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1.
Sci Rep ; 9(1): 3866, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30846742

RESUMO

Recordings of aortic root movement represent one of the first accomplishments of ultrasound in medicine and mark the beginning of functional cardiac imaging. However, the underlying mechanism is not completely understood. Since the aortic root is directly connected to the cardiac skeleton we hypothesize, that the amplitude of systolic aortic root motion (SARM) may be mainly caused by displacement of the cardiac base towards the apex and might therefore be used as measure of left ventricular longitudinal function (LV-LF). One hundred and eighty patients with dilated cardiomyopathy and 180 healthy controls were prospectively included into this study. SARM was lower in patients compared to controls (9 ± 3 mm vs. 12 ± 2 mm, p < 0.001) and lowest in patients with cardiovascular events (9 ± 3 mm vs. 7 ± 3 mm, p < 0.001). During a median follow-up time of 38 months, the combined end-point of cardiovascular death or hospitalization for heart failure was reached by 25 patients (13.9%). Reduced SARM had significant prognostic impact on outcome (hazard ratio 0.74, 95% confidence interval 0.63-0.88, p < 0.001) and remained an independent predictor in the multivariate analysis. Compared to parameters with potential influence on its mechanism, SARM correlated best (r = 0.75, p < 0.001) with global longitudinal strain (GLS). SARM may therefore represent an alternative echocardiographic parameter for the assessment of LV-LF, particularly when GLS is not feasible or apical views are not available.

2.
Clin Res Cardiol ; 108(4): 375-387, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30191296

RESUMO

BACKGROUND: Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for high-risk or non-surgical candidates with severe mitral regurgitation (MR) and advanced stages of heart failure (HF). However, these patients have a high mortality despite PMVR, and predictors for outcomes are not well established. Here, we evaluated invasive hemodynamics, echocardiography parameters, and biomarkers to predict outcomes after PMVR in severe HF patients. METHODS: Patients with reduced ejection fraction (EF) and severe and moderate-to-severe MR undergoing PMVR at our centre between September 2009 and January 2016 were analysed retrospectively. Inclusion criteria were: left ventricular EF < 45%, preoperative right heart catheterization, successful MitraClip deployment ("technical success"), and follow-up for at least 1 year after the procedure. Data from preoperative right heart catheterization, echocardiography, and biomarkers were assessed. Primary endpoint was all-cause mortality at 1 year after PMVR. We performed univariate and multivariate Cox regression analyses and generated a risk score to predict outcomes. RESULTS: Of 174 patients with PMVR and severe HF, 79.9% had functional MR. Mean EF was 25% (17.2; 30.7) and advanced New York Heart Association functional class was prevalent (class II: 13%; class III: 70%; and class IV: 17%). The cumulative incidences of all-cause death were 6.9% and 17.8% at 30 days and 1 year, respectively. In the Cox multivariate model, high-sensitive troponin T [hsTnT; hazard ratio (HR) 1.01; confidence interval (CI) 1.01-1.02; p < 0.0001] and mixed venous O2-saturation (HR 0.92; CI 0.89-0.96; p < 0.0001) were found to significantly and independently predict outcomes. A simple risk score including these two parameters was sufficient to discriminate between low- and high-risk patients (HR 7.22; CI 3.4-15.5; p < 0.001). CONCLUSION: In a cohort of patients with severe HF undergoing PMVR, patients with elevated hsTnT and reduced mixed venous O2-saturation carried the worst prognosis. A simple risk score including these two parameters may improve patient selection and outcomes after PMVR.


Assuntos
Cateterismo Cardíaco/métodos , Insuficiência Cardíaca/fisiopatologia , Implante de Prótese de Valva Cardíaca/métodos , Hemodinâmica/fisiologia , Insuficiência da Valva Mitral/cirurgia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
3.
Open Heart ; 5(2): e000903, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30245839

RESUMO

Objective: The aim of the prospective New-RV study was to evaluate a parameter for non-invasive quantification of right ventricular (RV) dysfunction in patients with precapillary pulmonary hypertension (PH) that yields prognostic information and is applicable in daily clinical routine. Methods: Sixty-five consecutive patients with precapillary PH under guideline conform therapy (43 women, 22 men) underwent clinical assessment, serological testing, as well as a comprehensive transthoracic echocardiography including strain imaging and a detailed assessment of RV haemodynamics. Results: The mean follow-up time was 844 days. Sixteen patients died during clinical follow-up. Right ventricular myo-mechanical index (RV-MMI) was calculated by right atrial size, mean RV pressure gradient and strain imaging of the RV free wall, and was measurable in all examinations. RV-MMI was tested for its diagnostic accuracy (sensitivity of 88% and specificity of 73% for an optimal cut-off value of ≤0.31 mm Hg*%; area under the curve=0.85), as well as its predictive value (HR=3.3, 95% CI 1.6 to 7.0, p<0.001), and was compared in detail with established parameters. RV-MMI and N-terminal pro-brain natriuretic peptide (NTproBNP)were independent predictors of survival (HR=2.9, 95% CI 1.4 to 6.2, p=0.006; and HR=2.6, 95% CI 1.5 to 4.6, p=0.001, respectively). Conclusion: In a cohort of patients with precapillary PH, the RV-MMI differentiates the outcome of patients better than other available non-invasive parameters of RV function by preload and afterload adjusted quantification. Trial registration number: NCT01230294.

4.
Int J Cardiol ; 272S: 11-19, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30219257

RESUMO

In the summer of 2016, delegates from the German Society of Cardiology (DGK), the German Respiratory Society (DGP), and the German Society of Pediatric Cardiology (DGPK) met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary hypertension (PH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines, aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. To this end, a number of working groups was initiated, one of which was specifically dedicated to the definition, clinical classification and initial diagnosis of PH. While the European guidelines provide a detailed clinical classification and a structured approach for diagnostic testing, their application in routine care may be challenging, particularly given the changing phenotype of PH patients who are nowadays often elderly and may present with multiple potential causes of PH, as well as comorbid conditions. Specifically, the working group addresses the thoroughness of diagnostic testing, and the roles of echocardiography, exercise testing, and genetic testing in diagnosing PH. Furthermore, challenges in the diagnostic work-up of patients with various causes of PH including "PAH with comorbidities", CTEPH and coexisting conditions are highlighted, and a modified diagnostic algorithm is provided. The detailed results and recommendations of the working group on definition, clinical classification and initial diagnosis of PH, which were last updated in the spring of 2018, are summarized in this article.


Assuntos
Conferências de Consenso como Assunto , Hipertensão Pulmonar/classificação , Hipertensão Pulmonar/diagnóstico , Guias de Prática Clínica como Assunto/normas , Teste de Esforço/métodos , Teste de Esforço/normas , Alemanha/epidemiologia , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/terapia
5.
Int J Cardiovasc Imaging ; 34(8): 1215-1225, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29552698

RESUMO

Pulmonary hypertension is a marker of disease severity. Exercise Doppler echocardiography (EDE) has proven to be feasible and reliable to assess pulmonary pressure. Increase in systolic pulmonary artery pressure (sPAP) has diagnostic and prognostic value in controlled studies. However, its value when assessed during routine examination in patients with cardiopulmonary diseases and resting sPAP > 35 mmHg is not clearly defined. Clinical documentation and offline reevaluation of digitally stored EDE examinations of patients with appropriate clinical indications for EDE were analyzed. N = 278 patients with sPAP at rest > 35 mmHg met inclusion criteria. One patient was lost to follow-up. Mean age of patients was 72 ± 10 years, 178 (64%) of the study population were men. There were no relevant differences among survivors and non-survivors concerning comorbidities. Exercise performance (3.6 ± 1.2 vs. 4.9 ± 1.4 MET, p < 0.001) was lower, whereas sPAP during exercise was higher (67.3 ± 14.7 vs. 62.1 ± 13.2 mmHg, p = 0.027) in non-survivors. Univariate predictors of all-cause mortality were NYHA functional class III (HR = 2.56, p < 0.001), ≥ 2-vessels coronary artery disease (CAD) (HR = 1.93, p = 0.04), left atrial diameter > 45 mm (HR = 2.58, p < 0.001), rest sPAP > 42 mmHg (HR = 1.94, p = 0.010) and ΔsPAP increase ≥ 0.23 mmHg/Watt (HF = 1.92, p = 0.010). After multivariate analysis, NYHA functional class III (HR = 2.35, p < 0.001), LA diameter (HR = 2.28, p = 0.003) and sPAP increase ≥ 0.23 mmHg/Watt (HF = 2.19, p = 0.002) remained significant predictors of mortality, whereas a double product (HR = 0.42, p = 0.005) was associated with better prognosis. sPAP assessment during routine EDE provides relevant prognostic information comparable to findings in studies in selected populations. A higher sPAP increase at lower exercise performance shows significant association with increased of mortality.


Assuntos
Pressão Arterial , Ecocardiografia Doppler/métodos , Teste de Esforço/métodos , Hipertensão Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sístole
6.
J Am Soc Echocardiogr ; 31(6): 733-742, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29402506

RESUMO

BACKGROUND: Impaired left ventricular (LV) longitudinal function (LF) is a known predictor of cardiac events in patients with heart failure, but two-dimensional strain imaging, the reference method to measure myocardial deformation, is not always feasible or available. Therefore, reliable and reproducible alternatives are needed. The aim of the present study was to evaluate unidimensional longitudinal strain (ULS) as a simple echocardiographic parameter for the assessment of LV LF. METHODS: Two hundred two patients with dilated cardiomyopathy who had their first presentation in the authors' cardiology department, as well as the same number of age- and gender-matched control subjects, were prospectively included in this study. ULS was compared with global longitudinal strain (GLS), the current gold standard for LV LF assessment by echocardiography. Uni- and multivariate Cox regression analyses were conducted to evaluate the prognostic value of ULS. RESULTS: LV LF was higher in the control group compared with patients: GLS -19.5 ± 1.7% versus -12.6 ± 4.8% and ULS -16.3 ± 1.5% versus -10.2 ± 3.9% (P < .001 for each). Correlation between ULS and GLS was excellent (r = 0.94), while Bland-Altman plots revealed lower values for ULS (bias -2.76%, limits of agreement ±3.31%). During a mean follow-up time of 39 months, the combined end point of cardiovascular death or hospitalization for acute cardiac decompensation was reached by 28 patients (13.9%). GLS (hazard ratio, 1.21; 95% CI, 1.10-1.34; P < .001) and ULS (hazard ratio, 1.24; 95% CI, 1.12-1.39; P < .001) had comparable prognostic impact on patient outcomes. CONCLUSIONS: ULS might be an alternative echocardiographic method for the assessment of LV LF, with similar diagnostic and prognostic value compared with GLS.


Assuntos
Ecocardiografia/métodos , Insuficiência Cardíaca Sistólica/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca Sistólica/diagnóstico , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
7.
PLoS One ; 13(1): e0191206, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29351312

RESUMO

BACKGROUND: The clinical relevance of non-invasively derived pulmonary arterial pressure (PAP) by Doppler echocardiography (DE) has been questioned in the past. However, transthoracic echocardiography is used as a cornerstone examination for patients with dyspnea and suspected pulmonary hypertension (PH). This study aimed to evaluate the prognostic value of non-invasive assessed PAP in a large population of patients with known or suspected cardiopulmonary disease. METHODS: The analyses are based on data of patients of a tertiary cardiology center that received right heart catheterization (RHC) as well as non-invasively assessed PAP by DE within five days, and includes serological and clinical parameters in a retrospective follow-up for up to eight years. RESULTS: Of 1,237 patients, clinical follow-up was possible in 1,038 patients who were included in the statistical analysis. The mean-follow up time was 1,002 days. The composite endpoint of heart transplantation (HTx) or death occurred in n = 308 patients. Elevated PAP measured non-invasively as well as invasively had significant prognostic impact (hazard ratio (HR) 2.32; 95% confidence interval (CI) 1.78-3.04; χ2 = 37.9; p<0.001 versus HR 2.84; 95%CI 2.11-3.82; χ2 = 51.9; p<0.001, respectively). By multivariate analysis, NYHA functional class, N-terminal pro-brain natriuretic peptide, cardiac troponin T, left ventricular ejection fraction, and right ventricular dysfunction remained independently predictive. Incremental prognostic information in a multimodal approach was highly relevant. CONCLUSIONS: In this comprehensive study, elevated pulmonary arterial pressure measured by DE offers similar prognostic information on survival or need for HTx as right heart catheterization. Furthermore, the addition of functional capacity and serological biomarkers delivered incremental prognostic information.


Assuntos
Pressão Arterial , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Artéria Pulmonar , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/métodos , Cateterismo Cardíaco , Estudos de Coortes , Ecocardiografia , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida
8.
Eur Heart J Cardiovasc Imaging ; 17(12): 1370-1378, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27013249

RESUMO

AIMS: Assessment of left ventricular (LV) systolic function plays a central role in cardiac imaging. Calculation of ejection fraction (EF) is the current method of choice; however, its limited intermodal comparability represents a major drawback. The assessment of myocardial mechanics by strain imaging may better reflect the complex myocardial contractility. We aimed to evaluate different methods for quantification of LV strain on global and regional levels with a focus on the new non-proprietary feature tracking (FT) algorithm. METHODS AND RESULTS: Measurements of LV deformation were performed by means of high-resolution two-dimensional (2D) speckle tracking echocardiography (STE) and compared with values obtained by 2D feature tracking echocardiography (FT-E) and feature tracking cardiac magnetic resonance imaging (FT-CMR). Assessments with echocardiography started within 30 min after CMR examination to minimize time-dependent variations in myocardial function. Forty-seven patients were included. Assessments by STE were -15.7 ± 5.0% for global longitudinal strain (GLS), -14.6 ± 4.5% for global circumferential strain (GCS), and 21.6 ± 13.3% for global radial strain (GRS), while values obtained with FT-E were -13.1 ± 4.0, -13.6 ± 4.0, 20.3 ± 9.5, and with FT-CMR -15.0 ± 4.0, -16.9 ± 5.4, and 35.0 ± 10.8, respectively. Linear regression and the Bland-Altman analysis showed the best intramodal association for STE GLS and FT-E GLS (r = 0.88, bias = -2.7%, LOA = ±4.7%). The correlation for GCS and GRS was weaker, and for regional strain was poor. In contrast to EF, GLS showed a better intermodal correlation between echocardiography and CMR (r = 0.81 by speckle tracking, r = 0.8 by FT, and r = 0.78 by EF). CONCLUSION: In our study, measurement of global longitudinal LV strain using the new FT algorithm with CMR and echocardiography was comparable with measurements obtained by high-resolution STE. Compared with echocardiographic EF determination, FT-E GLS shows a better reproducibility and a better intermodal agreement with CMR, representing a fair non-proprietary solution for this assessment. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Unique identifier: NCT01275963.


Assuntos
Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Processamento de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia
9.
High Alt Med Biol ; 16(1): 11-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25803140

RESUMO

BACKGROUND: Abnormally high pulmonary artery pressure (PAP) in hypoxia due to exaggerated hypoxic pulmonary vasoconstriction (HPV) is a key factor for development of high-altitude pulmonary edema (HAPE). It was shown that about 10% of a healthy Caucasian population has an exaggerated HPV that is comparable to the response measured in HAPE-susceptible individuals. Therefore, we hypothesized that those with exaggerated HPV are HAPE-susceptible. METHODS AND RESULTS: We screened 421 healthy Caucasians naïve to high altitude for HPV using Doppler echocardiography for assessment of systolic PAP in normobaric hypoxia (PASPHx; Po2 corresponding to 4500 m). Subjects with exaggerated HPV and matched controls were exposed to 4559 m with an identical protocol that causes HAPE in 62% of HAPE-S. Screening revealed 39 subjects with exaggerated HPV, of whom 33 (PASPHx 51±6 mmHg) ascended within 24 hours to 4559 m. Four (13%) of them developed HAPE during the 48 h-stay. This incidence is significantly lower than the recurrence rate of 62% previously observed in HAPE-S in the same setting. None of the control subjects (PASPHx 33±5 mmHg) developed HAPE. CONCLUSION: An exaggerated HPV cannot be considered a surrogate maker for HAPE-susceptibility although excessively elevated PAP is a hallmark in HAPE, while a normal HPV appears to protect from HAPE in this study.


Assuntos
Doença da Altitude/etiologia , Hipertensão Pulmonar/etiologia , Hipóxia/complicações , Artéria Pulmonar/fisiopatologia , Vasoconstrição , Adulto , Altitude , Doença da Altitude/epidemiologia , Pressão Arterial , Estudos de Casos e Controles , Suscetibilidade a Doenças , Grupo com Ancestrais do Continente Europeu , Humanos , Hipertensão Pulmonar/epidemiologia , Pulmão/irrigação sanguínea , Pessoa de Meia-Idade , Fatores de Tempo
10.
J Invasive Cardiol ; 27(3): 172-80, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25740972

RESUMO

PURPOSE: To investigate if the extent of aortic valve calcification is associated with postprocedural prosthesis eccentricity and paravalvular regurgitation (PAR) in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS: Cardiac computed tomography angiography (CCTA) was performed before and 3 months after TAVI in 46 patients who received the self-expanding CoreValve and in 22 patients who underwent balloon-expandable Edwards Sapien XT implantation. Aortic annulus calcification was measured with CCTA prior to TAVI and prosthesis eccentricity was assessed with post-TAVI CCTA. Standard echocardiography was also performed in all patients at 3-month follow-up exam. RESULTS: Annulus eccentricity was reduced during TAVI using both implantation systems (from 0.23 ± 0.06 to 0.18 ± 0.07 using CoreValve and from 0.20 ± 0.07 to 0.05 ± 0.03 using Edwards Sapien XT; P<.001 for both). With Edwards Sapien XT, eccentricity reduction at the level of the aortic annulus was significantly higher compared with CoreValve (P<.001). Annulus eccentricity after CoreValve use was significantly related to absolute valve calcification and to valve calcification indexed to body surface area (BSA) (r = 0.48 and 0.50, respectively; P<.001 for both). Furthermore, a significant association was observed between aortic valve calcification and PAR (P<.01 by ANOVA) in patients who received CoreValve. Using ROC analysis, a cut-off value over 913 mm² aortic valve calcification predicted the occurrence of moderate or severe PAR with a sensitivity of 92% and a specificity of 63% (area under the curve = 0.75). Furthermore, multivariable analysis showed that aortic valve calcification was a robust predictor of postprocedural eccentricity and PAR, independent of the aortic annulus size and native valve eccentricity and of CoreValve prosthesis size (adjusted r = 0.46 and 0.50, respectively; P<.01 for both). Such associations were not present with the Edwards Sapien XT system. CONCLUSION: The extent of native aortic annulus calcification is predictive for postprocedural prosthesis eccentricity and PAR, which is an important marker for long-term mortality in patients undergoing TAVI. This observation applies for the CoreValve, but not for the Edwards Sapien XT valve.


Assuntos
Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Calcinose/cirurgia , Próteses Valvulares Cardíacas , Tomografia Computadorizada Multidetectores , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Feminino , Humanos , Masculino , Desenho de Prótese , Curva ROC , Reoperação
11.
J Am Heart Assoc ; 3(4)2014 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-25146706

RESUMO

BACKGROUND: Pulmonary artery pressure (PAP) is an important marker in cardiovascular disorders, being closely associated with morbidity and mortality. Noninvasive assessment by Doppler echocardiography is recommended by current guidelines. So far, the reliability of this method has been assessed only in small studies with contradictory results. Therefore, the aim of this study was to analyze the reliability of noninvasive PAP assessment by Doppler echocardiography compared to invasive measurements in a large patient population. METHODS AND RESULTS: We retrospectively analyzed data from a large tertiary cardiology department over 6 years in order to compare invasively measured PAP to estimated PAP from echocardiography examinations. N=15 516 patients fulfilled inclusion criteria and n=1695 patients with timely matched examinations (within 5 days) were analyzed. In n=1221 (72%) patients, pulmonary hypertension (PH) was diagnosed invasively (postcapillary PH: n=1122 [66%]; precapillary PH: n=99 [6%]). Systolic pulmonary artery pressure (sPAP) was 45.3±15.5 mm Hg by Doppler echocardiography and 47.4±16.4 mm Hg by right heart catheterization. Pearson's correlation coefficient was r=0.87 (P<0.0001). Mean right atrial pressure (RAP) was 12.0±5.7 mm Hg by right heart catheterization and was estimated to be 12.1±6.6 mm Hg by echocardiography (r=0.82, P<0.0001). Bland-Altman analysis showed a bias of -2.0 mm Hg for sPAP (95% limits of agreement -18.1 to +14.1 mm Hg) and +1.0 mm Hg for RAP (95% limits of agreement +0.1 to +1.9 mm Hg). Noninvasive diagnosis of pulmonary hypertension with Doppler echocardiography had a good sensitivity (87%) and specificity (79%), positive and negative predictive values (91% and 70%), as well as accuracy (85%) for a sPAP cut-off value of 36 mm Hg (AUC 0.91, P<0.001, CI 0.90 to 0.93). CONCLUSIONS: In this study, Doppler echocardiography proved to be a reliable method for the assessment of sPAP, being well suited to establish the noninvasive diagnosis of pulmonary hypertension in patients with cardiac diseases.


Assuntos
Cateterismo Cardíaco , Ecocardiografia Doppler , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/fisiopatologia , Idoso , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiologia , Pressão Propulsora Pulmonar , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sístole
12.
J Am Coll Cardiol ; 64(8): 757-67, 2014 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-25145518

RESUMO

BACKGROUND: Inherited arrhythmias were originally considered isolated electrical defects. There is growing evidence that ion channel dysfunction also contributes to myocardial disorders, but genetic overlap has not been reported for sinus node dysfunction (SND) and noncompaction cardiomyopathy (NCCM). OBJECTIVES: The study sought to investigate a familial electromechanical disorder characterized by SND and NCCM, and to identify the underlying genetic basis. METHODS: The index family and a cohort of unrelated probands with sinus bradycardia were examined by electrocardiography, Holter recording, exercise stress test, echocardiography, and/or cardiac magnetic resonance imaging. Targeted next-generation and direct sequencing were used for candidate gene analysis and mutation scanning. Ion channels were expressed in HEK293 cells and studied using patch-clamp recordings. RESULTS: SND and biventricular NCCM were diagnosed in multiple members of a German family. Segregation analysis suggested autosomal-dominant inheritance of the combined phenotype. When looking for potentially disease-causing gene variants with cosegregation, a novel hyperpolarization-activated cyclic nucleotide channel 4 (HCN4)-G482R mutation and a common cysteine and glycine-rich protein 3 (CSRP3)-W4R variant were identified. HCN4-G482R is located in the highly conserved channel pore domain. Mutant subunits were nonfunctional and exerted dominant-negative effects on wild-type current. CSRP3-W4R has previously been linked to dilated and hypertrophic cardiomyopathy, but was also found in healthy subjects. Moreover, different truncation (695X) and missense (P883R) HCN4 mutations segregated with a similar combined phenotype in an additional, unrelated family and a single unrelated proband respectively, which both lacked CSRP3-W4R. CONCLUSIONS: The symptom complex of SND and NCCM is associated with heritable HCN4 defects. The NCCM phenotype may be aggravated by a common CSRP3 variant in one of the families.


Assuntos
Cardiopatias Congênitas/genética , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização/genética , Proteínas Musculares/genética , Canais de Potássio/genética , Síndrome do Nó Sinusal/genética , Adolescente , Animais , Ecocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Alemanha/epidemiologia , Células HEK293 , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Humanos , Masculino , Potenciais da Membrana , Pessoa de Meia-Idade , Linhagem , Fenótipo , Prevalência , Síndrome do Nó Sinusal/diagnóstico por imagem , Síndrome do Nó Sinusal/epidemiologia , Síndrome , Adulto Jovem
13.
J Am Soc Echocardiogr ; 27(10): 1017-24, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25129394

RESUMO

BACKGROUND: Routine quantitative assessment of left ventricular (LV) volumes with echocardiography is hindered by time-consuming methods requiring a manual trace of the LV cavity from two apical two-dimensional planes. Thus, the aim of this study was to evaluate faster new semiautomatic echocardiographic methods that could represent a feasible alternative for the assessment of LV volumes and ejection fraction (EF) in clinical practice. METHODS: Two semiautomatic methods, the automated EF (Auto-EF) for two-dimensional echocardiography and the 4D Auto LVQ tool for three-dimensional echocardiography (3DE), were compared with the biplane modified Simpson's method and cardiac magnetic resonance (CMR) imaging in 47 patients. To evaluate the accuracy of volumetry, additional in vitro measurements using water-filled latex balloons were performed with both modalities. RESULTS: Results of balloon volumetry by echocardiography and CMR measurements were in good agreement with real balloon volumes. The mean LV EF was 45 ± 11% by Auto-EF, 45 ± 11% by 3DE, 48 ± 11% by Simpson's method, and 54 ± 12% by CMR. Linear regression and Bland-Altman analyses showed good associations for semiautomatic methods with Simpson's method (Auto-EF, r = 0.85, bias = 3%, limits of agreement [LOA] = 12%; 3DE, r = 0.79, bias = 3%, LOA = 14%), as well as with CMR (Auto-EF, r = 0.74, bias = 9%, LOA = 17%; 3DE, r = 0.73, bias = 9%, LOA = 17%). Intra- and interobserver variability were 6% and 12% with Auto-EF and 8% and 11% with 3DE, respectively. CONCLUSIONS: Good correlations between semiautomatic echocardiographic parameters for assessment of LV volumes and EF could be observed when compared with Simpson's method or CMR. However, intertechnique agreement analysis of absolute LV volumes revealed considerable differences, with significant underestimation of volumes and EF with respect to CMR.


Assuntos
Ecocardiografia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Reconhecimento Automatizado de Padrão/métodos , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
14.
Clin Res Cardiol ; 103(10): 817-24, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24830514

RESUMO

INTRODUCTION: Recent studies showed the prognostic value of strain measurements of the free right ventricular (RV) wall. The aim of this study was to evaluate the feasibility and the diagnostic value of the assessment of longitudinal mechanics of all segments of the RV by multiplane, two-dimensional transthoracic (2D) strain echocardiography. METHODS: A triplane apical visualization of the RV was attempted in each individual. RV systolic function was assessed with RV 2D strain, RV automated systolic index, real-time 3D echocardiography and RV parameters according to current guidelines. RESULTS: The study population (n = 118) consisted of 81 consecutive patients with overt right ventricular systolic dysfunction due to different etiologies, 13 patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and 24 healthy controls. Triplane assessment of the RV was possible in all examinations. 2D strain of 18 segments could be obtained in 75 %, 9 segments of the RV free wall in 84 % and 3 segments in four-chamber view in 96 % of the examinations. Contrary to established RV parameters, RV 2D strain detected impaired RV function in all patient groups compared to the control group. In regard to global RV function, RV 2D strain by multiplane assessment was not superior to a monoplane approach. However, segmental strain analysis was able to define the presence of impaired RV function in ARVC patients which otherwise would have been missed by current standard parameters. CONCLUSION: Regional RV mechanics were reliably assessed by RV 2D strain in a multiplane apical chamber view mode.


Assuntos
Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador/métodos , Contração Miocárdica , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Adulto , Módulo de Elasticidade , Estudos de Viabilidade , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estresse Mecânico , Volume Sistólico , Resistência à Tração
15.
Int J Cardiol ; 171(2): 153-60, 2014 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-24342416

RESUMO

PURPOSE: To compare the value of Dobutamine stress echocardiography (DSE) with that provided by Dobutamine Cardiac Magnetic Resonance (DCMR) for the non-invasive risk stratification of patients with suspected or known coronary artery disease (CAD). METHODS: Patients with suspected or known CAD underwent either DSE or DCMR using the same standardized protocol. Patient matching was then performed retrospectively for age, gender and risk factors. Outcome data including cardiac death and non-fatal myocardial infarction (defined as hard cardiac events) and 'late' revascularization performed >90days after the diagnostic procedures were collected during at least 6months. RESULTS: Follow-up data were available in 1852 patients who completed either DSE (n=884) or DCMR (n=884) during a mean follow-up duration of 4.1±2.4 and 3.9±1.9years, respectively (p=NS). Matched patients exhibited an overall high risk profile (69±9years; 69% male, 70% history of CAD and 26% diabetes mellitus in both groups). Using multivariable analysis, both modalities successfully identified patients with inducible ischemia at higher risk for subsequent hard cardiac events, surpassing the value of conventional risk factors like age, male gender and diabetes (HR=9.2; 95%CI=5.6-14.9 for DCMR versus 2.5; 95%CI=1.7-3.7 for DSE). By testing for interaction the predictive capacity of DCMR was higher than that provided by DSE (p=0.02). Patients with negative DCMR exhibited lower event rates compared to those with negative DSE (annual hard cardiac event rate of 0.8% versus 3.2%, p=0.002). CONCLUSIONS: DSE & DCMR aid the risk stratification of CAD patients. However, inducible WMA during DCMR are associated with a higher risk for subsequent cardiac events. Patients with negative DCMR on the other hand, exhibited a lower event rate compared to those with negative DSE.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia sob Estresse/métodos , Teste de Esforço/métodos , Imagem Cinética por Ressonância Magnética/métodos , Idoso , Cardiotônicos , Morte , Dobutamina , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
16.
Clin Res Cardiol ; 102(3): 229-35, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23208080

RESUMO

BACKGROUND: Right ventricular (RV) function determines long-term outcome in many cardiopulmonary diseases. However, the assessment of RV function is time-consuming and surrogate parameters derived from two-dimensional (2D) or Doppler echocardiography show poor consistency. METHODS: Forty consecutive patients were examined within 30 min after magnetic resonance imaging (MRI) with comprehensive echocardiography, including strain imaging and real-time three-dimensional echocardiography. A new parameter, the RV automated systolic index (RV-ASI), was obtained from the apical four-chamber view using semi-automated border detection. RESULTS: RV-ASI could be assessed by 2D echocardiography in 38 of 40 patients. RV ejection fraction assessed by MRI was 48 ± 9 %, while RV-ASI was 52 ± 11 % (r = 0.74, SEE = 6 %, p < 0.0001). Intra- and inter-observer variabilities were 7.5 and 8.9 %, respectively. An RV-ASI cut-off value of 52 % in this cohort was able to differentiate between normal and impaired RV function (AUC 0.92, sensitivity 87 %, specificity 93 %). CONCLUSIONS: In this study, the RV-ASI showed to be an easy, rapid to assess and reliable tool for quantification of right ventricular function. Furthermore, this index can complement the assessment of right ventricular mechanics by 2D strain imaging for efficient and comprehensive non-invasive evaluation of right ventricular function.


Assuntos
Ecocardiografia Doppler/métodos , Interpretação de Imagem Assistida por Computador/métodos , Sístole , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Adulto , Idoso , Automação , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Volume Sistólico , Disfunção Ventricular Direita/fisiopatologia
17.
Eur J Immunol ; 37(4): 954-65, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17357104

RESUMO

A crucial event for the induction of an anti-viral immune response is the coordinated, phenotype-dependent migration of dendritic cells (DC) to sites of infection and secondary lymphoid organs. Here we show that the vaccinia virus (VV) strains Western Reserve (WR) and modified virus Ankara (MVA) inhibit directional migration of mature DC toward the lymphoid chemokines CCL19 and CXCL12 without affecting surface expression of the respective chemokine receptors or impairing undirected cellular locomotion. Instead, infection with VV results in a deficiency of extracellular signal-regulated kinase-1 and a disturbance of intracellular calcium mobilization, indicating a viral interference with signaling events downstream of the surface chemokine receptors. In immature DC, apart from inhibiting chemokine-induced migration of infected DC, infection with both VV strains increases expression of the inflammatory chemokine receptors CCR1 and CXCR1 on non-infected bystander DC, which depends on the activity of IFN-alpha. Although functional, these chemokine receptors are resistant to lipopolysaccharide-induced down-regulation. In addition, VV-infected and non-infected bystander DC fail to up-regulate the lymphoid chemokine receptor CCR7 upon activation, together pointing to a disability to undergo the chemokine receptor switch. This study shows that VV targets directional migration of professional antigen-presenting cells at multiple functional levels, revealing a potent viral strategy of immune escape.


Assuntos
Movimento Celular/imunologia , Células Dendríticas/metabolismo , Células Dendríticas/virologia , Receptores de Quimiocinas/antagonistas & inibidores , Receptores de Quimiocinas/fisiologia , Vírus Vaccinia/imunologia , Células Cultivadas , Células Dendríticas/imunologia , Humanos
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