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1.
Open Heart ; 8(2)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34782369

RESUMO

OBJECTIVE: To determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19. METHODS: A retrospective and prospective observational study of inpatients referred for transthoracic echocardiography for suspected cardiac pathology due to COVID-19 within a London NHS Trust. Echocardiograms were performed to assess left ventricular (LV), right ventricular (RV) and pulmonary variables along with collection of patient demographics, comorbid conditions, blood biomarkers and outcomes. RESULT: In the predominant non-white (72%) population, RV dysfunction was the primary cardiac abnormality noted in 50% of patients, with RV fractional area change <35% being the most common marker of this RV dysfunction. By comparison, LV systolic dysfunction occurred in 18% of patients. RV dysfunction was associated with LV systolic dysfunction and the presence of a D-shaped LV throughout the cardiac cycle (marker of significant pulmonary artery hypertension). LV systolic dysfunction (p=0.002, HR 3.82, 95% CI 1.624 to 8.982), pulmonary valve acceleration time (p=0.024, HR 0.98, 95% CI 0.964 to 0.997)-marker of increased pulmonary vascular resistance, age (p=0.047, HR 1.027, 95% CI 1.000 to 1.055) and an episode of tachycardia measured from admission to time of echo (p=0.004, HR 6.183, 95% CI 1.772 to 21.575) were independently associated with mortality. CONCLUSIONS: In this predominantly non-white population hospitalised with COVID-19, the most common cardiac pathology was RV dysfunction which is associated with both LV systolic dysfunction and elevated pulmonary artery pressure. The latter two, not RV dysfunction, were associated with mortality.


Assuntos
COVID-19/etnologia , Cardiopatias/etnologia , Ventrículos do Coração/diagnóstico por imagem , Vigilância da População , Comorbidade , Estudos Transversais , Ecocardiografia Doppler , Cardiopatias/diagnóstico , Hospitalização/tendências , Humanos , Pandemias , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
2.
Intern Med ; 60(21): 3377-3384, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34719624

RESUMO

Objective Patients with Prader-Willi syndrome (PWS) are known to have a high mortality rate. However, little is known about the exact reason for this, particularly in adults, because so few reports have been published. The present study examined cardiovascular abnormalities to determine the cause of death in adults with PWS. Methods From September 2017 to April 2019, a total of 18 adults with PWS, and, no history of cardiovascular diseases, were enrolled. We investigated the levels of the cardiovascular biomarkers: high-sensitivity C-reactive protein (hs-CRP) and troponin T (TnT). To estimate the cardiac function, we measured the left ventricular ejection fraction (LVEF), global longitudinal systolic strain (GLS) of the left ventricle, ratio of peak early mitral filling velocity (E) to early diastolic mitral annular velocity (E/e' ratio), mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) using standard and tissue Doppler echocardiography. Results The mean patient age was 28±9 years old. There were 11 men, and the mean body mass index was 45.1 kg/m2. Dyslipidemia (82%), diabetes mellitus (82%) and hypertension (83%) were commonly found as comorbidities. Most patients had elevated levels of hs-CRP (mean 1.007±0.538 mg/dL). The LVEF (mean 61%±5%) showed normal values, while the GLS (mean 15.0%±3.0%) was decreased. The TAPSE was mildly reduced (mean 16±3 mm). Conclusion These results suggest that subtle cardiovascular abnormalities have already begun in young adults with PWS. We need to manage obesity and the resultant obesity-related disorders in order to prevent heart failure and coronary atherosclerosis in PWS patients.


Assuntos
Anormalidades Cardiovasculares , Síndrome de Prader-Willi , Adulto , Ecocardiografia Doppler , Humanos , Masculino , Síndrome de Prader-Willi/complicações , Volume Sistólico , Função Ventricular Esquerda , Adulto Jovem
3.
Saudi J Gastroenterol ; 27(5): 289-295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34596593

RESUMO

Background: Inflammation plays an important role in the development of cardiovascular disease, including atherosclerosis and arrhythmia. The aim of this study was to evaluate atrial conduction times (ACTs) in patients with inflammatory bowel disease (IBD) in which systemic chronic inflammation is evident. Methods: In this cross-sectional, prospective, single-center study, 79 IBD patients (51 ulcerative colitis; 28 Crohn's disease) and 70 healthy controls were included. Atrial electromechanical properties were measured by recording simultaneous surface electrocardiography (ECG) with transthoracic echocardiography (ECHO) and tissue Doppler imaging methods. The relationship between age, disease duration, and ACT was evaluated. Results: There were significantly increased conduction durations of lateral-PA (time interval from the onset of the P-wave on surface ECG to the beginning of the late diastolic wave), septal-PA, tricuspid-PA, and interatrial-electromechanical delay (IA-EMD), right intraatrial EMD, and left intraatrial (LI-EMD) durations in IBD patients (P < 0.001). In IBD patients, there was a positive correlation with age, lateral PA, septal PA, tricuspid PA, IA-EMD, and LI-EMD (P < 0.05). A positive correlation was found between disease duration and only lateral PA and tricuspid PA (P < 0.05). Conclusion: In IBD patients, prolonged ACT consists a potential risk for severe atrial arrhythmias. ECG and ECHO screening can be useful in identifying risk groups in IBD patients and taking precautions for future cardiac complications.


Assuntos
Sistema de Condução Cardíaco , Doenças Inflamatórias Intestinais , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Estudos Transversais , Ecocardiografia Doppler , Eletrocardiografia , Sistema de Condução Cardíaco/diagnóstico por imagem , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Estudos Prospectivos
4.
Zhonghua Er Ke Za Zhi ; 59(9): 752-758, 2021 Sep 02.
Artigo em Chinês | MEDLINE | ID: mdl-34645215

RESUMO

Objective: To establish reference ranges for Doppler echocardiography in preterm infants within 7 days after birth based on different gestational age (GA), birth weight (BW) and body surface area (BSA). Methods: This retrospective study analyzed Doppler echocardiographic measurements of 489 premature infants, who were admitted to the neonatal Intensive Care Unit of Department of Pediatrics, Peking University Third Hospital from March 2017 to February 2020. These infants were divided into four groups according to GA:<28 weeks, 28-31+6 weeks, 32-33+6 weeks and 34-36+6 weeks; and five groups according to BW:<1 000 g, 1 000-1 499 g, 1 500-1 999 g, 2 000-2 499 g and ≥ 2 500 g;and 14 groups according to BSA from 0.07-0.20 m2. The Doppler values among groups were compared by independent sample KW test, and based on which, the 95%CI were established as reference ranges. Results: Among the 489 preterm infants, males were 264 and females were 225. Their GA, BW and BSA were 32.0 (30.0,33.9) weeks, 1 700 (1 260,2 040) g and 0.13 (0.11,0.15)m2, respectively. Measurements are presented charting as 95%CI with respect to GA,BW and BSA for preterm infants aged 0-7 days. Aortic valve(AV) flow rate, mitral valve E peak (MV-E), mitral valve E/A (MV-E/A) and tricuspid valve E peak (TV-E) were all correlated with GA, BW and BSA (r = 0.263, 0.256, 0.324 and 0.114 for GA; 0.292, 0.261, 0.281 and 0.135 for BW; 0.287, 0.268, 0.312 and 0.140 for BSA, all P<0.05). Within the first 7 days after birth, the greater the GA, birth weight and BSA, the greater the AV, MV-E, MV-E/A and pulmonary valve flow rate(all P<0.05). According to the above grouping of GA, the 95%CI of AV were 48-54, 52-57, 58-63 and 60-65 cm/s, respectively; and the 95%CI of MV-E were 32-37, 33-36, 39-42 and 40-45 cm/s, respectively; and the 95%CI of MV-E/A were 0.66-0.73, 0.74-0.80, 0.81-0.90 and 0.92-1.06. And according to the above grouping of BW, the 95%CI of AV were 45-53, 49-53, 59-64, 60-66 and 56-65 cm/s, respectively; 95%CI of MV-E were 29-35, 32-36, 38-41, 40-44 and 38-46 cm/s, respectively; 95%CI of MV-E/A were 0.65-0.74, 0.74-0.81, 0.81-0.99, 0.86-0.99 and 0.84-1.07. Conclusion: The 95%CI of Doppler echocardiographic measurements established based on GA, BW and BSA could provide a reference for preterm infants aged 0-7 days.


Assuntos
Ecocardiografia Doppler , Recém-Nascido Prematuro , Peso ao Nascer , Criança , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Valores de Referência , Estudos Retrospectivos
5.
Nutr Metab Cardiovasc Dis ; 31(11): 3176-3183, 2021 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-34629254

RESUMO

BACKGROUND AND AIMS: High hemoglobin A1c (HbAlc) level is associated with increased cardiovascular disease risk and thromboembolic events [1]. The study sought to explored the association between HbAlc and left atrial appendage flow velocity (LAAV) among non-valvular atrial fibrillation (AF) patients. METHODS AND RESULTS: A total of 249 consecutive non-valvular AF patients who underwent transesophageal echocardiography (TEE) were divided into two subgroups according to the median of LAAV level (<45 cm/s, ≥45 cm/s). Blood samples and other baseline clinical data of all patients were collected and analyzed. The low LAAV group included 126 patients and the high LAAV group included 123 patients. Patients in the low LAAV group were older and had a higher percentage of persistent AF, chronic heart failure, and higher CHA2DS2-VASc score (P < 0.05). HbAlc level in the low LAAV group was significantly higher than the high LAAV group [6.1 (5.7-6.5)% vs 5.9 (5.6-6.2)%, P = 0.010]. The low LAAV group had larger left atrial diameter (LAD), left atrial area (LAA), higher left atrial pressure (LAP), and lower left ventricular ejection fraction (LVEF) (P < 0.05). Spearman rank correlation analysis showed that the HbAlc level was negatively correlated with LAAV (r = -0.211, P = 0.001). Multivariate analysis indicated that female gender (OR = 2.233, 95% CI 1.110-4.492, P = 0.024), persistent AF (OR = 6.610, 95% CI 3.109-14.052, P < 0.001), and HbAlc (OR = 1.903, 95% CI 1.092-3.317, P = 0.023) were independent factors that associated with low LAAV in AF patients. CONCLUSION: Increased HbAlc level is associated with decreased LAAV and may reflect a low contractile function of the left atrial appendage.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Diabetes Mellitus/sangue , Hemoglobina A Glicada/metabolismo , Idoso , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etiologia , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Circulação Coronária , Diabetes Mellitus/diagnóstico , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Regulação para Cima
6.
PLoS One ; 16(10): e0258593, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34679117

RESUMO

BACKGROUND: Abnormalities of left ventricular (LV) structure, filling and long-axis function have all been reported in subjects with systemic sclerosis (SSc) and a normal LV ejection fraction (EF), but previous study findings have not been consistent. The aim of this study was to identify factors which could have confounded the analyses in previous studies of SSc, and in particular to consider the variables of body surface area (BSA), sex, age, heart rate, blood pressure (BP), disease duration (DD), disease type (limited versus diffuse) and interstitial lung disease (ILD). METHODS: Echocardiography was performed on 100 subjects with SSc (79 women; age 56±15 years) with a LVEF ≥50% and free of pulmonary arterial hypertension, coronary artery disease, more than mild valvular heart disease and atrial fibrillation. Measurements were performed of the LV end-diastolic dimension (LVEDD) and septal wall thickness (SWT), the transmitral Doppler E, A and deceleration time (DT), and the peak systolic (s') and early diastolic (e') LV long-axis velocities. Multivariate analyses were performed to investigate correlations of the above LV variables with BSA, sex, age, heart rate, BP, DD, disease type, and the presence of ILD. RESULTS: DD varied between 0.1 and 41.2 years, 25% had diffuse and 75% had limited disease, and 37% had ILD. SWT and LVEDD were positively correlated with BSA, SWT was also positively correlated with age and larger in males, and LVEDD was larger in diffuse disease. Age was positively correlated with A and DT, and inversely correlated with E and E/A, and heart rate was inversely correlated with E and E/A. None of E, A, E/A, or DT were independently associated with DD or disease type. Septal and lateral LV wall s' and e' were all inversely correlated with age, and there was a small independent contribution to the prediction of lateral s' from DD, but no association of either s' or e' with disease type. The presence of ILD was not a predictor of any of the LV variables. CONCLUSION: In SSc there are associations of sex, body size, age and disease type with LV structural variables, of age and heart rate with E/A, and of age with both systolic and early diastolic LV long-axis velocities. Appropriate adjustment for these variables could help to resolve current uncertainties regarding SSc effects on the left ventricle.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Escleroderma Sistêmico/fisiopatologia , Adulto , Idoso , Superfície Corporal , Ecocardiografia Doppler , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Escleroderma Sistêmico/diagnóstico por imagem , Caracteres Sexuais , Função Ventricular Esquerda
7.
Cardiovasc Ultrasound ; 19(1): 32, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583696

RESUMO

BACKGROUND: The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures. METHODS: In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. RESULTS: Pre- and postoperative values were septal e'; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e' 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e'19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e' ≥ 20 or septal e' < 5.0 cm/s increased prediction of NT-proBNP levels ≥500 ng/L with substantially improved specificity (> 85%). CONCLUSION: Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. TRIAL REGISTRATION: The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10 .


Assuntos
Estenose da Valva Aórtica , Disfunção Ventricular Esquerda , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Diástole , Ecocardiografia , Ecocardiografia Doppler , Humanos , Peptídeo Natriurético Encefálico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia
8.
PLoS One ; 16(9): e0257737, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34591884

RESUMO

BACKGROUND: An association was reported between the left ventricular longitudinal strain (LV-LS) and preload. LV-LS reflects the left cardiac function curve as it is the ratio of shortening over diastolic dimension. The aim of this study was to determine the sensitivity and specificity of LV-LS variations after a passive leg raising (PLR) maneuver to predict fluid responsiveness in intensive care unit (ICU) patients with acute circulatory failure (ACF). METHODS: Patients with ACF were prospectively included. Preload-dependency was defined as a velocity time integral (VTI) variation greater than 10% between baseline (T0) and PLR (T1), distinguishing the preload-dependent (PLD+) group and the preload-independent (PLD-) group. A 7-cycles, 4-chamber echocardiography loop was registered at T0 and T1, and strain analysis was performed off-line by a blind clinician. A general linear model for repeated measures was used to compare the LV-LS variation (T0 to T1) between the two groups. RESULTS: From June 2018 to August 2019, 60 patients (PLD+ = 33, PLD- = 27) were consecutively enrolled. The VTI variations after PLR were +21% (±8) in the PLD+ group and -1% (±7) in the PLD- group (p<0.01). Mean baseline LV-LS was -11.3% (±4.2) in the PLD+ group and -13.0% (±4.2) in the PLD- group (p = 0.12). LV-LS increased in the whole population after PLR +16.0% (±4.0) (p = 0.04). The LV-LS variations after PLR were +19.0% (±31) (p = 0.05) in the PLD+ group and +11.0% (±38) (p = 0.25) in the PLD- group, with no significant difference between the two groups (p = 0.08). The area under the curve for the LV-LS variations between T0 and T1 was 0.63 [0.48-0.77]. CONCLUSION: Our study confirms that LV-LS is load-dependent; however, the variations in LV-LS after PLR is not a discriminating criterion to predict fluid responsiveness of ICU patients with ACF in this cohort.


Assuntos
Ecocardiografia Doppler/métodos , Perna (Membro)/fisiologia , Choque/diagnóstico por imagem , Choque/tratamento farmacológico , Vasoconstritores/uso terapêutico , Adulto , Idoso , Feminino , Hidratação , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Choque/fisiopatologia , Volume Sistólico , Resultado do Tratamento
9.
Arthritis Res Ther ; 23(1): 247, 2021 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-34560895

RESUMO

BACKGROUND: Disturbances of diastolic function precede systolic heart failure and, although clinically silent, represent the earliest sign of cardiac involvement. Diastolic dysfunction (DD) is associated with age, gender (female), and hypertension. However, little is known about the age-specific incidence rates and risk factors for DD in patients with rheumatoid arthritis (RA). METHODS: We used standard two-dimensional/Doppler echocardiography to screen for the presence of diastolic dysfunction in 61 patients with RA and 107 healthy subjects. All participants were premenopausal women with no history of hypertension. DD includes an impaired relaxation with or without increased left ventricular (LV) filling pressures, pseudonormal filling, and restrictive filling based on parameters measured using echocardiography. RESULTS: The two groups were similar with respect to age (P=0.269). Patients with RA had significantly higher LV mass index, LV filling pressure, and lower E/A velocity than controls. All patients had preserved ejection fraction (EF ≥50%). DD was more common in patients with RA at 47% compared to 26% in the controls (P=0.004). Women with RA in the 30- to 49-year age range were over 3.5 times more likely to have DD than those of similar age in the control group (OR=3.54; 95% CI 1.27 to 9.85). Among patients with RA, high CRP levels were independently associated with DD even after adjustment for cardiovascular risk factors (P=0.009). CONCLUSIONS: In premenopausal women with RA, DD is much more common and the age of onset is reduced. Early screening of myocardial function may provide an opportunity for preventing future cardiovascular disease.


Assuntos
Artrite Reumatoide , Disfunção Ventricular Esquerda , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Diástole , Ecocardiografia , Ecocardiografia Doppler , Feminino , Humanos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/epidemiologia
10.
Pan Afr Med J ; 39: 181, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34584607

RESUMO

Leriche syndrome or aortoiliac occlusive disease is a particular obliterative arterial disease of the lower limbs, consisting of thrombotic occlusion of the aortoiliac junction. We here report the case of a 20-year-old female patient with no particular past medical history, presenting with acute lower limb ischemia. Lower extremity echo Doppler showed overall decrease in arterial blood flow without visualization of endoluminal material. Lower limb angioscaner showed arterial thrombosis of the abdominal aorta extended to bilateral external iliac arteries. The patient subsequently underwent aortic-bi-iliac bypass surgery with good evolution as well as assessments for possible thrombogenic mechanism.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Síndrome de Leriche/diagnóstico por imagem , Trombose/diagnóstico por imagem , Aorta Abdominal/cirurgia , Ecocardiografia Doppler/métodos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Isquemia/diagnóstico por imagem , Síndrome de Leriche/cirurgia , Extremidade Inferior/irrigação sanguínea , Adulto Jovem
11.
Anatol J Cardiol ; 25(8): 555-564, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34369883

RESUMO

OBJECTIVE: Cytokine storm with elevated levels of multiple proinflammatory cytokines and inflammatory system activation underlie the pathogenesis of coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate whether increased interleukin (IL)-6 levels can predict right ventricular (RV) systolic impairment in patients hospitalized with COVID-19. METHODS: This prospective, observational study included 100 consecutive patients hospitalized with mild and moderate COVID-19. All the patients underwent chest computerized tomography, detailed laboratory tests including IL-6, and two dimensional (2D) transthoracic echocardiography (TTE) with assessment of 2D conventional and Doppler echocardiography parameters and RV systolic functions. RESULTS: After the elimination of six patients with exclusion criteria, the remaining patients were classified into two groups, namely normal RV systolic functions (n=60) and impaired RV systolic functions (n=34). IL-6 levels were significantly higher in patients with impaired RV systolic functions than in those with normal RV systolic functions (20.3, 4.6, p<0.001, respectively). Tricuspid annular plane systolic excursion and RV derived tissue Doppler imaging (TDI) S' measurements were similar between the two groups. RV fractional area change was significantly lower, and RV TDI derived index of myocardial performance was significantly higher in patients with impaired RV systolic functions. In multivariate analysis, IL-6 levels independently predicted deterioration in RV systolic function at a significant level (odds ratio: 1.12, 95% confidence interval: 1.04-1.20, p=0.003). CONCLUSION: IL-6 is an independent predictor of RV systolic impairment in patients hospitalized with mild and moderate COVID-19 suggesting a possible pathogenetic mechanism. IL-6 levels can be used to predict RV systolic impairment in patients suffering from this infection.


Assuntos
COVID-19/complicações , Interleucina-6/metabolismo , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/imunologia , Adulto , COVID-19/diagnóstico por imagem , COVID-19/fisiopatologia , Ecocardiografia , Ecocardiografia Doppler , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X
12.
Open Heart ; 8(2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34376573

RESUMO

OBJECTIVES: To describe the use of echocardiography in patients hospitalised with suspected coronavirus infection and to assess its impact on clinical management. METHODS: We studied 79 adults from a prospective registry of inpatients with suspected coronavirus infection at a single academic centre. Echocardiographic indications included abnormal biomarkers, shock, cardiac symptoms, arrhythmia, worsening hypoxaemia or clinical deterioration. Study type (limited or complete) was assessed for each patient. The primary outcome measure was echocardiography-related change in clinical management, defined as intensive care transfer, medication changes, altered ventilation parameters or subsequent cardiac procedures within 24 hours of echocardiography. Coronavirus-positive versus coronavirus-negative patient groups were compared. The relationship between echocardiographic findings and coronavirus mortality was assessed. RESULTS: 56 patients were coronavirus-positive and 23 patients were coronavirus-negative with symptoms attributed to other diagnoses. Coronavirus-positive patients more often received limited echocardiograms (70% vs 26%, p=0.001). The echocardiographic indication for coronavirus-infected patients was frequently worsening hypoxaemia (43% vs 4%) versus chest pain, syncope or clinical heart failure (23% vs 44%). Echocardiography changed management less frequently in coronavirus-positive patients (18% vs 48%, p=0.01). Among coronavirus-positive patients, 14 of 56 (25.0%) died during hospitalisation. Those who died more often had echocardiography to evaluate clinical deterioration (71% vs 24%) and had elevated right ventricular systolic pressures (37 mm Hg vs 25 mm Hg), but other parameters were similar to survivors. CONCLUSIONS: Echocardiograms performed on hospitalised patients with coronavirus infection were often technically limited, and their findings altered patient management in a minority of patients.


Assuntos
COVID-19/diagnóstico por imagem , Ecocardiografia Doppler , Cardiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/fisiopatologia , COVID-19/terapia , COVID-19/virologia , Tomada de Decisão Clínica , Feminino , Coração/fisiopatologia , Coração/virologia , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Cardiopatias/virologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos
14.
Am J Cardiol ; 157: 128-134, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34392890

RESUMO

This study evaluated the preclinical effect of obesity on the ventricular remodeling in adolescents with morbid obesity, and determined if subjects labelled as metabolically healthy obesity (MHO) presented better heart index than those with metabolically unhealthy obesity (MUO). Prospective case-control research of 45 adolescents (14-year-old) with morbid obesity and 25 normal weight adolescents' gender- and age-matched with Tanner stage 4-5. Left ventricle (LV) was evaluated by conventional Doppler echocardiography, tissue Doppler imaging and two-dimensional speckle tracking echocardiography. Compared to normal-weight subjects, adolescents with morbid obesity presented a high percentage of pathological LV geometry (87%; p<0.01), and systolic and diastolic dysfunctions only detected by E/A ratio (2.0 vs 1.7, p<0.01), global longitudinal strain (-21.0% vs -16.5%, p<0.01), and early diastolic strain rate (3.2 vs 2.2, p<0.01). A correlation was found between impaired cardiac index and body mass index (BMI), high blood pressure, hyperglycemia, low HDL-cholesterol and hypertriglyceridemia. BMI and HDL-cholesterol were the most significant independent variables. No significant differences were found in structural and functional cardiac index when MHO and MUO subjects were compared (global longitudinal strain: -17.0% vs -16.4%, p0.79). Morbidly obese adolescents have an abnormal LV geometry, closely related to BMI, and systolic and diastolic LV dysfunctions. Adolescents labelled as MHO, despite exhibiting better BMI and insulin-resistance values, present the same pathological heart changes as MUO.


Assuntos
Índice de Massa Corporal , Ecocardiografia Doppler/métodos , Ventrículos do Coração/diagnóstico por imagem , Obesidade Mórbida/complicações , Obesidade Pediátrica/complicações , Disfunção Ventricular Esquerda/etiologia , Adolescente , Criança , Diástole , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Fatores de Risco , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
15.
Circ Cardiovasc Imaging ; 14(8): e012257, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34403263

RESUMO

BACKGROUND: Myocardial contraction fraction (MCF) is a volumetric measure of myocardial shortening independent of left ventricular size and geometry. This multicenter study investigates the usefulness of MCF for risk stratification in low-gradient severe aortic stenosis with preserved ejection fraction. METHODS: We included 643 consecutive patients with low-gradient severe aortic stenosis with preserved ejection fraction in whom MCF was computed at baseline and analyzed mortality during follow-up. RESULTS: Throughout follow-up with medical and surgical management (34.9 [16.1-65.3] months), lower MCF tertiles had higher mortality than the highest tertile. Eighty-month survival was 56±4% for MCF>41%, 41±4% for MCF 30% to 41%, and 40±4% for MCF<30% (P<0.001). After comprehensive adjustment, mortality risk remained high for MCF 30% to 41% (adjusted hazard ratio, 1.53 [1.08-2.18]) and for MCF<30% (adjusted hazard ratio, 1.82 [1.24-2.66]) versus MCF>41%. The optimal MCF cutoff point for mortality prediction was 41%. Age, body mass index, Charlson index, peak aortic velocity, and ejection fraction were independently associated with mortality. MCF (χ2 to improve 10.39; P=0.001), provided greater additional prognostic value over the baseline parameters than stroke volume (SV) index (χ2 to improve 5.41; P=0.042), left ventricular mass index (χ2 to improve 2.15; P=0.137), or global longitudinal strain (χ2 to improve 3.67; P=0.061). MCF outperformed ejection fraction for mortality prediction. When patients were classified by SV index and MCF, mortality risk was low when SV index was ≥30 mL/m2 and MCF>41%, higher for patients with SV index ≥30 mL/m2 and MCF≤41% (adjusted hazard ratio, 1.47 [1.05-2.07]) and extremely high for patients with SV index <30 mL/m2 (adjusted hazard ratio, 2.29 [1.45-3.62]). CONCLUSIONS: MCF is a valuable marker of risk in low-gradient severe aortic stenosis with preserved ejection fraction and could improve decision-making, especially in normal-flow low-gradient severe aortic stenosis with preserved ejection fraction.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Doppler , Contração Miocárdica , Volume Sistólico , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Bélgica , Tomada de Decisão Clínica , Feminino , França , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
16.
Circ Cardiovasc Imaging ; 14(7): e012453, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34250815

RESUMO

BACKGROUND: Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS). METHODS: One thousand five hundred forty-one patients with aortic valve area ≤1 cm2 and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS (<40 mm Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed. RESULTS: Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all P≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581-3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978-4229, P=0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817-2810, P=0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945-1832, P<0.001); AVCS in AF-LGAS were higher when HS were present (P=0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40-2.36], P<0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04-2.26], P=0.03) but not different in AF-LGAS without HS or SR-LGAS (both P=not significant). CONCLUSIONS: Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.


Assuntos
Estenose da Valva Aórtica/epidemiologia , Fibrilação Atrial/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Função Ventricular Esquerda , Função Ventricular Direita
17.
Sci Rep ; 11(1): 14589, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34272425

RESUMO

Postural change from a steep Trendelenburg position to a supine position (T-off) during robot-assisted laparoscopic prostatectomy (RALP) induces a considerable abrupt decrease in the mean arterial pressure (MAP). We investigated the variables for predicting postural hypotension induced by T-off using esophageal Doppler monitoring (EDM). One hundred and twenty-five patients undergoing RALP were enrolled. Data on the MAP, heart rate, stroke volume index (SVI), cardiac index, peak velocity, corrected flow time, stroke volume variation, pulse pressure variation, arterial elastance (Ea), and dynamic arterial elastance were collected before T-off and at 1, 3, 5, 7, and 10 min after T-off using EDM. MAP < 60 mmHg within 10 min after T-off was considered to indicate hypotension, and 25 patients developed hypotension. The areas under the curves of the MAP, SVI, and Ea were 0.734 (95% confidence interval [CI] 0.623-0.846; P < 0.001), 0.712 (95% CI 0.598-0.825; P < 0.001), and 0.760 (95% CI 0.646-0.875; P < 0.001), respectively, with threshold values of ≤ 74 mmHg, ≥ 42.5 mL/m2, and ≤ 1.08 mmHg/mL, respectively. If patients have MAP < 75 mmHg with SVI ≥ 42.5 mL/m2 or Ea ≤ 1.08 mmHg/mL before postural change from T-off during RALP, prompt management for ensuing hypotension should be considered.Trial registration: NCT03882697 (ClinicalTrial.gov, March 20, 2019).


Assuntos
Pressão Arterial , Ecocardiografia Doppler/métodos , Ecocardiografia Transesofagiana/métodos , Hipotensão Ortostática/etiologia , Monitorização Intraoperatória/métodos , Posicionamento do Paciente/efeitos adversos , Prostatectomia/efeitos adversos , Idoso , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Decúbito Dorsal
18.
Open Heart ; 8(2)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233914

RESUMO

AIMS: To investigate the changes in left atrial strain (LAS) after correction of severe aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact. METHODS AND RESULTS: One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro underwent echocardiographic examination including assessment of LAS before and after TAVR. Independent investigators collected outcome data and information. The primary study outcome was the difference in ΔLAS (postTAVR-preTAVR) between patients those met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalisation) and those not meeting the endpoint.During a median follow-up of 31 months, 35 patients (35%) met the combined clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR (ΔLAS) was significantly larger in patients who met the combined endpoint (HR=0.76 (0.67-0.86); p<0.001). Multivariate logistic regression analysis including ΔLAS, EuroSCORE II and left ventricular ejection fraction showed that ΔLAS (HR=0.80, p<0.001) was the only independent predictor of the combined clinical endpoint. Finally, a Kaplan-Maier analysis showed that patients with a ΔLAS above its median value had a significantly better event-free survival compared with those below the median (p<0.001). CONCLUSIONS: A lower reduction in ΔLAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalisation for heart failure.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Função do Átrio Esquerdo/fisiologia , Diagnóstico Precoce , Ecocardiografia Doppler/métodos , Insuficiência Cardíaca/diagnóstico , Medição de Risco/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Progressão da Doença , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Itália/epidemiologia , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico/fisiologia , Resultado do Tratamento
19.
BMJ Open ; 11(7): e049640, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233998

RESUMO

OBJECTIVES: The primary aim of this study was to establish the normal reference ranges of the fetal left ventricular (LV) Modified Myocardial Performance Index (Mod-MPI). A secondary aim was to evaluate the agreement between manual and automatic measurements for fetal Mod-MPI. DESIGN: A prospective, multicentre, cross-sectional study. PARTICIPANTS: Normal singleton pregnancies. METHODS: The LV functions of normal singleton pregnancies were assessed in nine centres covering eight provinces in China using unified ultrasound protocols and settings and standardised measurements by pulsed Doppler at 20-24, 28-32 and 34-38 weeks of gestation. The isovolumetric relaxation time (IRT), isovolumetric contraction time, ejection time (ET) and Mod-MPI were measured both automatically and manually. RESULTS: This cross-sectional study included 2081 fetuses, and there was a linear correlation between gestational age (GA) and Mod-MPI (0.416+0.001×GA (weeks), p<0.001, r2=0.013), IRT (36.201+0.162× GA (weeks), p<0.001, r2=0.021) and ET (171.418-0.078*GA (weeks), p<0.001, r2=0.002). This finding was verified using longitudinal data in a subgroup of 610 women. The agreement between the manual and automated measurements for Mod-MPI was good. CONCLUSIONS: We constructed normal reference values of fetal LV Mod-MPI. Automatic measurement can be considered for ease of measurement in view of the good agreement between the automatic and manual values.


Assuntos
Ecocardiografia Doppler , Ultrassonografia Pré-Natal , China , Estudos Transversais , Feminino , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Valores de Referência
20.
Medicine (Baltimore) ; 100(28): e26645, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260564

RESUMO

ABSTRACT: Gestational Diabetes Mellitus (GDM), as a common complication of pregnancy, has an increasing trend globally. GDM leads to maternal complications and fetal complications. Fetal cardiac diastolic dysfunction is strongly associated with GDM. This study aims to assess the ventricular diastolic function of fetuses exposed to GDM by looking into the diagnostic parameters using both conventional method and Dual-gate Doppler method (DD). And to investigate the potential of DD method in early detection of fetal cardiac diastolic dysfunction.56 women diagnosed with GDM and 55 non-GDM pregnant women were enrolled in their 24 to 30 weeks of gestation. Conventional method and DD method were applied to measure mitral and tricuspid inflow velocities E-waves, A-waves on pulsed-wave Doppler, and mitral and tricuspid annular velocities e'-waves, a'-waves on Tissue Doppler imaging. E/A, e'/a' and E/e' ratio was calculated. The difference between GDM and control groups was statistically tested and analysed using one-sample Kolmogorov-Smirnov test, Student t test, Mann-Whitney U test and Kruskal-Wallis test and Bland-Altman plot analysis.Intraobserver intraclass correlation coefficients of E/A, e'/a', and E/e' value of both mitral and tricuspid valve are all greater than 0.80, while interobserver intraclass correlation coefficients are between 0.71 and 0.88. Right (6.35 vs 6.79; P = .001) ventricular function showed significantly lower E/e' ratios in the GDM group compared with control fetuses by conventional method. Both left (6.16 vs 6.59; P = .036) and right (6.28 vs 6.75; P = .01) ventricular function showed significantly lower E/e' ratios in the GDM group compared with control fetuses by DD method.Exposure to high level of maternal blood glucose leads to impaired diastolic function in the fetuses. Fetal right ventricular function is a potential key point to study to enable an early detection for fetal diastolic dysfunction since the alteration and damage are more likely to happen in right ventricular. Measurement of E/e' ratio using DD method is considered as a promising method in fetal cardiac diastolic function assessment. Well or poorly control of the GDM does not have significant influence on the fetal diastolic function thus an early detection of GDM and GDM induced fetal cardiac dysfunction is necessary.


Assuntos
Diabetes Gestacional/fisiopatologia , Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Adulto , Glicemia , Estudos Transversais , Ecocardiografia Doppler , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Função Ventricular/fisiologia
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