound equipment. The acquired images automatically measured the isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT,) ejection time (ET), and filling time (FT), and calculated the Tei index (TI) and the K-index (KI); each interval was manually measured during the actual inspection for comparison. In this study, the ultrasonic Doppler waveform was objectively analyzed and measured by the automated program, and it will help with the evaluation of fetal heart function.
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Affiliation(s)
- Su-Min Kim
- Department of Obstetrics, Busan Well-High Woman’s Hospital, 95 Myeongji Ocean City 4-ro, Gangseo-gu, Busan 46764, Korea;
- Department of Radiological Science, Graduate School, Catholic University of Pusan, 57 Oryun-daero, Geumjeong-gu, Busan 46252, Korea
| | - Soo-Young Ye
- Department of Radiological Science, Graduate School, Catholic University of Pusan, 57 Oryun-daero, Geumjeong-gu, Busan 46252, Korea
- Correspondence: ; Tel.: +82-51-510-0589
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15
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Sascău R, Anghel L, Clement A, Bostan M, Radu R, Stătescu C. The Importance of Multimodality Imaging in the Diagnosis and Management of Patients with Infiltrative Cardiomyopathies: An Update. Diagnostics (Basel) 2021; 11:diagnostics11020256. [PMID: 33562254 PMCID: PMC7915769 DOI: 10.3390/diagnostics11020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022] Open
Abstract
Infiltrative cardiomyopathies (ICMs) comprise a broad spectrum of inherited and acquired conditions (mainly amyloidosis, sarcoidosis, and hemochromatosis), where the progressive buildup of abnormal substances within the myocardium results in left ventricular hypertrophy and manifests as restrictive physiology. Noninvasive multimodality imaging has gradually eliminated endomyocardial biopsy from the diagnostic workup of infiltrative cardiac deposition diseases. However, even with modern imaging techniques’ widespread availability, these pathologies persist in being largely under- or misdiagnosed. Considering the advent of novel, revolutionary pharmacotherapies for cardiac amyloidosis, the archetypal example of ICM, a standardized diagnostic approach is warranted. Therefore, this review aims to emphasize the importance of contemporary cardiac imaging in identifying specific ICM and improving outcomes via the prompt initiation of a targeted treatment.
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Affiliation(s)
- Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
| | - Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Alexandra Clement
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Mădălina Bostan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Rodica Radu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
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16
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Kidney function and the prognostic value of myocardial performance index. Int J Cardiovasc Imaging 2021; 37:1637-1647. [PMID: 33475871 DOI: 10.1007/s10554-020-02149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A decreased glomerular filtration rate (GFR) is a risk factor for cardiovascular disease even after adjustment for conventional risk factors. The myocardial performance index (MPI) is defined as (isovolumetric relaxation time (IVRT) + isovolumetric contraction time (IVCT))/ejection time (ET). It has been shown to be an independent predictor of cardiovascular events. We hypothesized the MPI could prove valuable for assessing cardiac risk in subjects of the general population with decreased estimated GFR (eGFR). MPI was measured in 1915 subjects from a large general population prospective cohort study using color tissue Doppler imaging (TDI) M-mode through the mitral valve. We compared the prognostic capabilities of the MPI between subjects with eGFR ≥ 75 mL/min/1.73 m2 and subjects with eGFR < 75 mL/min/1.73 m2 using multivariable adjusted Cox regression models. The composite endpoint was heart failure, myocardial infarction or cardiovascular death. Mean age was 58 years (SD 16.2), 58% were women, 42% had hypertension and 8.3% diabetes. During a median follow-up time of 12.4 years [IQR 10.6-12.7 years] 269 participants reached the combined endpoint. eGFR modified the prognostic capability of MPI (p-value for interaction < 0.001): After multivariable adjustment, MPI remained an independent predictor of the composite endpoint only in participants with eGFR < 75 mL/min/1.73 m2: HR 1.18 (95% CI 1.02-1.38), p = 0.03, vs. in subjects with eGFR ≥ 75 mL/min/1.73 m2: HR 1.14 (95% CI 0.94-1.39), p = 0.17. These results suggest the MPI could be particularly valuable for identifying elevated cardiac risk in individuals from the general population with decreased eGFR.
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Shahlaee S, Alimi H, Poorzand H, Morovatdar N, Vakilian F, Shahlaee S. <p>Relationship Between Isovolumic Acceleration (IVA) and TEI Index with Pro-BNP in Heart Failure</p>. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2020. [DOI: 10.2147/rrcc.s253688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Dereli S, Özer H, Özer N, Bayramoğlu A, Kaya A. Association between fragmented QRS and left ventricular dysfunction in acromegaly patients. Acta Cardiol 2020; 75:435-441. [PMID: 31079588 DOI: 10.1080/00015385.2019.1610835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In acromegaly patients; it has been observed that heart failure may develop even in the absence of predisposing factors such as hypertension, diabetes mellitus, so a specific acromegalic cardiomyopathy has been suggested. We aimed to evaluate the fQRS frequency in acromegaly patients and the left ventricular (LV) functions of acromegaly patients with fQRS.Methods: Our study included 60 acromegalic patients. Each patient underwent conventional echocardiography and tissue Doppler imaging. The patients included were separated into two groups: those with (n:23) and without (n:37) fQRS.Results: Significant differences were identified between fQRS(+) and fQRS (-) groups with respect to disease duration (p < .001), Left ventricular end diastolic volume (EDV) (p < .001), E velocity (p < .001), E\A ratio (p < .001), E' velocity (p < .001), E/E' ratio (p < .001), isovolumic relaxation time (IVRT) (p < .001), MPI (p < .001). Disease duration (odds ratio [OR]: 2.120 (1.023-1.703 95% confidence interval [CI]), p = .002), E' (OR:3.029 (1.013-1.703 95% CI) p = .004) and fQRS (OR:4.59 (1.94-10.87 95% CI), p = .001) were identified as the independent predictors of myocardial performance index (MPI). However, disease duration (OR:1.078 (1.030-1.128 95% CI), p = .001), E/E' (OR: 1.43 (1.22-1.97 95% CI), p = .001), IVRT (OR:1.65 (1.32-2.06 95% CI), p = .001) and MPI (OR:1.014 (1.004-1.024 95% CI), p = .002) were the independent predictors of fQRS.Conclusions: fQRS was frequent and an independent predictor of MPI that was independelty associated with LV dysfunction in patients with acromegaly. In light of these findings the presence of fQRS is thought to be an indicator of acromegalic CMP development.
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Affiliation(s)
- Seçkin Dereli
- Deparment of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Hatice Özer
- Deparment of Endocrinology, Ordu State Hospital, Ordu, Turkey
| | - Nurtaç Özer
- Deparment of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Adil Bayramoğlu
- Deparment of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Ahmet Kaya
- Deparment of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
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Ali S, Okasha A, Elsirgany S, Abdel-Rasheed M, Khalil A, El-Anwary S, Elsheikhah A. Normal reference ranges for fetal cardiac function: Assessed by modified Doppler myocardial performance index (Mod MPI) in the Egyptian population. Eur J Obstet Gynecol Reprod Biol 2020; 251:66-72. [PMID: 32502771 DOI: 10.1016/j.ejogrb.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
AIM To develop gestational age-based reference ranges for the modified Doppler myocardial performance index (Mod MPI) and to examine the maternal characteristics that affect this measurement. METHODS This was a cross-sectional study, comprised of 1021 healthy pregnancies between 20+0 to 35+6 weeks' gestation. They were all undergoing ultrasound examination in Cairo Fetal Medicine Unit (CAIFM) in Cairo University, Egypt from 1st April 2017 till 1st April 2019. Mod MPI was obtained used method described by Friedman et al. (2003). Median and SD models were fitted between Mod MPI and gestational age. The distributions of Mod MPI Z-scores were examined in relation to maternal characteristics RESULTS: The normal Mod MPI in second and third trimester (20 + 1 to 35 + 6 weeks' gestation) was 0.408 ± 0.08. Mod MPI was not affected by maternal age, body mass index (BMI) or parity (p value 0.5, 0.6 and 0.2 respectively). CONCLUSION This study established normal reference ranges for Mod MPI according to gestational age and generated a graph with 5th,10th, 90th and 95th centiles. Maternal characteristics as age, BMI or parity do not affect value of Mod MPI.
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Affiliation(s)
- Sief Ali
- Department of Obstetrics & Gynecology, Assiut University, Egypt
| | - Ahmed Okasha
- Reproductive Health Research Department, National Research Centre, Egypt
| | - Sherif Elsirgany
- Reproductive Health Research Department, National Research Centre, Egypt
| | | | - Ahmed Khalil
- Department of Obstetrics & Gynecology, Benha University, Egypt.
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Left ventricular output indices in hospitalized heart failure: when "simpler" may not mean "better". Int J Cardiovasc Imaging 2020; 37:59-68. [PMID: 32734497 DOI: 10.1007/s10554-020-01946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Assessment of left ventricular (LV) output in hospitalized patients with heart failure (HF) is important to determine prognosis. Although echocardiographic LV ejection fraction (EF) is generally used to this purpose, its prognostic value is limited. In this investigation LV-EF was compared with other echocardiographic per-beat measures of LV output, including non-indexed stroke volume (SV), SV index (SVI), stroke distance (SD), ejection time (ET), and flow rate (FR), to determine the best predictor of all-cause mortality in patients hospitalized with HF. A final cohort of 350 consecutive patients hospitalized with HF who underwent echocardiography during hospitalization was studied. At a median follow-up of 2.7 years, 163 patients died. Non-survivors at follow-up had lower SD, SVI and SV, but not ET, FR and LV-EF than survivors. At multivariate analysis, only age, systolic blood pressure, chronic kidney disease, chronic obstructive pulmonary disease, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SVI remained significantly associated with outcome [HR for SVI 1.13 (1.04-1.22), P = 0.003]. In particular, for each 5 ml/m2 decrease in SVI, a 13% increase in risk of mortality for any cause was observed. SVI is a powerful prognosticator in HF patients, better than other per-beat measures, which may be simpler but partial or incomplete descriptors of LV output. SVI, therefore, should be considered for the routine echocardiographic evaluation of patients hospitalized with HF to predict prognosis.
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21
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Wang TKM, Abou Hassan OK, Jaber W, Xu B. Multi-modality imaging of cardiac amyloidosis: Contemporary update. World J Radiol 2020; 12:87-100. [PMID: 32742575 PMCID: PMC7364284 DOI: 10.4329/wjr.v12.i6.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac amyloidosis is a heterogeneous and challenging diagnostic disease with poor prognosis that is now being altered by introduction of new therapies. Echocardiography remains the first-line imaging tool, and when disease is suspected on echocardiography, cardiac magnetic resonance imaging and nuclear imaging play critical roles in the non-invasive diagnosis and evaluation of cardiac amyloidosis. Advances in multi-modality cardiac imaging allowing earlier diagnosis and initiation of novel therapies have significantly improved the outcomes in these patients. Cardiac imaging also plays important roles in the risk stratification of patients presenting with cardiac amyloidosis. In the current review, we provide a clinical and imaging focused update, and importantly outline the imaging protocols, diagnostic and prognostic utility of multimodality cardiac imaging in the assessment of cardiac amyloidosis.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Ossama K Abou Hassan
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Wael Jaber
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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22
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Rigopoulos AG, Ali M, Abate E, Torky AR, Matiakis M, Mammadov M, Melnyk H, Vogt A, de Vecchis R, Bigalke B, Wohlgemuth W, Mavrogeni S, Noutsias M. Advances in the diagnosis and treatment of transthyretin amyloidosis with cardiac involvement. Heart Fail Rev 2020; 24:521-533. [PMID: 30790171 DOI: 10.1007/s10741-019-09776-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Amyloidosis is caused by extracellular deposition of insoluble abnormal fibrils constituted by misfolded proteins, which can modify tissue anatomy and hinder the function of multiple organs including the heart. Amyloidosis that can affect the heart includes mostly systemic amyloidosis (amyloid light chain, AL) and transthyretin amyloidosis (ATTR). The latter can be acquired in elderly patients (ATTRwt), or be inherited in younger individuals (ATTRm). The diagnosis is demanding given the high phenotypic heterogeneity of the disease. Therefore, "red flags," which are suggestive features giving support to diagnostic suspicion, are extremely valuable. However, the lack of broad awareness among clinicians represents a major obstacle for early diagnosis and treatment of ATTR. Furthermore, recent implementation of noninvasive diagnostic techniques has revisited the need for endomyocardial biopsy (EMB). In fact, unlike AL amyloidosis, which requires tissue confirmation and typing for diagnosis, ATTR can now be diagnosed noninvasively with the combination of bone scintigraphy and the absence of a monoclonal protein. Securing the correct diagnosis is pivotal for the newly available therapeutic options targeting both ATTRm and ATTRwt, and are directed to either stabilization of the abnormal protein or the reduction of the production of transthyretin. The purpose of this article is to review the contemporary aspects of diagnosis and management of transthyretin amyloidosis with cardiac involvement, summarizing also the recent therapeutic advances with tafamidis, patisiran, and inotersen.
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Affiliation(s)
- Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Abdel-Rahman Torky
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Hannes Melnyk
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Alexander Vogt
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Renato de Vecchis
- Preventive Cardiology and Rehabilitation Unit, DSB 29, S. Gennaro dei Poveri Hospital, 80136, Naples, Italy
| | - Boris Bigalke
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany
| | - Walter Wohlgemuth
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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A novel index equivalent to the myocardial performance index for right ventricular functional assessment in children and adolescent patients. Sci Rep 2019; 9:19975. [PMID: 31882794 PMCID: PMC6934714 DOI: 10.1038/s41598-019-56564-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/13/2019] [Indexed: 11/19/2022] Open
Abstract
The aims of the present study were to develop and check the utility and feasibility of a novel right ventricular (RV) functional index (RV angular velocity; RVω, s−1) derived from the angular velocity in harmonic oscillator kinematics obtained from the RV pressure waveform. We hypothesized that RVω reflects the myocardial performance index (MPI), which represents global RV function. A total of 132 consecutive patients, ranging in age from 3 months to 34 years with various cardiac diseases were included in this prospective study. RVω was defined as the difference between the peak derivative of pressure (dP/dt_max − dP/dt_min) divided by the difference between the maximum and minimum pressure (Pmax – Pmin). RVω showed significant negative correlations with the pulsed-wave Doppler-derived myocardial performance index (PWD-MPI) and the tissue Doppler imaging-derived MPI (TDI-MPI) (r = −0.52 and −0.51, respectively; both p < 0.0001). RVω also showed significant positive correlations with RV fractional area change (RVFAC) and RV ejection fraction (RVEF) (r = 0.41 and 0.39, respectively; both p < 0.0001), as well as a significant negative correlation with tricuspid E/e′ (r = −0.19, p = 0.0283). The clinical feasibility and utility of RVω for assessing global RV performance, incorporating both systolic and diastolic function, were demonstrated.
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol 2019; 26:2065-2123. [PMID: 31468376 DOI: 10.1007/s12350-019-01760-6] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, VA, USA
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25
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging. J Card Fail 2019; 25:e1-e39. [PMID: 31473268 DOI: 10.1016/j.cardfail.2019.08.001] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, Virginia
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Abstract
OBJECTIVE The purpose of this study was to assess fetal cardiac function in normal fetuses (control group) compared to those who are exposed to gestational diabetes mellitus using different echocardiographic measurements, and to explore the application of left atrial shortening fraction in determination of fetal diastolic function with gestational diabetes mellitus. METHODS A total of 50 women with gestational diabetes and 50 women with a healthy pregnancy were included in the study. Fetal echocardiography was performed and structural as well as functional fetal cardiac parameters were measured. Data were compared between with or without fetal myocardial hypertrophy and the control group. RESULTS In the study group, out of 50 fetuses of gestational diabetic mothers, 18 had myocardial hypertrophy and 32 had normal septal thickness. Gestational age at time of examination did not differ significantly between the control and gestational diabetes group (p = 0.55). Mitral E/A ratio was lower in gestational diabetes group as compared to the control (p < 0.001). Isovolumetric relaxation and contraction times and myocardial performance index were greater in fetuses of gestational diabetic mothers (p < 0.001). In fetuses of gestational diabetic mothers with myocardial hypertrophy, left atrial shortening fraction was lower as compared to those without myocardial hypertrophy and those of the control group (p < 0.001). CONCLUSIONS The results of this study suggest that fetuses of gestational diabetic mothers have altered cardiac function even in the absence of septal hypertrophy, and that left atrial shortening fraction can be used as a reliable alternate parameter in the assessment of fetal diastolic function.
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Ito T, Akamatsu K, Fujita SI, Kanzaki Y, Ukimura A, Hoshiga M. Transient depression of myocardial function after influenza virus infection: A study of echocardiographic tissue imaging. PLoS One 2019; 14:e0221628. [PMID: 31442264 PMCID: PMC6707632 DOI: 10.1371/journal.pone.0221628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/12/2019] [Indexed: 01/25/2023] Open
Abstract
Background Influenza virus infection (IVI) was reported to be associated with minor cardiac changes, mostly those detected on electrocardiogram with and without elevated blood markers of myocardial injury; however, the characteristics of myocardial involvement in association with IVI are poorly understood. This study used echocardiographic tissue imaging (tissue Doppler, strain, and strain rate) to evaluate changes in left atrial (LA) and left ventricular (LV) myocardial function after IVI. Methods and results We examined 20 adult individuals (mean age, 43 years) at 2 and 4 weeks after diagnosis of IVI. For myocardial functional variables, we obtained LV global longitudinal strain (GLS), LV early diastolic strain rate (e'sr), LA strain, and LA stiffness (E/e’/LA strain), in addition to data on tissue Doppler (s’, e’, and a’) and myocardial performance index. Blood markers of myocardial injury were also examined. During follow-up, there were no significant changes in global chamber function such as LV ejection fraction, E/e’, and LA volume. However, significant changes in myocardial function were observed, namely, in s’ (8.0 ± 1.6 cm/s to 9.3 ± 1.5 cm/s; p = 0.01), e’ (10.2 ± 2.8 cm/s to 11.4 ± 3.0 cm/s; p < 0.001), e’sr (1.43 ± 0.44 1/s to 1.59 ± 0.43 1/s; p = 0.005), and LA strain (35 ± 8% to 40 ± 12%; p = 0.025), and the myocardial performance index (0.52 ± 0.20 to 0.38 ± 0.09; p = 0.009), but not in a’, LA stiffness, or GLS. Cardiac troponin T and creatinine kinase isoenzyme MB were not elevated significantly at any examination. Conclusions Myocardial dysfunction during IVI recovery appeared to be transient particularly in the absence of myocardial injury. Echocardiographic tissue imaging may be useful to detect subclinical cardiac changes in association with IVI.
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Affiliation(s)
- Takahide Ito
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
- * E-mail:
| | - Kanako Akamatsu
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shu-ichi Fujita
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Akira Ukimura
- Department of General Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, Takatsuki, Osaka, Japan
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Kobayashi Y, Moneghetti KJ, Bouajila S, Stolfo D, Finocchiaro G, Kuznetsova T, Liang D, Schnittger I, Ashley E, Wheeler M, Haddad F. Time based versus strain based myocardial performance indices in hypertrophic cardiomyopathy, the merging role of left atrial strain. Eur Heart J Cardiovasc Imaging 2019; 20:334-342. [PMID: 30060097 DOI: 10.1093/ehjci/jey097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/28/2018] [Accepted: 06/21/2018] [Indexed: 11/15/2022] Open
Abstract
AIMS The myocardial performance index (MPI) is a time-based index of global myocardial performance. In this study, we sought to compare the prognostic value of the MPI with other strain and remodelling indices in hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS We enrolled 126 patients with HCM and 50 age- and sex-matched controls. Along with traditional echocardiographic assessment, MPI, left ventricular global longitudinal strain (LVGLS), E/e' ratio, and total left atrial (LA) global strain (LAS) were also measured. Time-based MPI was calculated from flow or tissue-based pulse wave Doppler (PWD and TDI) as the (isovolumic-relaxation and contraction time)/systolic-time. We used hierarchical clustering and network analysis to better visualize the relationship between parameters. The primary endpoint was the composite of all-cause death, heart transplantation, left ventricular assist device implantation, and clinical worsening. Left ventricular outflow tract (LVOT) obstruction was present in 56% of patients. Compared with controls, patients with HCM had worse LVGLS (-14.0 ± 3.4% vs. -19.6 ± 1.5%), higher E/e' (12.9 ± 7.2 vs. 6.1 ± 1.5), LA volume index (LAVI) (36.4 ± 13.8 ml/m2 vs. 25.6 ± 6.7 ml/m2), and MPI (0.55 ± 0.17 vs. 0.40 ± 0.11 for PWD and 0.59 ± 0.22 vs. 0.46 ± 0.09 for TDI) (all P < 0.001). During a median follow-up of 55 months, 47 endpoints occurred. PWD or TDI-based MPI was not associated with outcome, while LAVI, LAS, LVGLS, and E/e' were (all P < 0.01). On multivariable analysis, LVOT obstruction (P < 0.001), LAS (P < 0.001), and E/e' (P = 0.02) were retained as independent associates. They were in different clusters suggesting complemental relationship between them. CONCLUSION Time-based index is less predictive of outcome than strain or tissue Doppler indices. LAS may be a promising prognostic marker in HCM.
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Affiliation(s)
- Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Sara Bouajila
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Davide Stolfo
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Gherardo Finocchiaro
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA.,KU Leuven Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Leuven, Belgium
| | - David Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2170, Stanford, CA, USA.,Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, USA
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The Diagnosis of Early Fetal Cardiac Changes of the Gestational Diabetic Mothers: Presenting the Preload Index. IRANIAN JOURNAL OF PEDIATRICS 2019. [DOI: 10.5812/ijp.86450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Correction to: Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation: A Single-Center Study of Over 7000 Cases. Circ Cardiovasc Imaging 2019; 12:e000025. [PMID: 30866649 DOI: 10.1161/hci.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
PURPOSE OF REVIEW The aim is to provide a description of the most important echocardiographic features in systemic amyloidosis. RECENT FINDINGS Amyloidosis is a heterogeneous group of multisystem disorders, characterized by an extracellular deposition of amyloid fibrils. Several imaging tests are available for the diagnosis; however, echocardiography is the cornerstone of the non-invasive imaging modality for cardiac amyloidosis. So far, little is known about the diagnosis of cardiac amyloidosis through imaging modalities. We summarized the most important echocardiographic findings in cardiac amyloidosis. Hence, we offered a systematic report of the diagnostic performance of cardiac amyloidosis using echocardiography.
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Role of echocardiography in assessing cardiac amyloidoses: a systematic review. J Echocardiogr 2019; 17:64-75. [PMID: 30741395 DOI: 10.1007/s12574-019-00420-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/21/2022]
Abstract
Cardiac amyloidosis is a manifestation of one of several systemic amyloidoses, and is characterized by increased left-ventricular (LV) wall thickness and normal or decreased LV cavity size. Congestive heart failure in cardiac amyloidosis is characterized by a predominant diastolic LV dysfunction, and systolic dysfunction occurs only in late-stage disease. Echocardiography is a noninvasive, reproducible method for assessing cardiac morphology and function in cardiac amyloidosis, and some echocardiographic indices are prognostic for amyloidoses. This review describes the advances in echocardiography and its role in the diagnosis and management of cardiac amyloidoses. Our review suggests that LV longitudinal function and the cyclic variation of myocardial integrated backscatter may be the best predictors of adverse outcomes. In the future, new echocardiographic techniques, such as fully automated echocardiogram interpretation, should provide further useful information for assessing cardiac function and prognosis in cardiac amyloidosis patients.
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Kyriakou P, Mouselimis D, Tsarouchas A, Rigopoulos A, Bakogiannis C, Noutsias M, Vassilikos V. Diagnosis of cardiac amyloidosis: a systematic review on the role of imaging and biomarkers. BMC Cardiovasc Disord 2018; 18:221. [PMID: 30509186 PMCID: PMC6278059 DOI: 10.1186/s12872-018-0952-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiac Amyloidosis (CA) pertains to the cardiac involvement of a group of diseases, in which misfolded proteins deposit in tissues and cause progressive organ damage. The vast majority of CA cases are caused by light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). The increased awareness of these diseases has led to an increment of newly diagnosed cases each year. METHODS We performed multiple searches on MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews. Several search terms were used, such as "cardiac amyloidosis", "diagnostic modalities cardiac amyloidosis" and "staging cardiac amyloidosis". Emphasis was given on original articles describing novel diagnostic and staging approaches to the disease. RESULTS Imaging techniques are indispensable to diagnosing CA. Novel ultrasonographic techniques boast high sensitivity and specificity for the disease. Nuclear imaging has repeatedly proved its worth in the diagnostic procedure, with efforts now focusing on standardization and quantification of amyloid load. Because the latter would be invaluable for any staging system, those spearheading research in magnetic resonance imaging of the disease are also trying to come up with accurate tools to quantify amyloid burden. Staging tools are currently being developed and validated for ATTR CA, in the spirit of the acclaimed Mayo Staging System for AL. CONCLUSION Cardiac involvement confers significant morbidity and mortality in all types of amyloidosis. Great effort is made to reduce the time to diagnosis, as treatment in the initial stages of the disease is tied to better prognosis. The results of these efforts are highly sensitive and specific diagnostic modalities that are also reasonably cost effective.
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Affiliation(s)
- Panagiota Kyriakou
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Dimitrios Mouselimis
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Anastasios Tsarouchas
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Angelos Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle (Saale), D-06120 Germany
| | - Constantinos Bakogiannis
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle (Saale), D-06120 Germany
| | - Vasileios Vassilikos
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
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Ucar AB, Unal Akoglu E, Cimilli Ozturk T, Eyinc Y, Ak R, Demir H, Ilgezdi ZD, Onur O. Diagnostic value of Tei index for acute myocardial infarction in patients presenting to emergency department with ischemic chest pain and correlation with Hs-troponin. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918802735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Acute myocardial infarction is one of the most common causes of mortality in developed countries, and high-sensitive troponin test usually becomes positive within 3 h from the onset of symptoms. Myocardial perfusion index (Tei index) is a parameter measured during the echocardiographic examination. Objectives: The aim of this study is to investigate the diagnostic value of the Tei index for early diagnosis of acute myocardial infarction in the emergency department and to evaluate the correlation between the Tei index and Hs-Troponin value. Materials and Methods: A total of 129 cases were evaluated, and patients were divided into two groups according to their final diagnosis as “acute myocardial infarction (non-ST segment elevation myocardial infarction)” and “non-acute myocardial infarction” groups. Baseline and third-hour Hs-Troponin levels and Tei index values were determined, and their correlation was analyzed. Results: A total of 84 cases were diagnosed with acute myocardial infarction (non-ST segment elevation myocardial infarction), 84.5% had positive Tei index results at the time of admission while the remaining 45 patients were diagnosed as non-acute myocardial infarction and only 48.9% of them had positive Tei index. The diagnostic value of the Tei index and Hs-troponin were calculated as 79.8% and 60%; 67.9% and 60%, respectively. Also, we found that a 0.02 or more increase in the Tei index value has a 97.6 sensitivity and 97.5 specificity for the diagnosis of non-ST segment elevation myocardial infarction. A weak correlation was found between the Tei index and Hs-Troponin values in the acute myocardial infarction group (r = 0.425) and a negative correlation in non-acute myocardial infarction patients at presentation. Conclusion: It is suggested that the use of Tei index might be used as a supportive measure for the early diagnosis of acute myocardial infarction, and the deterioration of Tei index seems to be more significant than Hs-Troponin especially in ruling out acute myocardial infarction.
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Affiliation(s)
- Aslı Bahar Ucar
- Diyarbakir Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Ebru Unal Akoglu
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Tuba Cimilli Ozturk
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Yalman Eyinc
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
- Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Rohat Ak
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
- Department of Emergency Medicine, Sancaktepe Sehit Prof. Dr. Ilhan Varank Education and Research Hospital, Istanbul, Turkey
| | - Hasan Demir
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Demet Ilgezdi
- Department of Cardiology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Ozge Onur
- Department of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
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Abuomara HZA, Hassan OM, Rashid T, Baraka M. Myocardial performance index as an echocardiographic predictor of early in-hospital heart failure during first acute anterior ST-elevation myocardial infarction. Egypt Heart J 2018; 70:71-75. [PMID: 30166885 PMCID: PMC6112368 DOI: 10.1016/j.ehj.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the value of Myocardial Performance Index (MPI) as an echocardiographic predictor of early in-hospital heart failure (HF) during first acute anterior ST-Elevation Myocardial Infarction (STEMI). Background Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. The ejection fraction (EF) and transmitral flow, the most frequently used methods for evaluation of systolic and diastolic functions respectively, both have considerable limitations. The MPI is a single parameter, capable of estimating combined systolic and diastolic performance and lacks such limitations. Methods We enrolled 60 patients presented with a first acute anterior STEMI who have undergone primary PCI. Echocardiography was done within 24 h of chest pain with measurement of MPI. The LV MPI was calculated as (isovolumic contraction time “ICT” + relaxation time “IRT”)/Ejection time “ET”. Besides, clinical and echocardiographic variables were analyzed and CHF was defined as Killip class ≥ II. Results Early in-hospital HF occurred in 23 of patients (38%). Ejection fraction was found to have a highly significant negative correlation with the development of in-hospital HF (p = .0001), while MPI was found to have a highly significant positive correlation (p = .0001). A cut-off point of MPI > 0.73 showed a very high specificity (94.6%) and sensitivity (78.3%) for identifying patients with HF. On the other hand, a cut-off point of EF ≤ 33% has shown 94.6% specificity and 56.5% sensitivity for HF prediction. Conclusions The MPI might be a strong predictor of in-hospital HF after first acute anterior STEMI.
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Affiliation(s)
| | | | - Tarek Rashid
- Cardiology Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Mahmoud Baraka
- Cardiology Department, Ain Shams University Hospitals, Cairo, Egypt
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Song ES, Yoon S, Cho JH, Yang EM, Cho HJ, Choi YY, Ma JS, Eom GH, Cho YK. Serial evaluation of myocardial function using the myocardial performance index in Kawasaki disease. World J Pediatr 2018. [PMID: 29532436 DOI: 10.1007/s12519-018-0142-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is known as systemic vasculitis, and more than half of the patients with KD have myocarditis, which can induce ventricular dysfunction. In this study, we evaluate left ventricular (LV) dysfunction in patients with KD based on the myocardial performance index (MPI) using pulse Doppler (PD) and tissue Doppler imaging (TDI), from the acute to convalescent phases. METHODS We retrospectively studied 89 children diagnosed with KD from January 2010 to August 2012. We assessed the presence of coronary artery lesions (CALs) and the LV ejection fraction, PD-MPI, and TDI-MPI at diagnosis, and 2, 14, and 56 days after intravenous immunoglobulin (IVIG) treatment. We enrolled 70 healthy children as a control group. RESULTS The ejection fraction in patients with KD at diagnosis (67.3 ± 0.9%) was lower than that in the control group (69.8 ± 0.8%, P = 0.035), and the LV TDI-MPIs for patients with KD at diagnosis (0.49 ± 0.01) and 2 days after IVIG treatment (0.48 ± 0.01) were higher than those in the control group (0.45 ± 0.01, P = 0.002, P = 0.033, respectively). No significant differences were found in the LV dysfunction between the patients with complete and incomplete KD. Septal TDI-MPIs in patients with KD with CAL at diagnosis (0.52 ± 0.02) were higher than those in patients with KD without CAL (0.47 ± 0.01, P = 0.019). CONCLUSIONS Transient LV dysfunction occurred in patients with complete and incomplete KD in the acute stage. In patients with KD with CAL at diagnosis, the LV dysfunction was more prominent. The PD-MPI and TDI-MPI are useful parameters for assessing LV function in patients with KD.
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Affiliation(s)
- Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Somy Yoon
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea
| | - Joo Hyun Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Jae Sook Ma
- Department of Pediatrics, KS Hospital, Gwangju, South Korea
| | - Gwang Hyeon Eom
- Department of Pharmacology and Medical Research Center for Gene Regulation, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea.
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
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Siddiqi OK, Sanchorawala V, Ruberg FL. Echocardiography and Survival in Light Chain Cardiac Amyloidosis: Back to Basics. Circ Cardiovasc Imaging 2018; 11:e007826. [PMID: 29752394 DOI: 10.1161/circimaging.118.007826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omar K Siddiqi
- Section of Cardiovascular Medicine, Department of Medicine (O.K.S., F.L.R.).,Amyloidosis Center (O.K.S., V.S., F.L.R.)
| | - Vaishali Sanchorawala
- Amyloidosis Center (O.K.S., V.S., F.L.R.).,Division of Hematology and Oncology, Department of Medicine (V.S)
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine (O.K.S., F.L.R.) .,Amyloidosis Center (O.K.S., V.S., F.L.R.).,and Department of Radiology (F.L.R.), Boston University School of Medicine, Boston Medical Center, MA
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Cong Z, Jiang B, Lu J, Cong Y, Fu J, Jin M, Wang X. A potentially new phase of the cardiac cycle: Pre-isovolumic contraction recognized by echocardiography. Medicine (Baltimore) 2018; 97:e10770. [PMID: 29794754 PMCID: PMC6392727 DOI: 10.1097/md.0000000000010770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Clinically the isovolumic contraction time (IVCT) can be measured by 3 echocardiographic methods of M-mode, pulse-wave Doppler (PWD), and tissue Doppler imaging (TDI). But IVCT can be clinically different by the 3 methods. This study is to investigate whether there is a potentially unidentified phase causing the discrepancies by analyzing electric mechanical delay time (EMD), IVCT, and pre-ejection period (PEP).A total of 30 healthy subjects were recruited for the study. EMD, IVCT, and PEP were obtained by the 3 methods, respectively. MCT (the interval from the onset of the QRS wave to the closure point of the mitral valve measured by TDI) and ICMC (the interval from the onset of IVC wave S1 to the closure point of the mitral valve measured by TDI) were both measured by color TDI.IVCTt (IVCT measured by TDI) was significantly longer than IVCTm or IVCTd (IVCT measured by M-mode or PWD) (both P < .0001), while EMDt (EMD measured by TDI) was significantly shorter than EMDm or EMDd (EMD measured by M-mode or PWD) (both P < .0001). But MCT was not significantly different from EMDm or EMDd (P > .05) and ICMC did not differ significantly from EMDm or EMDd minus EMDt or IVCTt minus IVCTm or IVCTd (P > .05), in other words, ICMC almost equaled to (EMDm or EMDd minus EMDt) or (IVCTt minus IVCTm or IVCTd).There may be an unidentified phase between the end of atrial contraction and the closure of mitral valve causing the discrepancies in IVCT, which is named as the pre-isovolumic contraction phase. It is a non-isovolumic phase and is included in the traditional isovolumic contraction phase.
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Affiliation(s)
- Zhibin Cong
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Bin Jiang
- Department of Ultrasonography, The First Hospital of China Medical University, Shengyang
| | - Jianbo Lu
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Yunyi Cong
- Bethune Medical College, Jilin University, Changchun, China
| | - Jili Fu
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Mingyue Jin
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
| | - Xue Wang
- Department of Electrodiagnosis, Changchun University of Traditional Chinese Medicine, Changchun
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Abstract
The heart, like any organ in the body, is susceptible to amyloid deposition. Although more than 30 types of protein can cause amyloidosis, only two types commonly deposit in the ventricular myocardium: amyloid light chain and amyloid transthyretin. Amyloid cardiomyopathy is usually a major determinant of patient outcomes, and the diagnosis of heart involvement can be often relatively under-diagnosed, owing to nonspecific presenting symptoms and signs at a subclinical stage. The diagnosis of cardiac amyloidosis is usually performed by endomyocardial biopsy; however, the invasive nature and related high-risk complications restrict its wide use in clinical settings. Recently, with the advent of innovative techniques used for evaluating cardiac amyloidosis, noninvasive methods become increasingly important, especially in earlier diagnosis, distinguishing typing, risk prediction and response to treatment. Here, we will review recent developments in the noninvasive methods used in the assessment of cardiac amyloidosis, focused on the laboratory biomarkers and imaging modalities.
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China.
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Increased Cathepsin D Correlates with Clinical Parameters in Newly Diagnosed Type 2 Diabetes. DISEASE MARKERS 2017; 2017:5286408. [PMID: 29375176 PMCID: PMC5742441 DOI: 10.1155/2017/5286408] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/24/2017] [Indexed: 12/17/2022]
Abstract
Background Cathepsin D has been recently implicated in insulin resistance and cardiovascular disease. This study was designed to investigate the relationship between cathepsin D and newly diagnosed type 2 diabetes. Methods Circulating cathepsin D levels and metabolic variables were measured in 98 cases and 98 controls. Myocardial performance index "Tei index" that reflects both left ventricular systolic and diastolic function was measured with Doppler echocardiography in cases. Results Newly diagnosed type 2 diabetes demonstrated significantly higher circulating cathepsin D concentrations than controls (median level: 227 ng/ml versus 174 ng/ml, P < 0.01). In newly diagnosed type 2 diabetes, a significant correlation was found between cathepsin D levels and HOMA-IR (homeostatic model assessment of insulin resistance) (r = 0.25, P = 0.01). In contrast, no significant correlation was found between cathepsin D levels and clinical parameters in the control group (all P > 0.05). Interestingly, correlation analysis revealed a positive association between cathepsin D levels and Tei index in type 2 diabetes (r = 0.22, P = 0.03). Conclusions Increased levels of circulating cathepsin D are closely linked with the presence of type 2 diabetes, and cathepsin D might serve as a novel biomarker for cardiac dysfunction in newly diagnosed type 2 diabetes.
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Kingwill AC, van der Westhuizen J, Turton EW. The effect of sevoflurane induction on the myocardial performance index in healthy individuals. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1402536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aidan C Kingwill
- Department of Anaesthesia, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | | | - Edwin W Turton
- Department of Anaesthesia, School of Medicine, University of the Free State, Bloemfontein, South Africa
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Kinno M, Nagpal P, Horgan S, Waller AH. Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 1 (Global Assessment). Curr Cardiol Rep 2017; 19:9. [PMID: 28176279 DOI: 10.1007/s11886-017-0815-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assessing left ventricular function is an essential part of the cardiovascular evaluation as it plays an important role in managing the patient and predicting prognosis. Recent advances in the imaging modalities currently allow a non-invasive comprehensive assessment of cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare the currently available techniques and novel approaches utilized by echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of global left ventricular performance.
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Affiliation(s)
- Menhel Kinno
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Prashant Nagpal
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephen Horgan
- Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA.
- Department of Radiology, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
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Abstract
BACKGROUND Long-term intensive training leads to morphological and mechanical changes in the heart generally known as "athlete's heart". Previous studies have suggested that the diastolic and systolic function of the ventricles is unaltered in athletes compared to sedentary. The purpose of this study was to investigate myocardial performance index (MPI) by pulsed wave Doppler (PWD) and by tissue Doppler imaging (TDI) in female elite athletes compared to sedentary controls. METHODS The study consisted of 32 athletes (mean age 20 ± 2 years) and 34 sedentary controls (mean age 23 ± 2 years). MPI by PWD and TDI were measured in the left (LV) and right ventricle (RV) in both groups. Moreover, comparisons of MPI by the two methods and between the LV and RV within the two groups were made. RESULTS There were no significant differences in MPI between athletes and controls (p > 0.05), whereas the LV had significantly higher MPI compared to RV (p < 0.001, in athletes and controls). The agreement and the correlation between the two methods measuring MPI showed low agreement and no correlation (athletes RV r = -0.027, LV r = 0.12; controls RV r = 0.20, LV r = 0.30). CONCLUSION The global function of the LV and RV measured by MPI with PWD and TDI is similar in female athletes compared to sedentary controls. Conversely, both MPI by PWD and by TDI shows a significant difference between the LV and RV. However, the agreement and correlation between conventional methods of measuring MPI by PWD compared to MPI by TDI is very poor in both these populations.
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Biering-Sørensen T, Querejeta Roca G, Hegde SM, Shah AM, Claggett B, Mosley TH, Butler KR, Solomon SD. Left ventricular ejection time is an independent predictor of incident heart failure in a community-based cohort. Eur J Heart Fail 2017; 20:1106-1114. [PMID: 28872225 DOI: 10.1002/ejhf.928] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/10/2023] Open
Abstract
AIMS Systolic time intervals change in the progress of cardiac dysfunction. The usefulness of left ventricular ejection time (LVET) to predict cardiovascular morbidity, however, is unknown. METHODS AND RESULTS We studied middle-aged African-Americans from one of four cohorts of the Atherosclerosis Risk in Communities study (Jackson cohort, n=1980) who underwent echocardiography between 1993 and 1995. Left ventricular ejection time was measured by pulsed-wave Doppler of the left ventricular outflow tract and related to outcomes. A shorter LVET was associated with younger age, male sex, higher diastolic blood pressure, higher proportion of diabetes, higher heart rate, higher blood glucose levels and worse fractional shortening. During a median follow-up of 17.6 years, 384 (19%) had incident heart failure (HF), 158 (8%) had a myocardial infarction, and 587 (30%) died. In univariable analysis, a lower LVET was significantly associated with increased risk of all events (P<0.05 for all). However, after multivariable adjustment for age, sex, hypertension, diabetes, body mass index, heart rate, systolic and diastolic blood pressure, fractional shortening and left atrial diameter, LVET remained an independent predictor only of incident HF [hazard ratio 1.07 (1.02-1.14), P=0.010 per 10 ms decrease]. In addition, LVET provided incremental prognostic information to the known risk factors included in the Framingham risk score, in regard to predicting all outcomes except for myocardial infarction. CONCLUSION Left ventricular ejection time is an independent predictor of incident HF in a community-based cohort and provides incremental prognostic information on the risk of future HF and death when added to known risk prediction models.
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Affiliation(s)
- Tor Biering-Sørensen
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Gabriela Querejeta Roca
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sheila M Hegde
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amil M Shah
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Claggett
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth R Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Scott D Solomon
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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45
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Mutlu K, Karadas U, Yozgat Y, Meşe T, Demirol M, Coban S, Karadeniz C, Özdemir R, Orbatu D, Karaarslan U, Tavli V. Echocardiographic evaluation of cardiac functions in newborns of mildly preeclamptic pregnant women within postnatal 24-48 hours. J OBSTET GYNAECOL 2017. [PMID: 28631496 DOI: 10.1080/01443615.2017.1322564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study is to detect preeclampsia-related cardiac dysfunction within 24-48 hours of delivery in newborns born from preeclamptic mothers. Forty newborns from mildly preeclamptic mothers formed the study group and the control group was formed by 40 healthy newborns. Cardiac function for the groups were evaluated using conventional echocardiography and myocardial performance index (MPI) within the first 24-48 hours of their lifetime and the results of both groups were compared. A significant difference between the groups was observed especially in the PW Doppler MPI measurements (the left ventricle MPI 0.37 ± 0.09 and 0.26 ± 0.11, p < .001; the right ventricle MPI 0.29 ± 0.08 and 0.26 ± 0.07, p < .035) for the control group and the study group. Elongation in the left and right ventricle MPI was detected to be more significant in terms of comparing systolic and diastolic functions to determine preeclampsia-related cardiac injury in newborns from preeclamptic mothers within the first 24-48 hours of their lifetime. Impact statement Today, the methods which may detect cardiac injury earlier than conventional echocardiographic methods are used for evaluating cardiac functions. Among them, myocardial performance index (MPI) measurement with PW Doppler is the most common ones. While studies are available in the literature evaluating foetal cardiac functions with MPI in foetuses of preeclamptic women, studies evaluating cardiac functions with MPI index within the first 24-48 hours in postnatal period are not available. This is the first study to detect cardiac injury by measuring cardiac functions of the newborns of preeclamptic babies using conventional echocardiography (EF, SF, mitral and tricuspid E/A) and myocardial performance index within the first 24-48 hours of life and compare these values with those of a control group composed of healthy newborns with similar demographic characteristics. According to the results of the study, elongation in right and left ventricle MPI was detected to be more significant compared to systolic and diastolic functions for determining preeclampsia-related cardiac injury in newborns of preeclamptic mothers within 24-48 hours of delivery. Ventricle functions of the newborns of preeclamptic mothers should also be evaluated with MPI measurement besides conventional echocardiographic measurements.
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Affiliation(s)
- Kadir Mutlu
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Ulas Karadas
- b MH Aegean Maternity , Teaching and Training Hospital , İzmir , Turkey
| | - Yilmaz Yozgat
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Timur Meşe
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Mustafa Demirol
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Senay Coban
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Cem Karadeniz
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Rahmi Özdemir
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Dilek Orbatu
- b MH Aegean Maternity , Teaching and Training Hospital , İzmir , Turkey
| | - Utku Karaarslan
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
| | - Vedide Tavli
- a Department of Pediatric Cardiology , Dr. Behcet Uz Children's Hospital , İzmir , Turkey
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Castaño A, Manson DK, Maurer MS, Bokhari S. Transthyretin Cardiac Amyloidosis in Older Adults: Optimizing Cardiac Imaging to the Corresponding Diagnostic and Management Goal. CURRENT CARDIOVASCULAR RISK REPORTS 2017; 11:17. [PMID: 29057029 PMCID: PMC5648026 DOI: 10.1007/s12170-017-0541-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Transthyretin cardiac amyloidosis is increasingly recognized as an important cause of heart failure in older adults. Many cardiac imaging modalities have evolved to evaluate transthyretin cardiac amyloidosis and include 2D echocardiography with tissue Doppler and speckle-strain imaging, nuclear scintigraphy, cardiac magnetic resonance imaging, and positron emission tomography. The purpose of this review is to highlight the optimal selection of advanced cardiac imaging techniques with corresponding diagnostic goals including raising suspicion, making an early diagnosis, and subtyping transthyretin cardiac amyloid, as well as management goals including assessment of ventricular impairment, prognosticating, and monitoring disease progression. Potential benefits of optimizing cardiac imaging in the elderly patient with transthyretin cardiac amyloidosis may include enhanced and earlier diagnosis and refined long-term management. RECENT FINDINGS Advances in cardiac imaging techniques are changing diagnostic and management algorithms for transthyretin cardiac amyloidosis. SUMMARY With a new era of novel therapeutics, enhanced recognition, and earlier diagnosis approaching, selecting the appropriate non-invasive cardiac imaging modality will be essential for optimal care in the elderly patient with transthyretin cardiac amyloidosis.
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Affiliation(s)
- Adam Castaño
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, Laboratory of Nuclear Cardiology, New York, NY 10032-3784, USA,
| | - Daniel K Manson
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, New York, NY 10032-3784, USA
| | - Mathew S Maurer
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, New York, NY 10032-3784, USA
| | - Sabahat Bokhari
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Laboratory of Nuclear Cardiology, New York, NY 10032-3784, USA
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Karabulut A, Doğan A, Tuzcu AK. Myocardial Performance Index for Patients with Overt and Subclinical Hypothyroidism. Med Sci Monit 2017; 23:2519-2526. [PMID: 28540919 PMCID: PMC5452865 DOI: 10.12659/msm.905190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypothyroid has several effects on the cardiovascular system. Global myocardial performance index (MPI) is used in assessment of both left ventricular (LV) systolic and diastolic function. We compared MPI in hypothyroidism patients vs. normal control subjects. MATERIAL AND METHODS Eighty-two hypothyroid patients were divided into 2 groups: a subclinical hypothyroid (SH) group (n=50), and an overt hypothyroid (OH) group (n=32). The healthy control group (CG) constituted of 37 patients. TSH, FT3, and FT4, anti-TPO, anti-TG, insulin, lipid values, and fasting glucose levels were studied. All patients underwent an echocardiographic examination. Myocardial performance indexes were assessed and standard echocardiographic examinations were investigated. RESULTS MPI averages in OH, SH, and control groups were 0.53±0.06, 0.51±0.05, and 0.44±0.75 mm, respectively. MPI was increased in the OH and SH groups in comparison to CG (p<0.001, p<0.001, respectively). CONCLUSIONS MPI value was significantly higher in hypothyroid patients in comparison to the control group, showing that regression in global left ventricular functions is an important echocardiographic finding. Future studies are required to determine the effects of this finding on long-term cardiovascular outcomes.
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Affiliation(s)
- Aziz Karabulut
- Department of Cardiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
| | - Abdullah Doğan
- Department of Internal Medicine, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
| | - Alpaslan Kemal Tuzcu
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
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Liu D, Hu K, Herrmann S, Cikes M, Ertl G, Weidemann F, Störk S, Nordbeck P. Value of tissue Doppler-derived Tei index and two-dimensional speckle tracking imaging derived longitudinal strain on predicting outcome of patients with light-chain cardiac amyloidosis. Int J Cardiovasc Imaging 2017; 33:837-845. [PMID: 28265790 PMCID: PMC5406485 DOI: 10.1007/s10554-017-1075-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/13/2017] [Indexed: 12/29/2022]
Abstract
Prognosis of patients with light-chain cardiac amyloidosis (AL-CA) is poor. Speckle tracking imaging (STI) derived longitudinal deformation parameters and Doppler-derived left ventricular (LV) Tei index are valuable predictors of outcome in patients with AL-CA. We estimated the prognostic utility of Tei index and deformation parameters in 58 comprehensively phenotyped patients with AL-CA after a median follow-up of 365 days (quartiles 121, 365 days). The primary end point was all-cause mortality. 19 (33%) patients died during follow-up. Tei index (0.89 ± 0.29 vs. 0.61 ± 0.16, p < 0.001) and E to global early diastolic strain rate ratio (E/GLSRdias) were higher while global longitudinal systolic strain (GLSsys) was lower in non-survivors than in survivors (all p < 0.05). Tei index, NYHA functional class, GLSsys and E/GLSRdias were independent predictors of all-cause mortality risk, and Tei index ≥0.9 (HR 7.01, 95% CI 2.43–20.21, p < 0.001) was the best predictor of poor outcome. Combining Tei index and GLSsys yielded the best results on predicting death within 1 year (100% with Tei index ≥0.9 and GLSsys ≤13%) or survival (95% with Tei index ≤0.9 and GLSsys ≥13%). We conclude that 1-year mortality risk in AL-CA patients can be reliably predicted using Tei index or deformation parameters, with combined analysis offering best performance.
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Affiliation(s)
- Dan Liu
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Kai Hu
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Sebastian Herrmann
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Maja Cikes
- Department for Cardiovascular Diseases, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | | | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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Al-Daydamony MM, El-Tahlawi MA, Shawky A. Can myocardial performance index predict the presence of silent ischemia in asymptomatic type 2 diabetic patients? Echocardiography 2016; 33:1823-1827. [PMID: 27677770 DOI: 10.1111/echo.13359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with diabetes. Silent myocardial ischemia (SMI) is common in patients with diabetes and is associated with poorer prognosis. Myocardial performance index "Tei index" that reflects both left ventricular (LV) systolic and diastolic function. The aim of our study was to test the value of Tei index in prediction of SMI in asymptomatic patients with type 2 diabetes. PATIENTS AND METHODS Asymptomatic patients with type 2 diabetes were included in our study. We excluded patients with known CAD, previous revascularization, low ejection fraction, or abnormal ECG from the study. All patients had undergone history taking and clinical examination, ECG, echocardiography with measuring of Tei index and Holter monitoring for detecting silent ischemia. RESULTS A total of 200 patients were recruited. We divided our patients into two groups: Group I: 64 patients with SMI, Group II: 136 patients without SMI. There was no significant difference between the two groups regarding clinical and conventional echocardiographic data. Tei index was significantly higher in patients with silent ischemia (P<.00001). Sensitivity, specificity, positive, and negative predictive values of Tei index ≥0.6 in prediction of Holter detected silent ischemia were 85.9%, 90%, 78.6%, and 88.6%, respectively. We found a significant positive correlation between Tei index and number of ischemic episodes (r=.366, P=.0029). CONCLUSION Measuring Tei index is helpful in predicting the presence of silent ischemia in asymptomatic patients with type 2 diabetes.
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Affiliation(s)
| | | | - Ahmad Shawky
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Balli S, Yucel IK, Kibar AE, Ece I, Dalkiran ES, Candan S. Assessment of cardiac function in absence of congenital and acquired heart disease in patients with Down syndrome. World J Pediatr 2016; 12:463-469. [PMID: 27059745 DOI: 10.1007/s12519-016-0012-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/12/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Extra genetic material in patients with Down syndrome (DS) may affect the function of any organ system. We evaluated cardiac functions using conventional tissue Doppler and two-dimensional speckle tracking echocardiography in patients with DS in the absence of congenital and acquired heart disease in patients. METHODS A total of 115 patients with DS between 6 and 13 years of age with clinically and anatomically normal heart and 55 healthy children were included in this cross-sectional study. DS was diagnosed by a karyotype test. Patients with mosaic type were not included in this study. Systolic and diastolic functions were evaluated by echocardiography. RESULTS Pulsed waved Doppler transmitral early/late inflow velocity (E/A), tissue Doppler mitral annular early/late diastolic peak velocity (Ea/Aa), transtricuspid E/A and tricuspid valve annulus Ea/Aa, pulmonary venous Doppler systolic/diastolic (S/D) wave ratio were lower in patients with Down syndrome than in the control group (P=0.04, P=0.001, P<0.05, P<0.001, P<0.001, respectively). Mitral and tricuspid annular Ea were lower in patients with DS (P<0.001). The right and left ventricular myocardial performance indexes were higher in patients with DS than in the controls (P<0.01). They had significantly higher left ventricular mass, ejection fraction, the mitral annular plane systolic excursion values. However, the Down syndrome group compared with the controls had a lower strain values examined by two-dimensional longitudinal speckle-tracking strain echocardiography. CONCLUSION These findings suggest conventional tissue Doppler and two-dimensional longitudinal speckletracking strain echocardiography were useful methods of investigating ventricular function and identifying a higher incidence of biventricular dysfunction in patients with Down syndrome compared with the healthy controls.
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Affiliation(s)
- Sevket Balli
- Department of Pediatric Cardiology, Balikesir Ataturk Hospital, Balikesir, Turkey.
| | - Ilker Kemal Yucel
- Department of Pediatric Cardilogy, Siyami Ersek Education and Research Hospital, Istanbul, Turkey
| | - Ayse Esin Kibar
- Department of Pediatric Cardiology, Children's Hospital, Mersin, Turkey
| | - Ibrahim Ece
- Department of Pediatric Cardiology, Yuzuncu Yil University of Medicine, Van, Turkey
| | | | - Sukru Candan
- Department of Medical Genetics, Balikesir Ataturk Hospital, Balikesir, Turkey
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