RESUMEN
PURPOSE: During the last decade, a number of echocardiographic studies have employed speckle tracking echocardiography (STE) for assessing myocardial deformation properties in individuals with mitral valve prolapse (MVP), reporting not univocal results. Accordingly, we performed a systematic review and meta-analysis to summarize the main findings of these studies and to examine the overall influence of MVP on left ventricular (LV) global longitudinal strain (GLS). METHODS: All echocardiographic studies assessing conventional echoDoppler parameters and myocardial strain indices in MVP individuals vs. controls without MVP, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS) were pooled as a standardized mean difference (SMD) comparing MVP group with healthy controls. The overall SMD of LV-GLS was calculated using the random-effect model. RESULTS: The full-texts of 15 studies with 1088 individuals with MVP and 591 healthy controls were analyzed. Average LV-GLS magnitude was significantly, even though modestly, reduced in MVP individuals in comparison to controls (19.4 ± 3.4% vs. 21.1 ± 2.8%, P < 0.001). The overall effect of MVP on LV-GLS was small-to-medium (SMD - 0.54, 95%CI -0.76,-0.32, P < 0.001). Substantial heterogeneity was detected for the included studies, with an overall I2 statistic value of 75.9% (P < 0.001). Egger's test for a regression intercept gave a P-value of 0.58, indicating no publication bias. On meta-regression analysis, none of the moderators (the age, the percentage of females among MVP individuals, body mass index, heart rate and systolic blood pressure of MVP individuals, the degree of mitral regurgitation, the type of ultrasound machine employed for strain echocardiographic imaging and finally the beta blocker treatment) was significantly associated with effect modification (all P < 0.05). Regional strain analysis, performed by two-third of the studies, highlighted a more enhanced reduction in myocardial strain parameters at level of the LV basal infero-lateral segments in all directions (longitudinal, circumferential and radial), with apical sparing. CONCLUSIONS: The longitudinal strain impairment detected in MVP individuals is more regional than global, with peculiar involvement of the LV basal infero-lateral segments and relative apical sparing pattern.
RESUMEN
AIMS: The Fick principle states that oxygen uptake (VÌO2) is cardiac output (Qc)*arterial-venous O2 content difference [ΔC(a-v)O2]. Blood flow distribution is hidden in Fick principle and its relevance during exercise in heart failure (HF) is undefined.To highlight the role of blood flow distribution, we evaluated peak-exercise VÌO2, Qc and ΔC(a-v)O2, before and after HF therapeutic interventions. METHODS: Symptoms-limited cardiopulmonary exercise tests with Qc measurement (inert-gas-rebreathing) was performed in 234 HF patients before and 6 months after successful exercise training, cardiac-resynchronization therapy or percutaneous-edge-to-edge mitral valve repair. RESULTS: Considering all tests (n=468) a direct correlation between peakVÌO2 and peakQc (R2=0.47) and workload (R2=0.70) were observed. Patients were grouped according to treatment efficacy in group 1 (peakVÌO2 increase >10%, n=93), group 2 (peakVÌO2 change between 0 and 10%, n=60) and group 3 (reduction in peakVÌO2, n=81). Post-treatment peakVÌO2 changes poorly correlated with peakQc and peakΔC(a-v)O2 changes. Differently, post-procedures peakQc vs. peakΔC(a-v)O2 changes showed a close negative correlation (R2=0.46), becoming stronger grouping patients according to peakVÌO2 improvement (R2=0.64, 0.79 and 0.58 in group 1, 2 and 3, respectively). In 76% of patients peakQc and ΔC(a-v)O2 changes diverged regardless of treatment. CONCLUSION: The bulk of these data suggests that blood flow distribution plays a pivotal role on peakVÌO2 determination regardless of HF treatment strategies. Accordingly, for assessing HF treatment efficacy on exercise performance the sole peakVÌO2 may be deceptive and the combination of VÌO2, Qc and ΔC(a-v)O2, must be considered.
This study aimed to understand how oxygen uptake during exercise is affected by heart failure therapeutic intervention. We evaluated 234 heart failure patients before and after treatments such as exercise training, cardiac resynchronization therapy, or mitral valve repair, finding that changes in oxygen uptake were poorly correlated with changes in cardiac output and oxygen content difference between arteries and veins. However, we observed a strong negative correlation between changes in cardiac output and oxygen content difference, especially in patients with significant improvement in oxygen uptake. This suggests that blood flow distribution is crucial for oxygen uptake during exercise, regardless of treatment. Therefore, relying solely on oxygen uptake may not accurately assess treatment effectiveness, and considering a combination of oxygen uptake, cardiac output, and oxygen content difference is important. Oxygen uptake during exercise was strongly related to cardiac output and workload.Changes in cardiac output and oxygen content difference were closely related after treatments, especially in patients with significant improvement in oxygen uptake.
RESUMEN
OBJECTIVE: The influence of hypertensive disorders of pregnancy (HDP) on left atrial (LA) mechanics assessed by speckle tracking echocardiography (STE) has been poorly investigated. Accordingly, we performed a meta-analysis to summarize the main findings of STE studies who measured LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain in HDP women. STUDY DESIGN: All echocardiographic studies assessing LA strain parameters in HDP women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LASr, LAScd and LASct) were pooled as standardized mean difference (SMD) comparing HDP group with healthy controls. The overall SMDs of LASr, LAScd and LASct were calculated using the random-effect model. RESULTS: The full-texts of 8 studies with 566 HDP women and 420 healthy pregnant women were analyzed. Average LASr (34.3 ± 6.4 vs 42.7 ± 5.3 %, P = 0.01) and LAScd (23.4 ± 6.3 vs 32.5 ± 6.0 %, P < 0.001) were significantly lower in HDP women than controls, whereas LASct (-13.0 ± 5.4 vs -13.7 ± 4.5 %, P = 0.18) was similar in the two groups of women. Substantial heterogeneity was detected among the studies evaluating LASr (I2 = 94.3 %), LAScd (I2 = 64.9 %) and LASct (I2 = 86.4 %). SMDs were large and statistically significant for LASr (-1.70, 95 %CI -2.34,-1.06, P < 0.001) and LAScd (-1.35, 95 %CI -1.69,-1.00, P < 0.001), small and not statistically significant for LASct (-0.11, 95 %CI -0.60,0.39, P = 0.678) assessment. Egger's test gave P-values of 0.10, 0.34 and 0.75 for LASr, LAScd and LASct measurement respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LASr and its components (all P < 0.05). CONCLUSIONS: HDPs are independently associated with LASr impairment in pregnancy. STE allows to identify, among HDP women, those who might benefit from a more aggressive antihypertensive treatment and/or a closer clinical follow-up, aimed at reducing the risk of adverse maternal outcome and cardiovascular complications later in life.
Asunto(s)
Función del Atrio Izquierdo , Ecocardiografía , Atrios Cardíacos , Hipertensión Inducida en el Embarazo , Humanos , Femenino , Embarazo , Hipertensión Inducida en el Embarazo/fisiopatología , Hipertensión Inducida en el Embarazo/diagnóstico por imagen , Ecocardiografía/métodos , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Función del Atrio Izquierdo/fisiologíaRESUMEN
BACKGROUND: Literature data suggest high inter-study variability in mitral valve prolapse (MVP) prevalence among individuals with thoracic skeletal abnormalities (TSA). This systematic review aimed at estimating the overall prevalence of MVP in individuals with the most common TSA, including not only the oldest studies (before the year 2000) but also the most recent ones (after the year 2000). METHODS: PubMed and EMBASE databases were systematically reviewed in November 2023. Studies assessing the relationship between MVP and TSA and estimating the MVP prevalence in pectus excavatum (PE), pectus carinatum (PC), scoliosis, straight back syndrome (SBS) and Marfan syndrome (MS) were included. There was no limitation on time periods. RESULTS: Twenty-five studies with a total of 2800 patients (27.9â±â13.9 years, 48.2% females) were analyzed. The highest prevalence of MVP was observed among MS patients (47.3%), while the lowest was detected in PC individuals (23%). Prevalence of MVP was similar among PE (30.8%), scoliosis (26.3%) and SBS (25.5%) patients. When dividing the studies on the basis of temporal period, the average MVP prevalence was approximately two-fold higher in all studies conducted before the year 2000 in comparison with the most recent ones, regardless of TSA type. This discrepancy might be primarily ascribed to relevant differences in the echocardiographic criteria employed for MVP diagnosis before (less specific) and after (more specific) the year 2000, respectively. CONCLUSIONS: The estimated MVP prevalence in TSA individuals is significantly higher than that observed in the general population. Individuals with TSA should be screened for MVP presence on transthoracic echocardiography.
Asunto(s)
Prolapso de la Válvula Mitral , Humanos , Prolapso de la Válvula Mitral/epidemiología , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/fisiopatología , Prevalencia , Femenino , Masculino , Adulto , Adulto Joven , Adolescente , Escoliosis/epidemiología , Escoliosis/diagnóstico por imagen , Niño , Tórax en Embudo/epidemiología , Tórax en Embudo/diagnóstico por imagen , Tórax en Embudo/complicaciones , Tórax en Embudo/diagnóstico , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/epidemiología , Pectus Carinatum/epidemiología , Pectus Carinatum/diagnóstico , Pectus Carinatum/diagnóstico por imagen , Persona de Mediana Edad , Anomalías Musculoesqueléticas/epidemiología , Anomalías Musculoesqueléticas/diagnóstico por imagen , Anomalías Musculoesqueléticas/diagnóstico , Factores de RiesgoRESUMEN
BACKGROUND: Left atrial (LA) size is a well-known prognostic determinant in the setting of coronary artery disease (CAD). No previous study has evaluated LA antero-posterior (A-P) diameter as a potential screening method for identifying individuals with a low probability of CAD. We aimed to assess the influence of LA A-P diameter adjusted for chest wall conformation (A-P thoracic diameter) on the occurrence of false-positive (FP) results on exercise stress echocardiography (ESE) in patients with suspected CAD. METHODS: All consecutive patients who had undergone coronary angiography at MultiMedica IRCCS (via San vittore 12, 20123, Milan, Italy) within two months from a positive ESE over a seven-year period were retrospectively analyzed. All patients underwent LA A-P diameter/A-P thoracic diameter ratio assessment, resting transthoracic echocardiography, and subsequent ESE. The primary endpoint was FP-ESE, defined as a positive ESE with no evidence of obstructive CAD (≥70% stenosis in any epicardial coronary artery) on subsequent coronary angiography. RESULTS: A total of 160 patients (64.4±13.0 years, 56.9% females) with a positive ESE were retrospectively analyzed. In light of coronary angiography results, 129 patients (80.6%) had an obstructive CAD, while 31 (19.4%) did not (FP). On the multivariate logistic regression analysis, the LA A-P diameter/A-P thoracic diameter ratio (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.31-0.57) showed a strong inverse correlation with the primary endpoint. An LA A-P diameter/A-P thoracic diameter ratio ≤0.25 had 100% sensitivity and 85% specificity for predicting FP-ESE results (area under the curve (AUC) = 0.94). A strong linear correlation was demonstrated between the LA A-P diameter and A-P thoracic diameter (r = 0.85), whereas the correlation between the LA volume index and A-P thoracic diameter was moderate (r = 0.47). CONCLUSIONS: Echocardiographic assessment of the LA A-P diameter adjusted for the A-P thoracic diameter may allow clinicians to identify, among individuals with suspected CAD, those at lower risk of obstructive CAD.
RESUMEN
BACKGROUND: The possible influence of chest wall conformation, as noninvasively assessed by Modified Haller Index (MHI, the ratio of chest transverse diameter over the distance between sternum and spine), on reproducibility of both left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) has never been previously investigated. METHODS: Two equal groups of healthy individuals, matched by age, sex, and cardiovascular risk factors and categorized according to MHI in those with concave-shaped chest wall (MHI>2.5) and those with normal chest shape (MHI≤2.5), who underwent transthoracic echocardiography implemented with echocardiographic deformation imaging between June 2018 and May 2019, were retrospectively analyzed. LVEF and GLS were measured twice by the two echocardiographers in a double blinded manner. Intra-class correlation coefficients (ICCs), bias and limits of agreement determined with Bland-Altman analysis were calculated for repeated measurements of both LVEF and GLS. RESULTS: Thirty-four healthy individuals with MHI>2.5 (54.9±6.4 years, 58.8% females) and 34 matched controls with MHI≤2.5 (52.5±8.1 years, 50% females) were separately analyzed. In comparison to MHI≤2.5 group, the MHI>2.5 group was found with significantly smaller cardiac chambers and significantly lower GLS magnitude (-15.8±2.5 vs. -22.2±1.3%, P<0.001), despite similar LVEF (61.3±6.4 vs. 61.1±3.6%, P=0.87). In the MHI>2.5 group, intra-rater and inter-rater ICCs were ≤0.5 for both LVEF and LV-GLS, whereas in the MHI≤2.5 group intra-rater and inter-rater ICCs values indicated good reliability for LVEF and excellent reliability for GLS. The greatest bias and largest limits of agreement were detected for LVEF assessment (bias ranging from -1.09 to 2.94%, with the 95% limits of agreement ranging from -13.9 to 21.3%) in individuals with MHI>2.5. On the other hand, the smallest bias and narrowest limits of agreement were obtained for GLS measurement (bias ranging from -0.26 to 0.09%, with the 95% limits of agreement ranging from -1.4 to 1.4%) in participants with normal chest wall conformation (MHI≤2.5). CONCLUSIONS: The test reliability of LVEF and GLS is strongly influenced by the chest wall conformation. MHI might represent an innovative approach for selecting the best echocardiographic method for LV systolic function estimation in the individual case.
Asunto(s)
Pared Torácica , Función Ventricular Izquierda , Femenino , Humanos , Masculino , Volumen Sistólico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Pared Torácica/diagnóstico por imagen , Ecocardiografía/métodosRESUMEN
BACKGROUND: The possible influence exerted by mechanical factors and/or compressive phenomena on myocardial strain parameters in healthy individuals with opposite obesity phenotypes (android vs gynoid) has never been previously investigated. Accordingly, we aimed at evaluating the relationship between anthropometrics, such as the waist-to-hip ratio (WHR), modified Haller index (MHI, the ratio of chest transverse diameter over the distance between sternum and spine), and epicardial adipose tissue (EAT), and left ventricular (LV)-global longitudinal strain (GLS), in healthy women with opposite obesity phenotypes (android vs gynoid). METHODS: Forty healthy women with obesity (body mass index (BMI) ≥30 Kg/m2) and WHR ≥0.85 ("android group") (52.5±13.2 yrs), 40 age- and BMI-matched healthy women with obesityand WHR <0.78 ("gynoid group") (49.8±13.4 yrs) and 40 age-matched healthy women without obesity (BMI <30 Kg/m2) (controls) (50.3±12.5 yrs) were retrospectively analyzed. All women underwent transthoracic echocardiography implemented with echocardiographic strain analysis of all cardiac chambers. Correlation between LV-GLS and anthropometrics (WHR, MHI, and EAT) was assessed in both groups of obese women. Age, WHR, homeostasis model assessment for insulin resistance (HOMA-IR), and left ventricular mass index (LVMi) were included in the logistic regression analysis performed for evaluating the independent predictors of reduced LV-GLS magnitude (less negative than -20%) in women with android obesity. RESULTS: Compared to the other groups of women, those with android obesity were found with significantly greater LVMi, higher LV filling pressures, and lower biventricular and biatrial deformation indices. A strong inverse correlation between LV-GLS and all anthropometrics (WHR, MHI, and EAT) was demonstrated in both groups of women with obesity. Univariate logistic regression analysis revealed that WHR (OR 1.58, 95%CI 1.22-2.03, p<0.001) and LVMi (OR 1.09, 95%CI 1.02-1.16, p=0.006) were independently correlated with LV-GLS impairment in women with android obesity. On multivariate logistic regression analysis, the WHR maintained a statistically significant association with the above-mentioned outcome (OR 1.68, 95%CI 1.14-2.48, p=0.009). Receiver operating characteristic (ROC) curve analysis showed that a WHR value ≥1.01 had 93% sensitivity and 100% specificity for detecting LV-GLS impairment in women with android obesity (AUC=0.98; 95%CI 0.96-1.00). CONCLUSIONS: Anthropometrics may strongly influence cardiac mechanics in healthy women with obesity. The WHR is associated with reduced LV-GLS magnitude in healthy women with android obesity, independent of age, glycometabolic status, and LV size.
RESUMEN
AIMS: The association between gestational diabetes mellitus (GDM) and common carotid artery (CCA) intima-media thickness (IMT) is still controversial. This systematic review and meta-analysis was performed to assess the correlation between GDM and CCA-IMT in and after pregnancy. METHODS: PubMed and EMBASE databases were systematically reviewed on April 2023. Studies measuring CCA-IMT in both pregnant women with GDM and women with previous history of GDM (pGDM) vs. healthy controls were included. The subtotal and overall standardized mean differences (SMDs) of CCA-IMT were calculated using the random-effect model. RESULTS: Nineteen studies with a total of 302 GDM and 861 pGDM women were analyzed. The average value of CCA-IMT measured in GDM/pGDM (0.59 ± 0.12 mm) was slightly increased in comparison to the accepted reference limits of IMT according to age classes. Substantial heterogeneity was detected for the studies involving both GDM and pGDM women, with an overall statistic I2 of 86.0% (p < 0.001). Large SMDs were obtained for the studies conducted on both GDM and pGDM women, with an overall SMD of 0.89 (95%CI 0.63-1.15, p < 0.001). Egger's test for a regression intercept gave a p-value of 0.37, indicating no publication bias. On meta-regression analysis, all potential confounders (number of patients, age at pregnancy, body mass index, measuring time, follow-up duration and GDM criteria) were not significantly associated with effect modification. CONCLUSIONS: GDM in and after pregnancy is independently associated with subclinical atherosclerosis. The association between GDM and carotid remodeling is potentially mediated by the longstanding underlying risk.
Asunto(s)
Aterosclerosis , Diabetes Gestacional , Humanos , Femenino , Embarazo , Grosor Intima-Media Carotídeo , Aterosclerosis/etiología , Arterias Carótidas , Factores de RiesgoRESUMEN
OBJECTIVE: The correlation between gestational diabetes mellitus (GDM) and subclinical myocardial dysfunction has been poorly investigated. Accordingly, we performed a meta-analysis to examine the influence of GDM on left ventricular (LV) global longitudinal strain (GLS), assessed by speckle tracking echocardiography (STE), during pregnancy. STUDY DESIGN: All echocardiographic studies assessing conventional echoDoppler parameters and LV-GLS in GDM women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. The subtotal and overall standardized mean differences (SMDs) of LV-GLS were calculated using the random-effect model. RESULTS: The full-texts of 10 studies with 1147 women with GDM and 7706 pregnant women without diabetes were analyzed. GDM women enrolled in the included studies were diagnosed with a small reduction in LV-GLS in comparison to controls (average value -19.4 ± 2.5 vs -21.8 ± 2.5 %, P < 0.001) and to the accepted reference values (more negative than -20 %). Substantial heterogeneity was detected for the included studies, with an overall statistic value I2 of 94.4 % (P < 0.001). Large SMDs were obtained for the included studies, with an overall SMD of -0.97 (95 %CI -1.32, -0.63, P < 0.001). Egger's test for a regression intercept gave a P-value of 0.99, indicating no publication bias. On meta-regression analysis, all moderators and/or potential confounders (age at pregnancy, BMI, systolic blood pressure and ethnicity) were not significantly associated with effect modification (all P < 0.05). CONCLUSIONS: GDM is independently associated with subclinical myocardial dysfunction in pregnancy. STE analysis allows to identify, among GDM women, those who might benefit of targeted non-pharmacological and/or pharmacological interventions, aimed at reducing the risk of developing type 2 diabetes and cardiovascular complications later in life.
Asunto(s)
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Humanos , Embarazo , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ecocardiografía , Estudios de Casos y ControlesRESUMEN
BACKGROUND: No previous study evaluated the possible influence of chest wall conformation on symptoms perception in atrial fibrillation (AF) patients candidates for electrical cardioversion (ECV). We aimed at evaluating the anthropometric and clinical characteristics of patients with persistent AF undergoing ECV, categorized according to the presence or absence of symptoms. METHODS: This study retrospectively analyzed a series of persistent AF patients scheduled for early ECV who underwent pre-procedural clinical evaluation, MHI (the ratio of chest transverse diameter over the distance between sternum and spine) assessment, transthoracic and transesophageal echocardiography implemented with strain analysis of both left atrium and left atrial appendage. Thromboembolic risk and burden of comorbidities were assessed by CHA
Asunto(s)
Fibrilación Atrial , Masculino , Humanos , Femenino , Fibrilación Atrial/terapia , Cardioversión Eléctrica/efectos adversos , Estudios Retrospectivos , Atrios Cardíacos/diagnóstico por imagen , Ecocardiografía TransesofágicaRESUMEN
Sutureless bioprostheses are more frequently used for the surgical treatment of elderly patients with high burden of comorbidity, who are candidates to aortic valve replacement (AVR). Among the sutureless bioprostheses, the Perceval valve has shown a good midterm durability, with very few reports of valve deterioration and low risk of complications. Herein, we present an unusual case of ascending aorta dissection which occurred 4 years after AVR with a Perceval sutureless pericardial bioprosthesis, likely related to the peculiar prosthetic design. A high right parasternal longitudinal view of the aorta in the right lateral decubitus allowed to suspect the acute aortic syndrome, thus accelerating the subsequent diagnostic and therapeutic iter.
RESUMEN
Given the aging of general population, very elderly females with Takotsubo syndrome (TTS) are not rarely encountered in clinical practice. Although coronary angiography with left ventriculography is the gold standard diagnostic tool to exclude or confirm TTS, currently, this invasive procedure is less frequently performed in older patients with several comorbidities, such as renal failure, anemia, infections, neurological disorders, malignancy, and severe frailty. In these patients, a "presumed" TTS is diagnosed on the basis of clinical presentation, electrocardiogram, cardiac biomarkers, and echocardiographic findings without coronary angiography. While, in younger patients, TTS is generally a benign condition, in very elderly females, it is associated with higher in-hospital mortality and poor prognosis. Herein, we present four cases of ultra-octogenarian females diagnosed with "presumed TTS", who did not undergo coronary angiography due to severe frailty and multiple comorbidities and who exhibited poor outcome. This could arise the question if an early more aggressive approach could have changed final results. Probably, the solution could only be a personalized decision deriving from a profound and detailed discussion of each case through a multidisciplinary team approach.
Asunto(s)
Fragilidad , Cardiomiopatía de Takotsubo , Anciano de 80 o más Años , Anciano , Humanos , Femenino , Mortalidad Hospitalaria , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/diagnóstico , Anciano Frágil , Fragilidad/complicaciones , Angiografía CoronariaRESUMEN
A 97-year-old female was admitted to the emergency department of our hospital due to paroxysmal nocturnal dyspnea and chest pain. At the hospital admission, the patient manifested transient psychomotor agitation and dysarthria. On physical examination, blood pressure was 115/60â mmHg and pulse 96â b.p.m. On blood tests, troponine I was 0.08â ng/mL (normal range <0.04â ng/mL). Electrocardiography (ECG) showed sinus rhythm and ST segment elevation in both inferior and anterior leads except in lead V1. Transthoracic echocardiography (TTE) revealed a right atrial multilobulated, hypermobile, echogenic cauliflower mass (maximum size of 5â cm × 4â cm), which was attached to the tricuspid lateral annulus with a short stalk (Figure 1A). The right atrial mass, which had filiform extremities and was found to prolapse through the tricuspid valve into the right ventricle, was ascribed to a peduncolated myxoma. Its motion was very rapid and uncoordinated, with increased peak antegrade velocity (Vmax = 35â cm/s), as precisely measured by pulsed wave tissue Doppler imaging (PW-TDI) (Figure 1B). Estimated left ventricular ejection fraction (LVEF) was normal (60%), and no significant valvulopathy was detected. Finally, a bulging of the interatrial septum with right-to-left shunt, through a patent foramen ovale (PFO), was observed by using colour Doppler (Figure 1C). Acute ischaemic lesions were excluded by brain computed tomography scan.
RESUMEN
BACKGROUND: During the last few years, increasing focus has been placed on heart failure with mildly reduced ejection fraction (HFmrEF), an intermediate phenotype from preserved to reduced ejection fraction (EF). However, clinical features and outcome of HFmrEF in elderly patients aged ≥ 70 yrs have been poorly investigated. METHODS: The present study retrospectively included all consecutive patients aged ≥ 70 yrs discharged from our Institution with a first diagnosis of HFmrEF, between January 2020 and November 2020. All patients underwent transthoracic echocardiography. The primary outcome was all-cause mortality, while the secondary one was the composite of all-cause mortality + rehospitalization for all causes over a mid-term follow-up. RESULTS: The study included 107 HFmrEF patients (84.3 ± 7.4 yrs, 61.7% females). Patients were classified as "old" (70-84 yrs, n = 55) and "oldest-old" (≥ 85 yrs, n = 52) and separately analyzed. As compared to the "oldest-old" patients, the "old" ones were more commonly males (58.2% vs 17.3%, p < 0.001), with history of coronary artery disease (CAD) (54.5% vs 15.4%, p < 0.001) and significantly lower EF (43.5 ± 2.7% vs 47.3 ± 3.6%, p < 0.001) at hospital admission. Mean follow-up was 1.8 ± 1.1 yrs. During follow-up, 29 patients died and 45 were re-hospitalized. Male sex (HR 6.71, 95% CI 1.59-28.4), history of CAD (HR 5.37, 95% CI 2.04-14.1) and EF (HR 0.48, 95% CI 0.34-0.68) were independently associated with all-cause mortality in the whole study population. EF also predicted the composite of all-cause mortality + rehospitalization for all causes. EF < 45% was the best cut-off value to predict both outcomes. CONCLUSIONS: EF at hospital admission is independently associated with all-cause mortality and rehospitalization for all causes in elderly HFmrEF patients over a mid-term follow-up.
Asunto(s)
Enfermedad de la Arteria Coronaria , Insuficiencia Cardíaca , Femenino , Humanos , Masculino , Volumen Sistólico , Estudios Retrospectivos , Pronóstico , Universidades , HospitalesRESUMEN
BACKGROUND: During the last decade, a number of clinical scores, such as Gender-Age-Physiology (GAP) Index, TORVAN Score and Charlson Comorbidity Index (CCI), have been separately used to measure comorbidity burden in idiopathic pulmonary fibrosis (IPF). However, no previous study compared the prognostic value of these scores to assess mortality risk stratification in IPF patients with mild-to-moderate disease. METHODS: All consecutive patients with mild-to-moderate IPF who underwent high-resolution computed tomography, spirometry, transthoracic echocardiography and carotid ultrasonography at our Institution, between January 2016 and December 2018, were retrospectively analyzed. GAP Index, TORVAN Score and CCI were calculated in all patients. Primary endpoint was all-cause mortality, whereas secondary endpoint was the composite of all-cause mortality and rehospitalizations for all-causes, over medium-term follow-up. RESULTS: Seventy IPF patients (70.2±7.4 yrs, 74.3% males) were examined. At baseline, GAP Index, TORVAN Score and CCI were 3.4±1.1, 14.7±4.1 and 5.3±2.4, respectively. A strong correlation between coronary artery calcification (CAC) and common carotid artery (CCA) intima-media thickness (IMT) (r=0.88), CCI and CAC (r=0.80), CCI and CCA-IMT (r=0.81), was demonstrated in the study group. Follow-up period was 3.5±1.2 years. During follow-up, 19 patients died and 32 rehospitalizations were detected. CCI (HR 2.39, 95% CI: 1.31-4.35) and heart rate (HR 1.10, 95% CI: 1.04-1.17) were independently associated with primary endpoint. CCI (HR 1.54, 95% CI: 1.15-2.06) predicted secondary endpoint, also. A CCI ≥6 was the optimal cut-off for predicting both outcomes. CONCLUSIONS: Due to the increased atherosclerotic and comorbidity burden, IPF patients with CCI ≥6 at an early-stage disease have poor outcome over medium-term follow-up.
Asunto(s)
Enfermedad de la Arteria Coronaria , Fibrosis Pulmonar Idiopática , Masculino , Humanos , Femenino , Estudios Retrospectivos , Grosor Intima-Media Carotídeo , Comorbilidad , Fibrosis Pulmonar Idiopática/diagnóstico por imagenRESUMEN
BACKGROUND: A number of anterior chest wall deformities, most notably pectus excavatum (PE), may have a detrimental effect on cardiac motion and function. Interpretation of transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE) results may be hampered by the possible influence of PE on cardiac kinetics. METHODS: A comprehensive search of all articles assessing cardiac function in PE individuals was carried out. Inclusion criteria were: 1) individuals aged >10 years; 2) studies providing objective assessment of chest deformity (Haller index). Studies that measured myocardial strain parameters in PE patients were also included. RESULTS: The search (EMBASE and Medline) yielded a total of 392 studies, 36 (9.2%) of which removed as duplicates; a further 339 did not meet inclusion criteria. The full-texts of 17 studies were then analyzed. All studies concordantly reported impaired right ventricular volumes and function. With respect to left ventricle (LV), TTE studies uniformly demonstrated a significant impairment in conventional echoDoppler indices in PE individuals, whereas STE studies provided conflicting results. Importantly, LV functional alterations promptly reverted upon surgical correction of chest defect. In subjects with PE of mild-to-moderate severity, we observed that degree of anterior chest wall deformity, as noninvasively assessed by modified Haller index (MHI), was strongly associated with myocardial strain magnitude, in heterogenous cohorts of otherwise healthy PE individuals. CONCLUSIONS: Clinicians should be aware that in PE individuals, TTE and STE results may not always be indicative of intrinsic myocardial dysfunction, but may be, at least in part, influenced by artifactual and/or external chest shape determinants.