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2.
J Am Coll Cardiol ; 74(18): 2278-2291, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31672185

RESUMO

BACKGROUND: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). OBJECTIVES: The purpose of this study was to assess the feasibility and functional correlates of CFVR. METHODS: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. RESULTS: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. CONCLUSIONS: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.

3.
Kardiol Pol ; 77(7-8): 696-702, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31215525

RESUMO

BACKGROUND: The rotation and twist of the left ventricle (LV) have been comprehensively evaluated at rest. However, little is known about rotational mechanics during dobutamine stress echocardiography (DSE). AIMS: We aimed to quantify and compare the basal and apical rotation and twist of the LV at rest as well as at the peak and recovery stages of DSE in patients with and without coronary artery disease (CAD). METHODS: We enrolled 91 patients, including 48 patients with CAD and 43 patients without CAD (mean [SD] age, 62 [9] years and 61 [10] years, respectively). Coronary artery disease was defined as the presence of stenoses of 50% or more in the left main coronary artery and/or stenoses of 70% or more in other epicardial arteries. Rotation was measured by 2­dimensional speckle­tracking echocardiography, and twist was calculated as the difference between the basal and apical rotation. RESULTS: Neither rotation nor twist differed between patients with and without CAD at rest, although apical rotation was significantly greater in the CAD group at peak DSE (mean [SD], 5.43° [3.45°] vs 3.71° [3.52°], P = 0.01) and at recovery (mean [SD], 5.05° [3.65°] vs 2.87° [2.73°], P <0.01). On the contrary, the absolute value for basal rotation at recovery was higher in patients without CAD (mean [SD], 3.87° [3.37°] vs 2.63° [2.43°], P = 0.03). In both groups, the rotation and twist did not change significantly during the dobutamine challenge. CONCLUSIONS: During DSE, we observed differences in LV rotation between patients with and without CAD, revealing the effect of ischemia on deformation parameters.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Idoso , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia sob Estresse , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Rotação , Função Ventricular Esquerda
4.
Eur Heart J Cardiovasc Imaging ; 20(9): 1027-1034, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30824900

RESUMO

AIMS: Echocardiography can estimate pulmonary arterial pressure (PAP) from tricuspid regurgitation velocity (TRV) or acceleration time (ACT) of pulmonary flow. We assessed the feasibility of TRV and ACT measurements during exercise stress echocardiography (ESE) and their correlation in all stages of ESE. METHODS AND RESULTS: We performed ESE in 102 subjects [mean age 49 ± 17 years, 50 females, 39 healthy, 30 with cardiovascular risk factors, and 33 with pulmonary hypertension (PH)] referred for the assessment of exercise tolerance and ischaemia exclusion. ESE was performed on cycloergometer with the load increasing by 25 W for each 2 min. Assessment of TRV with continuous wave and ACT with pulsed Doppler were attempted in 306 time points: at rest, peak exercise, and recovery. In 20 PH patients we evaluated the correlations of TRV and ACT with invasively measured PAP. The success rate was 183/306 for TRV and 304/306 for ACT (feasibility: 60 vs. 99%, P < 0.0001). There was a close correlation between TRV and ACT: r = 0.787, P < 0.001 and ACT at peak ≤67 ms showed 94% specificity for elevated systolic PAP detection. Moreover, TRV and ACT at peak exercise reflected better that resting data the invasive systolic PAP and mean PAP with r = 0.76, P = 0.0004 and r = -0.67, P = 0.0018, respectively. CONCLUSION: ACT is closely correlated with and substantially more feasible than TRV during ESE and inclusion of both parameters (TRACT approach) expands the possibility of PAP assessment, especially at exercise when TRV feasibility is the lowest but correlation with invasive PAP seems to increase.

5.
Curr Cardiol Rep ; 21(4): 22, 2019 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-30828743

RESUMO

PURPOSE OF REVIEW: Pulmonary arterial hypertension (PAH) is a devastating disease which can result in right heart (RH) failure and death. Herein, we discuss the current clinical applications of echocardiography in PAH. RECENT FINDINGS: Advanced echocardiographic techniques (strain, strain rate, 2D-speckle tracking strain, and three-dimensional echocardiography) may reveal in the near future additional important insights into RH structure and function. Although right-heart catheterization is mandatory for a definitive diagnosis, echocardiography (resting and exercise) represents a key noninvasive imaging test on the diagnostic-prognostic-therapeutic PAH algorithm.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia , Humanos , Função Ventricular Direita
7.
Kardiol Pol ; 77(2): 164-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30644080

RESUMO

Stress echocardiography (SE) is based on the detection of regional wall motion abnormalities (RWMA) mirroring a physiologi-cally critical epicardial artery stenosis which determines subendocardial underperfusion. Recently, the core protocol of SE has been enriched by the addition of left ventricular contractile reserve (LVCR) based on force. Changes in force can be caused by microvascular and/or epicardial coronary artery disease, but also by myocardial scar, necrosis, and/or sub-epicardial layer disease. Left ventricular contractile reserve is calculated as the stress-to-rest ratio of force (systolic arterial pressure measured by cuff sphygmomanometer to end-systolic volume determined by two-dimensional echocardiography). In contrast to the ejection fraction, force is not dependent on changes in preload and afterload. Cut-off values for a preserved LVCR are > 2.0 for dobu-tamine or exercise stress and > 1.1 for vasodilators, which are weaker inotropic stimuli. Patients with a "strong" heart (normal LVCR values) have a better outcome than patients with a "weak" heart (reduced LVCR values), and this is the prognostic "bright side of the force," meaning that the prognostic value of force-based contractile reserve is higher than that of ejection fraction-based contractile reserve or RWMA. The addition of force to standard SE based on RWMA detection increases the spectrum of risk stratification without any signifi-cant increase in imaging time and only a slight increase in analysis time. In both ischaemic (with RWMA) and non-ischaemic (without RWMA) hearts, the preserved force is associated with a more benign prognosis. The prospective multicentre interna-tional Stress Echo 2020 trial which started in September 2016 has already recruited > 5000 patients with dual RWMA-force imaging and will systematically test the impact of force on the prognosis within and beyond coronary artery disease, including heart failure and hypertrophic cardiomyopathy.


Assuntos
Ecocardiografia sob Estresse/métodos , Ventrículos do Coração/fisiopatologia , Contração Miocárdica , Ecocardiografia/métodos , Humanos
9.
Psychiatr Pol ; 53(5): 1037-1051, 2019 Oct 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-31955184

RESUMO

OBJECTIVES: This study is an attempt to provide an analysis of the influence of implementation of cognitive behavioral intervention (CBI) in patients after cardiovascular implantable electronic device (CIED) implantation on the quality of life following the procedure as well as the level of illness acceptance. METHODS: The study group consisted of patients who underwent standard medical care related to CIED implantation and who additionally received CBI. Patients who received only standard medical care related to CIED implantation constituted a control group. CBI consisted of four sessions conducted over 30 (±3) days after the implantation. Demographic, clinicaland psychological factors were assessed.The Acceptance of Illness Scale (AIS) and EuroQol-5D (EQ-5D) were applied. RESULTS: In total, 128 patients (women: 36.7%, mean age 64.5 ± 8.9) were included in the study. The proposed cycle of four structured CBI meetings was well accepted by the patients, which is confirmed by their high turnout for these meetings. After six months, quality of life indices were significantly improved in cardiac electrotherapy recipients assigned to CBI, including: Visual Analogue Scale EQ-5D (80.2 ± 11.8 vs. 64.9 ± 14.3; p < 0.0001) and better acceptance of illness (AIS: 35.6 ± 4.3 vs. 28.7 ± 6.1; p < 0.0001). CONCLUSIONS: Implementation of CBI in patients after CIED implantation significantly improved indices of quality of life as well as illness acceptance, when compared to the control group of patients in standard care following electrotherapy. CBI showed multiple benefits in this population, as well as ensures the fulfilment of its expected therapeutic effect, while short duration of the intervention did not prolong the hospitalization itself.

10.
Cardiovasc Ultrasound ; 16(1): 22, 2018 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-30285774

RESUMO

BACKGROUND: The detection of regional wall motion abnormalities is the cornerstone of stress echocardiography. Today, stress echo shows increasing trends of utilization due to growing concerns for radiation risk, higher cost and stronger environmental impact of competing techniques. However, it has also limitations: underused ability to identify factors of clinical vulnerability outside coronary artery stenosis; operator-dependence; low positivity rate in contemporary populations; intermediate risk associated with a negative test; limited value of wall motion beyond coronary artery disease. Nevertheless, stress echo has potential to adapt to a changing environment and overcome its current limitations. INTEGRATED-QUADRUPLE STRESS-ECHO: Four parameters now converge conceptually, logistically, and methodologically in the Integrated Quadruple (IQ)-stress echo. They are: 1- regional wall motion abnormalities; 2-B-lines measured by lung ultrasound; 3-left ventricular contractile reserve assessed as the stress/rest ratio of force (systolic arterial pressure by cuff sphygmomanometer/end-systolic volume from 2D); 4- coronary flow velocity reserve on left anterior descending coronary artery (with color-Doppler guided pulsed wave Doppler). IQ-Stress echo allows a synoptic functional assessment of epicardial coronary artery stenosis (wall motion), lung water (B-lines), myocardial function (left ventricular contractile reserve) and coronary small vessels (coronary flow velocity reserve in mid or distal left anterior descending artery). In "ABCD" protocol, A stands for Asynergy (ischemic vs non-ischemic heart); B for B-lines (wet vs dry lung); C for Contractile reserve (weak vs strong heart); D for Doppler flowmetry (warm vs cold heart, since the hyperemic blood flow increases the local temperature of the myocardium). From the technical (acquisition/analysis) viewpoint and required training, B-lines are the kindergarten, left ventricular contractile reserve the primary (for acquisition) and secondary (for analysis) school, wall motion the university, and coronary flow velocity reserve the PhD program of stress echo. CONCLUSION: Stress echo is changing. As an old landline telephone with only one function, yesterday stress echo used one sign (regional wall motion abnormalities) for one patient with coronary artery disease. As a versatile smart-phone with multiple applications, stress echo today uses many signs for different pathophysiological and clinical targets. Large scale effectiveness studies are now in progress in the Stress Echo2020 project with the omnivorous "ABCD" protocol.


Assuntos
Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Ultrassonografia Doppler de Pulso/métodos , Idoso , Circulação Coronária/fisiologia , Ecocardiografia sob Estresse/normas , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Contração Miocárdica/fisiologia , Guias de Prática Clínica como Assunto , Sensibilidade e Especificidade , Volume Sistólico/fisiologia
11.
Cardiovasc Ultrasound ; 16(1): 20, 2018 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-30249305

RESUMO

BACKGROUND: The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. PURPOSE: To provide web-based upstream quality control and harmonization of B-lines reading criteria. METHODS: 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. RESULTS: All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). CONCLUSIONS: Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.


Assuntos
Ecocardiografia sob Estresse/normas , Pulmão/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Controle de Qualidade , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade
12.
Heart Fail Clin ; 14(3): 271-281, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29966626

RESUMO

Involvement of the right heart-pulmonary circulation system in systemic sclerosis is a typical feature, with critical prognostic implications. Pulmonary hypertension may occur in association with interstitial lung disease or as a result of an isolated pulmonary vascular disease that may affect both the precapillary arterioles and the postcapillary venules, as well as a consequence of left heart involvement. These apparently different phenotypes often underlie a significant pathophysiologic overlap, which makes the diagnosis and management of these patients highly complex and uncertain.


Assuntos
Coração/fisiopatologia , Hipertensão Pulmonar/etiologia , Programas de Rastreamento/métodos , Circulação Pulmonar/fisiologia , Escleroderma Sistêmico/complicações , Cardiologistas , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Reumatologistas , Escleroderma Sistêmico/terapia
13.
Heart Fail Clin ; 14(3): 361-376, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29966634

RESUMO

Echocardiography is the first step in imaging the right heart pulmonary circulation unit (RH-PCU), and the only one to allow its complete morphologic, functional, and hemodynamic analysis in all clinical scenarios. Right ventricular (RV) function is not only the consequence of its intrinsic contractile function (morphology and contractility) but also highly dependent on preload, afterload, and ventricular interdependence. Comprehensive echocardiographic examination of RH-PCU allows insight into intrinsic and extrinsic factors of RV function. Newer echocardiographic techniques allow for 3-dimensional evaluation of RV and detailed measurements of regional function using tissue Doppler or speckle tracking-based strain estimates.


Assuntos
Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Circulação Pulmonar/fisiologia , Função Ventricular Direita/fisiologia , Ventrículos do Coração/fisiopatologia , Hemodinâmica/fisiologia , Humanos
14.
Echocardiography ; 35(5): 667-677, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29399873

RESUMO

AIM: To evaluate the impact of the 2 most common bicuspid aortic valve (BAV) morphology patterns [right-left (RL) vs right-noncoronary (RN) cusp fusion] on the aortic diameters and the impact of gender, aortic stenosis (AS), aortic regurgitation (AR), and age on the observed effects. METHODS: The PubMed databases was searched up to December 31, 2016 to identify studies investigating the morphology of BAV and aortic diameters. Inclusion criteria were as follows: the data on diameter of sinuses of Valsalva (SVD) and/or ascending aorta (AAD) and BAV morphology. The additional characteristics [gender, AS and AR (% of patients with moderate or severe AS/AR) and mean age] were collected to perform a meta-regression analysis. RESULTS: A total of 12 studies with 2192 patients with indexed AAD, 15 studies with 3104 patients with nonindexed AAD and 8 studies with 1271 patients with indexed SVD, and 16 studies with 3454 patients with nonindexed SVD were included. There was no difference between RL and RN group in indexed/nonindexed AAD-mean difference (MD): 0.06 mm/m2 (95% CI: -0.65 to 0.77 mm/m2 , P = .87) and -0.06 mm (95% CI: 1.10-0.97 mm, P = .91). Differently, the RL BAV was associated with larger indexed/nonindexed SVD than RN phenotype-MD: 1.66 mm/m2 (95% CI: 0.83-2.49 mm/m2 , P < .001) and 2.03 mm (95% CI: 0.97-3.09 mm, P < .001). Age, gender, AS, and AR had no influence on observed differences. CONCLUSIONS: RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.


Assuntos
Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico , Humanos
15.
Kardiol Pol ; 76(5): 852-859, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29350394

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare disease with a very serious prognosis. It seems that mutations in genes related to transforming growth factor-b signalling pathway are often related to the development of the disease. No study covers this problem in a Polish population. AIM: To screen for genetic mutations in a Polish cohort of patients with pulmonary hypertension, especially with idiopathic PAH, treated in a single hospital in Poland. METHODS: DNA sequencing method was used. Samples from 50 patients with pulmonary hypertension were screened for mutations in type 2 bone morphogenetic protein receptor of the transforming growth factor-b superfamily gene (BMPR2). Samples from 20 patients with idiopathic PAH (11 men, mean age 55 years) were also screened for mutations in activin A receptor-like type 1 gene (ALK1) and endoglin gene (ENG). RESULTS: No genetic variations were found for the BMPR2 gene. In all 20 samples from idiopathic pulmonary hypertension patients we found heterozygosity of single nucleotide polymorphism (SNP) rs 372023206 in ALK1 gene. Three samples from these patients showed variations of ENG gene: we found one sample with heterozygosity of SNP rs 200525684, one with heterozygosity of SNP rs 3739817, and one with both. CONCLUSIONS: We detected benign polymorphisms or genetic variants of unknown importance. It is possible that the Polish population of PAH patients differs from the previously described populations of other countries in terms of the frequency and importance of mutations in BMPR2, ALK1 and ENG genes.


Assuntos
Receptores de Activinas Tipo II/genética , Receptores de Proteínas Morfogenéticas Ósseas Tipo II/genética , Endoglina/genética , Predisposição Genética para Doença , Hipertensão Pulmonar/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertensão Pulmonar/metabolismo , Masculino , Pessoa de Meia-Idade , Polônia , Análise de Sequência de DNA , Adulto Jovem
16.
Kardiol Pol ; 76(3): 586-593, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29297193

RESUMO

BACKGROUND: Whether non-invasive electrocardiographic parameters may be of similar relevance in pulmonary arterial hy-pertension (PAH) as in left ventricular heart failure (LVHF) remains unclear. AIM: To examine a profile of electrocardiographic parameters in PAH and to determine their prognostic significance. Com-parison of profile in patients with pulmonary hypertension secondary to left ventricular dysfunction was planned in order to put PAH group results into context. METHODS: We included 41 patients with type 1.1/1.4.4 (according to the European Society of Cardiology) PAH and 31 patients with LVHF and type 2.1 pulmonary hypertension. All patients underwent 24-h ambulatory electrocardiography monitoring. RESULTS: Among heart rate variability parameters, only RMSSD was different (mean, 75 ms [PAH] vs. 112 ms [LVHF], p = 0.016). In PAH, fewer patients had ventricular tachycardia (15% vs. 48%, p = 0.004), abnormal deceleration capacity (54% vs. 84%, p = 0.011), positive heart rate turbulence (11% vs. 48%, p = 0.003), severe autonomic failure (10% vs. 39%, p = 0.005), and ventricular late potentials (LP) (19% vs. 62%, p = 0.001). In PAH, four deaths occurred in 42 months. In univariate analysis, the risk factors for death were: LP (hazard ratio 13.55, 95% confidence interval 1.41-130.72; p = 0.024), age, N-terminal prohormone of B-type natriuretic peptide, while the protective factors were minimal and mean heart rate, as well as the six-minute walk test (6MWT) distance. In multivariate analysis, the influence of LP and the 6MWT distance remained significant. CONCLUSIONS: Ventricular LP were present in 19% of PAH patients and were the most powerful risk factor of mortality .


Assuntos
Hipertensão Pulmonar/fisiopatologia , Adulto , Idoso , Eletrocardiografia Ambulatorial , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Prognóstico , Fatores de Risco , Taquicardia Ventricular , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
18.
Eur Heart J Cardiovasc Imaging ; 19(11): 1276-1286, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29236974

RESUMO

Aims: Diabetes (DM) is a strong cardiovascular risk factor modifying also the left ventricular (LV) function that may be objectively assessed with echocardiographic strain analysis. Although the impact of isolated DM on myocardial deformation has been already studied, few data concern diabetics with coronary artery disease (CAD), especially in all stages of dobutamine stress echocardiography (DSE). We compared LV systolic function during DSE in CAD with and without DM using state-of-the art speckle-tracking quantification and assessed the impact of DM on LV systolic strain. Methods and results: DSE was performed in 250 patients with angina who afterwards had coronarography with ≥50% stenosis in the left main artery and ≥70% in other arteries considered as significant. In this analysis, we included 127 patients with confirmed CAD: 42 with DM [DM(+); mean age 64 ± 9 years] and 85 patients without DM [DM(-); mean age 63 ± 9 years]. The severity of CAD and LV ejection fraction (EF) were similar in both groups. Global and regional LV peak systolic longitudinal strain (PSLS) revealed in all DSE phases lower values in DM(+) group: 14.5 ± 3.6% vs. 17.4 ± 4.0% at rest; P = 0.0001, 13.8 ± 3.9% vs. 16.7 ± 4.0% at peak stress; P = 0.0002, and 14.2 ± 3.1% vs. 15.5 ± 3.5% at recovery; P = 0.0432 for global parameters, although dobutamine challenge did not enhance further resting differences. LV EF, body surface area, and diabetes were independent predictors for strain in 16-variable model (R2 = 0, 51, P < 0.001). Conclusion: PSLS although diminished in both groups with CAD was lower in diabetics at all DSE stages, and DM was an independent predictor of this impairment. However, the dobutamine challenge did not deepen the resting differences, suggesting that the direct impact of coronary stenoses effaces the influence of DM during DSE. The comparison with our previous data revealed synergistic, detrimental effect of coexisting CAD and DM on myocardial strain.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Ecocardiografia sob Estresse/métodos , Interpretação de Imagem Assistida por Computador , Disfunção Ventricular Esquerda/diagnóstico , Fatores Etários , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Estudos de Casos e Controles , Doença da Artéria Coronariana/diagnóstico , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/epidemiologia
19.
Int J Occup Med Environ Health ; 30(4): 681-683, 2017 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-28584311

RESUMO

Takotsubo cardiomyopathy (TC) is related to a transient systolic dysfunction of left ventricle (LV), accompanied by clinical and electrocardiographic symptoms of myocardial ischemia in the absence of hemodynamically significant coronary artery disease. Takotsubo cardiomyopathy is usually provoked by a psychologically or/and physically stressful event which may be related to occupational activities. Although visually assessed evolution of LV function is well documented, the data concerning strain changes is sparse and various patterns of deformation abnormalities are suggested. We have described a 72-year-old woman with chest pain related to a lecture given at the meeting of the Senior University, fulfilling all the Mayo Clinic criteria of the TC. The longitudinal strain analysis with automated function imaging (AFI) documented severe impairment and stepwise recovery of regional and global LV contractility. The case described confirms that accurate diagnosis, treatment and documenting of functional improvement in takotsubo cardiomyopathy may enable the return to occupational activities even for elderly persons. Int J Occup Med Environ Health 2017;30(4):681-683.


Assuntos
Estresse Ocupacional/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Idoso , Ecocardiografia , Docentes/psicologia , Feminino , Humanos , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/reabilitação , Cardiomiopatia de Takotsubo/terapia
20.
Echocardiography ; 34(7): 1020-1028, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28560766

RESUMO

BACKGROUND: The relationship between visual and strain assessment of left ventricular (LV) function during dobutamine stress echocardiography (DSE) remains poorly investigated. We assessed systolic longitudinal strain (SLS) and strain rate (SLSR) in segments visually graded as normokinetic, hypokinetic, or akinetic at baseline (0) and peak stage (1) of DSE and compared deformation changes between segments with and without induced contractility worsening. METHODS: From 250 patients examined by DSE, 238 patients with diagnostic test were included, mean age of 62±9 years (105 females). Regional LV contractility was assessed visually and measured using SLS and SLSR in 4284 segments. RESULTS: The LV segments during baseline and peak stage of DSE revealed gradual decrease in absolute values of SLS (from 17.7±6.4% in normokinetic to 11.7±8.4% in akinetic segments at rest, and from 17.2±8.5% to 14.4±7.8% at peak, P<.001), as measured by automated function imaging (AFI) and SLSR (from 1.1±0.37 s-1 in normokinetic to 0.9±0.29 s-1 in akinetic at rest, and from 2.32±0.92 to 2.13±0.85 s-1 at peak). The decrease in SLS in segments with contractility worsening was higher than in segments without induced impairment (ΔSLS 2% vs 0%, P<.0001 for all LV segments and 2% vs 1%, P=.02 in mid-LV segments). Absolute value of regional SLS <23% at peak DSE and decrease in SLS >2% from baseline showed 90% and 76% sensitivity for the detection of contractility impairment. CONCLUSION: Strain analysis quantifies segmental LV contractility not only at rest and peak DSE but may be helpful in detection of stress-induced contractility worsening.


Assuntos
Ecocardiografia sob Estresse/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/diagnóstico
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