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1.
Eur Radiol ; 30(1): 609-619, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31372784

RESUMO

OBJECTIVES: This study was conducted in order to evaluate the accuracy of a compressed sensing (CS) real-time single-breath-hold cine sequence for the assessment of left and right ventricular functional parameters in daily practice. METHODS: Cardiac magnetic resonance (CMR) cine images were acquired from 100 consecutive patients using both the reference segmented multi-breath-hold steady-state free precession (SSFP) acquisition and a prototype single-breath-hold real-time CS sequence, providing the same slice number, position, and thickness. For both sequences, the left (LV) and right ventricular (RV) ejection fractions (EF) and end-diastolic volumes (EDV) were assessed as well as LV mass (LVM). The visualization of wall-motion disorders (WMD) and signal void related to mitral or tricuspid regurgitation was also analyzed. RESULTS: The CS sequence mean scan time was 23 ± 6 versus 510 ± 109 s for the multi-breath-hold SSFP sequence (p < 0.001). There was an excellent correlation between the two sequences regarding mean LVEF (r = 0.995), LVEDV (r = 0.997), LVM (r = 0.981), RVEF (r = 0.979), and RVEDV (r = 0.983). Moreover, inter- and intraobserver agreements were very strong with intraclass correlations of 0.96 and 0.99, respectively. On CS images, mitral or tricuspid regurgitation visualization was good (AUC = 0.85 and 0.81, respectively; ROC curve analysis) and wall-motion disorder visualization was excellent (AUC ≥ 0.97). CONCLUSION: CS real-time single-breath-hold cine imaging reduces CMR scan duration by almost 20 times in daily practice while providing reliable measurements of both left and right ventricles. There was no clinically relevant information loss regarding valve regurgitation and wall-motion disorder depiction. KEY POINTS: • Compressed sensing single-breath-hold real-time cine imaging is a reliable sequence in daily practice. • Fast CS real-time imaging reduces CMR scan time and improves patient workflow. • There is no clinically relevant information loss with CS regarding heart valve regurgitation or wall-motion disorders.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Suspensão da Respiração , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Volume Sistólico , Disfunção Ventricular/patologia , Adulto Jovem
2.
Best Pract Res Clin Anaesthesiol ; 33(2): 221-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31582101

RESUMO

Diastolic dysfunction (DD) is a common condition that is increasingly encountered in patients undergoing both cardiac and noncardiac surgery as the age profile of our patient population increases and the noninvasive diagnosis of DD becomes more accessible. There is a growing body of evidence demonstrating the significance of DD and adverse perioperative outcomes, and thus, it is becoming imperative for anesthesiologists to have an understanding of the pathophysiology, diagnosis, and management of patients with DD. Current guidelines are based on transthoracic echocardiogram (TTE) measurements in patients who are spontaneously breathing and in a euvolemic state and, consequently, not applicable to the perioperative period. In this review article, we discuss the grading of DD as well as introduce a practical approach to the diagnosis and management of patients with DD during the perioperative period.


Assuntos
Anestesiologistas , Ecocardiografia Transesofagiana/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Monitorização Intraoperatória/métodos , Disfunção Ventricular/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/prevenção & controle , Disfunção Ventricular/fisiopatologia
3.
PLoS One ; 14(7): e0215364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31361748

RESUMO

BACKGROUND: Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients. METHODS AND FINDINGS: A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to ≥15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001). CONCLUSIONS: Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Diástole , Disfunção Ventricular/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/patologia , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Volume Sistólico , Disfunção Ventricular/patologia , Disfunção Ventricular Esquerda , Disfunção Ventricular Direita , Função Ventricular Esquerda
4.
Pediatr Cardiol ; 40(7): 1476-1487, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342112

RESUMO

The optimal timing of stage-2-palliation (S2P) in single left ventricle is not clear. The aim of this study was to identify S2P related factors associated with outcomes after total cavopulmonary connection (TCPC), particularly relative to the dominant systemic ventricle. A total of 405 patients who underwent both S2P and TCPC at our institute between 1997 and 2017 was included. Patients were divided into two groups, dominant right ventricle (RV type, n = 235) and dominant left ventricle (LV type, n = 170). S2P related factors associated with mortality, postoperative ventricular function, and late exercise capacity following TCPC, were analyzed. The median age at S2P was 4 [3-7] and 6 [3-11] months in RV and LV type patients, respectively (p = 0.092). Survival after TCPC was similar in RV and LV type patients (p = 0.280). In those with RV type, risk factors for mortality following TCPC were older age (p < 0.001), heavier weight (p = 0.001), higher PAP (p < 0.001), higher TPG (p = 0.010), and lower SO2 (p = 0.008) at S2P. In those with LV type, no risk factor was identified. Risk factors for postoperative impaired ventricular function were older age and higher weight at S2P in both RV and LV type patients. Older age at S2P was also identified as a risk for inferior peak oxygen uptake (VO2) years after TCPC both in RV and LV type patients. Older age at S2P was associated with higher mortality after Fontan completion only in RV type patients. However, it was associated with postoperative ventricular dysfunction and lower exercise capacity after TCPC in both RV and LV type patients.


Assuntos
Técnica de Fontan/mortalidade , Cuidados Paliativos/métodos , Disfunção Ventricular/fisiopatologia , Fatores Etários , Pré-Escolar , Feminino , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/anormalidades , Humanos , Lactente , Masculino , Fatores de Risco , Resultado do Tratamento
5.
Int J Artif Organs ; 42(12): 711-716, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31238772

RESUMO

Echocardiographic strain and strain-rate imaging is a promising tool for the evaluation of myocardial segmental function, for the early detection of myocardial dysfunction, and for the prediction of reverse remodeling. We aimed at studying the changes in left and right ventricular function in pulsatile left ventricular assist device pediatric patients by two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography. Echocardiographic and clinical data of patients implanted with a pulsatile-flow left ventricular assist device from 2011 to 2018 were retrospectively reviewed before and after implantation at 1, 3, and 6 months. A total of 18 patients were enrolled. Median age and weight at implantation were 9 months (5-23 months) and 5.85 kg (4.85-8.75 kg), respectively; median left ventricular assist device support was 181 (114.5-289.5) days. 13 patients (73%) were transplanted and 5 patients (27%) died. At follow-up: left ventricular ejection fraction increase at 1 month (p = 0.001) and 3 months (p = 0.01), left ventricular global longitudinal strain improvement at 1 month (p = 0.0008) and 3 months (p = 0.02), and right ventricular free-wall longitudinal strain increase at 1 month (p = 0.01). At short term after left ventricular assist device implantation, both left ventricular and right ventricular mechanics improved. The temporary benefit seems to decrease over time. The worsening of left ventricular function has been followed by a worsening of right ventricular function probably due to the ventricular interdependence.


Assuntos
Ecocardiografia/métodos , Ventrículos do Coração , Coração Auxiliar/efeitos adversos , Disfunção Ventricular , Cardiomiopatias/complicações , Criança , Análise de Falha de Equipamento/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Prognóstico , Fluxo Pulsátil , Reprodutibilidade dos Testes , Estudos Retrospectivos , Disfunção Ventricular/diagnóstico , Disfunção Ventricular/etiologia , Disfunção Ventricular/fisiopatologia , Adulto Jovem
6.
J Neonatal Perinatal Med ; 12(2): 117-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814366

RESUMO

BACKGROUND: Hypoxic ischemic encephalopathy (HIE) affects  one to two newborns per 1,000 live births and oftentimes involves multi-organ insult. The objectives were to assess the evolution of cardiac function in infants with HIE treated with therapeutic hypothermia using echocardiography (ECHO). METHODS: Archived data during the period 2010-2016 was assessed. Amongst the infants with baseline ECHO assessments, a sub-cohort which had assessments in all the three phases (baseline/pre-active cooling [T1], cooling [T2] and rewarming [T3]) was analyzed separately. RESULTS: Thirty three infants formed part of the overall cohort, the gestation and birthweight were 39.6 ± 1.6 weeks and 3306 ± 583 g, respectively. Baseline (T1) information noted impaired cardiac performance (right ventricle stroke volume 1.08 ± 0.04 ml/kg, fractional area change [FAC] 24 ± 0.5% and tricuspid annular peak systolic excursion [TAPSE] 7.46 ± 0.11mm). Serial information was available for 24 of 33 infants. Cardiac function improved significantly between the cooling and the re-warming kphases. This included changes in right ventricular output (127 ± 34 vs 164 ± 47 ml/kg/min, p <0.01) and FAC (20 ± 3 vs 28 ± 2%, p<0.01). Pairwise comparisons for fractional shortening did not show significant changes. From the cooling to the rewarming phase, maximum change was noted in FAC (26.3 ± 9.8%) while minimum change was noted in fractional shortening (median, interquartile range) of 4.6% (1.4, 9.1). Significant correlation between TAPSE and time to peak velocity as a proportion of right ventricular ejection time was noted (r2 = 0.68, p <0.001). CONCLUSIONS: In infants with moderate to severe HIE, cardiac function evolves during various phases of therapeutic hypothermia. Low output state during cooling may be due to a combination of the disease state (HIE) and cooling therapy.


Assuntos
Adaptação Fisiológica , Asfixia Neonatal/terapia , Coração/diagnóstico por imagem , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Reaquecimento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Disfunção Ventricular/diagnóstico por imagem , Asfixia Neonatal/fisiopatologia , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia , Feminino , Idade Gestacional , Coração/fisiopatologia , Humanos , Hipóxia-Isquemia Encefálica/fisiopatologia , Recém-Nascido , Masculino , Volume Sistólico , Insuficiência da Valva Tricúspide/fisiopatologia , Disfunção Ventricular/fisiopatologia , Função Ventricular
7.
Heart Fail Clin ; 15(2): 267-274, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30832817

RESUMO

The heart and blood vessels are constantly interfering with each other in a closed system. For a few decades, the concept of ventricular-arterial coupling has been considered as a key pathogenesis of heart failure especially in heart failure with preserved ejection fraction.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Rigidez Vascular/fisiologia , Disfunção Ventricular/fisiopatologia , Hemodinâmica/fisiologia , Humanos
8.
PLoS One ; 14(1): e0210603, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30633768

RESUMO

It remains unclear as to whether cardiac resynchronization therapy (CRT) would be as effective in patients with atrial fibrillation (AF) accompanied by slow ventricular response (AF-SVR, < 60 beats/min) as in those with sinus rhythm (SR). Echocardiographic reverse remodeling was compared between AF-SVR patients (n = 17) and those with SR (n = 88) at six months and 12 months after CRT treatment. We also evaluated the changes in QRS duration; New York Heart Association (NYHA) functional class; and long-term composite clinical outcomes including cardiac death, heart transplantation, and heart failure (HF)-related hospitalization. Left ventricular pacing sites and biventricular pacing percentages were not significantly different between the AF-SVR and SR groups. However, heart rate increase after CRT was significantly greater in the AF-SVR group than in the SR group (P < 0.001). At six and 12 months postoperation, both groups showed a comparable improvement in NYHA class; QRS narrowing; and echocardiographic variables including left ventricular end-systolic volume, left ventricular ejection fraction, and left atrial volume index. Over the median follow-up duration of 1.6 (interquartile range: 0.8-2.2) years, no significant between-group differences were observed regarding the rates of long-term composite clinical events (35% versus 24%; hazard ratio: 1.71; 95% confidence interval: 0.23-12.48; P = 0.60). CRT implantation provided comparable beneficial effects for patients with AF-SVR as compared with those with SR, by correcting electrical dyssynchrony and increasing biventricular pacing rate, in terms of QRS narrowing, symptom improvement, ventricular reverse remodeling, and long-term clinical outcomes.


Assuntos
Fibrilação Atrial/terapia , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Disfunção Ventricular/terapia , Idoso , Fibrilação Atrial/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Disfunção Ventricular/fisiopatologia , Remodelação Ventricular
9.
PLoS One ; 14(1): e0210127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682045

RESUMO

BACKGROUND: Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software. METHODS: Intra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers. RESULTS: Training improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance. CONCLUSION: Observer experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.


Assuntos
Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular/diagnóstico , Adulto , Idoso , Feminino , Voluntários Saudáveis , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Software , Disfunção Ventricular/complicações , Disfunção Ventricular/fisiopatologia
10.
Ultrasound Obstet Gynecol ; 53(2): 219-228, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29536575

RESUMO

OBJECTIVES: To measure, using speckle-tracking technology, the fractional area change (FAC) of the right and left ventricles in normal fetal hearts between 20 and 40 weeks of gestation. METHODS: The four-chamber view of the fetal heart was obtained in 200 normal fetuses between 20 and 40 weeks of gestation. FAC was computed from the ventricular areas (((end-diastolic area - end-systolic area)/end-diastolic area) × 100) for the right and left ventricles, and regressed against seven independent biometric and age variables. FAC was correlated with longitudinal fractional shortening (LFS) (((end-diastolic longitudinal length - end-systolic longitudinal length)/end-diastolic longitudinal length) × 100) obtained from the mid-ventricular basal-apical lengths of the right and left ventricular chambers and with transverse fractional shortening (TFS) (((end-diastolic transverse length - end-systolic transverse length)/end-diastolic transverse length) × 100) from three transverse positions (base, mid, apical) located within each ventricular chamber. To evaluate potential clinical utility, FAC, LFS and TFS results were examined in nine fetuses with a congenital heart defect (CHD). RESULTS: Regression analysis demonstrated significant associations between FAC and the independent biometric and age variables (R2  = 0.13-0.15). FAC was significantly correlated with LFS (R2  = 0.18-0.28) and TFS (R2  = 0.13-0.33). Examination of the fetuses with CHD revealed that six of the nine had abnormal FAC Z-score values for the index pathological ventricle. When abnormal LFS and TFS values were compared to the FAC in these fetuses, the FAC was either abnormally low or normal. CONCLUSIONS: This study reports results from measuring the FAC of the right and left ventricles, and demonstrates a correlation with LFS and TFS. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Ecocardiografia/métodos , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Disfunção Ventricular/diagnóstico por imagem , Adulto , Algoritmos , Estudos de Casos e Controles , Feminino , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/anormalidades , Humanos , Gravidez , Estudos Prospectivos , Sístole , Disfunção Ventricular/embriologia , Disfunção Ventricular/fisiopatologia
12.
Am J Physiol Heart Circ Physiol ; 316(3): H684-H692, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30575433

RESUMO

Right ventricular (RV) dysfunction can lead to complications after acute inferior myocardial infarction (MI). However, it is unclear how RV failure after MI contributes to left-sided dysfunction. The aim of the present study was to investigate the consequences of right coronary artery (RCA) ligation in mice. RCA ligation was performed in C57BL/6JRj mice ( n = 38). The cardiac phenotypes were characterized using high-resolution echocardiography performed up to 4 wk post-RCA ligation. Infarct size was measured using 2,3,5-triphenyltetrazolium chloride staining 24 h post-RCA ligation, and the extent of the fibrotic area was determined 4 wk after MI. RV dysfunction was confirmed 24 h post-RCA ligation by a decrease in the tricuspid annular plane systolic excursion ( P < 0.001) and RV longitudinal strain analysis ( P < 0.001). Infarct size measured ex vivo represented 45.1 ± 9.1% of the RV free wall. RCA permanent ligation increased the RV-to-left ventricular (LV) area ratio ( P < 0.01). Septum hypertrophy ( P < 0.01) was associated with diastolic septal flattening. During the 4-wk post-RCA ligation, LV ejection fraction was preserved, yet it was associated with impaired LV diastolic parameters ( E/ E', global strain rate during early diastole). Histological staining after 4 wk confirmed the remodeling process with a thin and fibrotic RV. This study validates that RCA ligation in mice is feasible and induces RV heart failure associated with the development of LV diastolic dysfunction. Our model offers a new opportunity to study mechanisms and treatments of RV/LV dysfunction after MI. NEW & NOTEWORTHY Right ventricular (RV) dysfunction frequently causes complications after acute inferior myocardial infarction. How RV failure contributes to left-sided dysfunction is elusive because of the lack of models to study molecular mechanisms. Here, we created a new model of myocardial infarction by permanently tying the right coronary artery in mice. This model offers a new opportunity to unravel mechanisms underlying RV/left ventricular dysfunction and evaluate drug therapy.


Assuntos
Vasos Coronários/cirurgia , Modelos Animais de Doenças , Ligadura/métodos , Disfunção Ventricular/fisiopatologia , Animais , Vasos Coronários/patologia , Ligadura/efeitos adversos , Camundongos , Camundongos Endogâmicos C57BL , Disfunção Ventricular/etiologia , Disfunção Ventricular/patologia
13.
Clin Respir J ; 12(12): 2676-2682, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30471203

RESUMO

INTRODUCTION: Recurrent hypoxia makes asthmatics at risk for pulmonary hypertension and ventricular dysfunction. Early stages of these cardiovascular diseases cannot be detected by conventional echocardiography. Tissue Doppler imaging has been introduced recently as a more sensitive and more accurate tool for investigating cardiovascular diseases. OBJECTIVE: Investigating ventricular functions in asymptomatic asthmatic children using tissue Doppler echocardiography. METHOD: Fifty asthmatic children and 50 controls were examined by conventional echocrdiography. Tissue Doppler echocardiography was performed to measure the myocardial performance (Tei) index at the lateral mitral, septal and tricuspid annuli. RESULTS: Septal Tei indices among patients and uncontrolled asthmatics were significantly higher than healthy subjects and controlled asthmatics, respectively (P < 0.05). Septal and tricuspid Tei indices were significantly higher among severe asthmatics and patients with concomitant nasal allergy than those with mild asthma and those without concomitant nasal allergy, respectively (P < 0.05). Septal Tei index correlated negatively with daily inhaled corticosteroid dose (r = -0.412, P = 0.003) and forced expiratory volume in the 1st second/forced vital capacity (r = -0.877, P < 0.001). Lateral Tei index correlated positively with the patient age (r = 0.312, P = 0.027) and duration of asthma (r = 0.359, P = 0.011). CONCLUSION: Tei index can detect subclinical ventricular dysfunction in asthmatics and is affected by asthma duration, control and severity. It can be used for future scoring of asthma severity. Septal annulus seems to be the best location for assessing Tei index in asthmatics.


Assuntos
Corticosteroides/efeitos adversos , Asma/fisiopatologia , Ecocardiografia Doppler/métodos , Septos Cardíacos/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Administração por Inalação , Adolescente , Corticosteroides/administração & dosagem , Asma/complicações , Asma/tratamento farmacológico , Asma/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Septos Cardíacos/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Masculino , Valva Mitral/fisiopatologia , Miocárdio , Índice de Gravidade de Doença , Valva Tricúspide/fisiopatologia , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/etiologia , Disfunção Ventricular/fisiopatologia
14.
Am J Physiol Heart Circ Physiol ; 315(6): H1724-H1734, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30289293

RESUMO

Pregnancy at an advanced maternal age has an increased risk of complications for both the mothers and their offspring. We have previously shown that advanced maternal age in a rat model leads to poor fetal outcomes, maternal vascular dysfunction, and hypertension, concordant with findings in humans. Moreover, offspring from aged dams had sex-specific cardiovascular dysfunction in young adulthood. However, the detrimental impact of aging on the cardiovascular system of the offspring in this model is unknown. We hypothesized that offspring born to aged dams (9.5-10 mo old) would have impaired cardiovascular function at 12 mo of age. Echocardiographic data revealed signs of mild left ventricular diastolic dysfunction in only male offspring from aged dams [isovolumetric relaxation time: 34.27 ± 2.04 in the young dam group vs. 27.61 ± 0.99 ms in the aged dam group, P < 0.01; mitral annular velocity ratio ( E'/ A'): 1.08 ± 0.04 in the young dam group vs. 0.96 ± 0.02 in the aged dam group, P < 0.05]. We have previously shown that in young adulthood (4 mo of age), male, but not female, offspring born to aged dams had impaired recovery from ischemia-reperfusion injury. Aging did not alter the susceptibility of female offspring to ischemia-reperfusion injury. Interestingly, wire myography data revealed that male offspring from aged dams had enhanced vascular sensitivity to methacholine (negative log of EC50: 7.4 ± 0.08 in young dams vs. 7.9 ± 0.11 in aged dams, P = 0.007) due, in part, to increased prostaglandin-mediated vasodilation. Despite intact endothelium-dependent relaxation, female offspring from aged dams had elevated systolic blood pressure (125.3 ± 4.2 mmHg in young dams vs. 144.0 ± 6.9 mmHg in aged dams, P = 0.03). These data highlight sex-specific mechanisms underlying cardiovascular programming in offspring born to dams of advanced age. NEW & NOTEWORTHY Our study demonstrated that adult male and female offspring (12 mo old) born to aged dams had impaired cardiac diastolic function and increased blood pressure, respectively, signifying sex-specific differential cardiovascular effects of advanced maternal age.


Assuntos
Idade Materna , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Disfunção Ventricular/fisiopatologia , Animais , Pressão Sanguínea , Feminino , Masculino , Traumatismo por Reperfusão Miocárdica/etiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Ratos , Ratos Sprague-Dawley , Fatores Sexuais , Vasodilatação , Disfunção Ventricular/etiologia
16.
Rev Port Cir Cardiotorac Vasc ; 25(1-2): 19-26, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30317706

RESUMO

Intraventricular pressure gradients (IVPGs) play a physiological role in normal filling and emptying of the left ventricle. Regional alterations in IVPGs might be an important factor in the characteristic changes that occur in intraventricular flow in specific cardiac disorders and may contribute to and represent an early sign of ventricular dysfunction. Diastolic IVPGs, a marker of normal ventricular filling, and systolic IVPGs, a marker of normal ventricular emptying, can be attenuated, lost entirely or even reversed when ventricular emptying is opposed by afterload elevations, after regional acute ischaemia and in failing hearts. Moreover, in patients with severe aortic valve stenosis showing IVPGs impairment, diastoIic and systolic IVPGs improved after aortic valve replacement. The importance of IVPGs in cardiac function has so far not been entirely evaluated. A proof of the prognostic role or of the ability to identify incipient ventricular dysfunction or lack of functional reserve may help clinical decisions, turning non-invasive IVPGs into useful clinical tools.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Diástole/fisiologia , Sístole/fisiologia , Disfunção Ventricular/fisiopatologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos
17.
J Crit Care ; 48: 307-310, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30273910

RESUMO

PURPOSE: The ratio of right ventricular end-diastolic diameter (EDD) to left ventricular EDD (RV/LV) is a measure predictive of right ventricular failure. We hypothesized that an increase in RV/LV would be associated with poor prognosis in severe sepsis and septic shock. MATERIALS AND METHODS: This is a retrospective chart review of patients with severe sepsis and septic shock admitted to a medical intensive care unit (ICU) at a single tertiary care hospital. Patients were identified by ICD-9 codes: 995.92 for severe sepsis and 785.52 for septic shock; and had to have an echocardiogram within 48 h of ICU admission. Increased RV/LV was defined as RV/LV ≥ 0.9. Left and right-sided chamber dimensions were measured according to American Society of Echocardiography guidelines. RESULTS: We included 146 consecutive ICU patients admitted with septic shock (72) or severe sepsis (74). There was no significant difference in ICU mortality in patients with RV/LV ≥ 0.9 versus RV/LV < 0.9 (p = .49). CONCLUSIONS: An increased RV/LV does not predict mortality in severe sepsis or septic shock.


Assuntos
Cuidados Críticos , Sepse/fisiopatologia , Choque Séptico/fisiopatologia , Disfunção Ventricular/fisiopatologia , Adulto , Idoso , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/diagnóstico por imagem , Sepse/mortalidade , Choque Séptico/diagnóstico por imagem , Choque Séptico/mortalidade , Disfunção Ventricular/etiologia , Disfunção Ventricular/mortalidade
18.
J Am Heart Assoc ; 7(15): e009218, 2018 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-30371239

RESUMO

Background Atrial fibrillation ( AF ) is associated with myocardial infarction, and patients with AF and no obstructive coronary artery disease can present with symptoms and evidence of cardiac ischemia. We hypothesized that microvascular coronary dysfunction underlies these observations. Methods and Results Myocardial blood flow ( MBF ) at baseline and during adenosine stress and left ventricular and left atrial function were evaluated by magnetic resonance in 49 patients with AF (25 paroxysmal, 24 persistent) with no history of epicardial coronary artery disease or diabetes mellitus, before and 6 to 9 months after ablation. Findings were compared with those obtained in matched controls in sinus rhythm (n=25). Before ablation, patients with AF had impaired left atrial function and left ventricular ejection fraction and strain indices (all P<0.05 versus controls). MBF was impaired in patients both under baseline conditions (1.21±0.24 mL/min per g·[mm Hg·bpm/104]-1 versus 1.34±0.28 mL/min per g·[mm Hg·bpm/104]-1 in controls, P=0.044) and during adenosine stress (2.29±0.48 mL/min per g versus 2.73±0.37 mL/min per g in controls, P<0.001). Under baseline conditions, MBF correlated with left ventricular strain and left atrial function (all P≤0.001), so that cardiac function was most impaired in patients with the lowest MBF . Baseline and stress MBF remained unchanged postablation (both P=ns), and baseline MBF showed similar correlations with functional indices to those present preablation (all P≤0.001). Conclusions Baseline and stress MBF are significantly impaired in patients with AF but no epicardial coronary artery disease. Reduction in MBF is proportional to severity of left ventricular and left atrial dysfunction, even after successful ablation. Coronary microvascular dysfunction may be a relevant pathophysiological mechanism in patients with a history of AF .


Assuntos
Fibrilação Atrial/metabolismo , Circulação Coronária/fisiologia , Microvasos/fisiopatologia , Isquemia Miocárdica/metabolismo , Idoso , Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Estudos de Casos e Controles , Ablação por Cateter , Vasos Coronários , Teste de Esforço , Feminino , Humanos , Imagem por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Imagem de Perfusão do Miocárdio , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/metabolismo , Disfunção Ventricular/fisiopatologia , Função Ventricular Esquerda
19.
Am J Physiol Heart Circ Physiol ; 315(6): H1691-H1702, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30265559

RESUMO

Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow. A subset of patients ( n = 8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared with control subjects in the lateral-septal/LV outflow tract ( P = 0.011 and P = 0.0031) and inferior-anterior ( P < 0.0001 and P < 0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared with control subjects in the diaphragm-right ventricular (RV) outflow tract (RVOT; P < 0.001) and apical-basal ( P = 0.0017) directions. After PVR, RV systolic forces in the diaphragm-RVOT direction decreased ( P = 0.039) to lower levels than in control subjects ( P = 0.0064). RV diastolic forces decreased in all directions ( P = 0.0078, P = 0.0078, and P = 0.039) but were still higher than in control subjects in the diaphragm-RVOT direction ( P = 0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with intraventricular blood flow compared with control subjects and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in the LV and RV after PVR suggest that biventricular pumping does not normalize after surgery. NEW & NOTEWORTHY Biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and pulmonary regurgitation were quantified for the first time. Left ventricular hemodynamic forces were less aligned to the main blood flow direction in patients compared with control subjects. Higher right ventricular forces were seen along the pulmonary regurgitant and tricuspid inflow directions. Differences in forces versus control subjects remain after pulmonary valve replacement, suggesting that altered biventricular pumping does not normalize after surgery.


Assuntos
Hemodinâmica , Complicações Pós-Operatórias/fisiopatologia , Insuficiência da Valva Pulmonar/fisiopatologia , Tetralogia de Fallot/fisiopatologia , Disfunção Ventricular/fisiopatologia , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/etiologia
20.
Biomed Pharmacother ; 107: 212-218, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30092400

RESUMO

Diminazene aceturate (DIZE) has been reported to enhance the catalytic efficiency of ACE-2 and presumably increases angiotensin 1-7 generation, interfering with cardiac remodeling after myocardial infarction (MI). Our aim was to investigate the chronic effects of DIZE on cardiac dysfunction post-MI. Male Wistar rats underwent myocardial infarction (MI) or SHAM surgery (SO) and were divided into groups treated with DIZE 15 mg/kg/day, s.c. or vehicle (Control). After 4 weeks, the hemodynamic variables were recorded by cardiac catheterism. Hearts were then arrested to obtain the left ventricular (LV) pressure-volume curves in situ. Cardiomyocyte hypertrophy and collagen content were determined by histology. DIZE prevented LV end-diastolic pressure increases in MI rats (MI: 26 ± 3.3 vs. MI-DIZE: 15 ± 1.6 mmHg, P < 0.001) without a significant effect on LV systolic pressure (LVSP). Moreover, DIZE improved LV contractility (+dP/dt, MI: 3014 ± 161 vs. MI-DIZE: 3884 ± 104 mmHg/s, P < 0.001) and relaxation (-dP/dt, MI: -2333 ± 91 vs. MI-DIZE: -2798 ± 120 mmHg/s, P < 0.05). Right ventricular SP was increased in the MI compared to that in the SO group (40 ± 0.6 vs. 30 ± 1.2 mmHg; P < 0.01), and DIZE partially prevented this augmentation. LV stiffness was reduced in MI-DIZE compared with that in MI (0.64 ± 0.01 vs. 0.78 ± 0.02 mmHg/mL; P < 0.01). DIZE treatment reduced the interstitial collagen content by 18% in the surviving LV myocardium. Cardiomyocyte hypertrophy remained unaffected by DIZE treatment. Our findings show that chronic DIZE treatment post-MI attenuates the morphofunctional changes induced by MI in rats. The effects on LV -dP/dt, chamber stiffness and collagen content suggest this drug can be used as a therapeutic agent to reduce interstitial fibrosis and diastolic dysfunction after MI.


Assuntos
Diástole , Diminazena/análogos & derivados , Ativadores de Enzimas/uso terapêutico , Infarto do Miocárdio/complicações , Peptidil Dipeptidase A/metabolismo , Disfunção Ventricular/tratamento farmacológico , Disfunção Ventricular/etiologia , Animais , Cardiomegalia/patologia , Cardiomegalia/fisiopatologia , Colágeno/metabolismo , Diástole/efeitos dos fármacos , Diminazena/farmacologia , Diminazena/uso terapêutico , Ativadores de Enzimas/farmacologia , Hemodinâmica/efeitos dos fármacos , Masculino , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/patologia , Ratos Wistar , Disfunção Ventricular/patologia , Disfunção Ventricular/fisiopatologia , Função Ventricular/efeitos dos fármacos
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