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1.
Cardiol Young ; 29(10): 1248-1256, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31477187

RESUMO

BACKGROUND: While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis. METHODS: Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman's test. RESULTS: Median age at echocardiogram was 4.6 (range 2.5-7.4) months. Median ventricular end-diastolic pressure was 7 (range 3-19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range -35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = -0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure. CONCLUSION: In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Doppler/métodos , Enalapril/uso terapêutico , Cardiopatias Congênitas/diagnóstico , Ventrículos do Coração/anormalidades , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Anti-Hipertensivos/uso terapêutico , Diástole , Método Duplo-Cego , Feminino , Seguimentos , Cardiopatias Congênitas/tratamento farmacológico , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
3.
Am J Cardiol ; 124(3): 325-333, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31151655

RESUMO

The inter-relationships between minimal and maximal left atrial volume index (LAVI), left ventricular filling pressures and survival have not been well studied. This study aimed to compare LAVImin with LAVImax with respect to (1) relative prognostic value, and (2) correlation with left ventricular end-diastolic pressures (LVEDP), in patients with myocardial infarction (MI). A retrospective study involving consecutive patients with a first-ever MI (n = 419) was undertaken. LAVIs were determined using Simpson's biplane method from 2D echocardiography performed the day after admission. LAVmin ≥ 18 mls/m2 and LAVImax ≥ 34 mls/m2 were considered enlarged. The primary end point was composite major adverse cardiovascular events (MACE) (death/MI/heart failure). Correlation between LVEDP and LAVI was assessed in 120 patients who underwent echocardiography and cardiac catheterization either simultaneously (n = 30) or same-day (n = 90). At a median follow-up of 24 months, there were 61 MACE events. On Cox proportional hazards multivariate analysis incorporating significant clinical predictors and LVEF, whereas both LAVImin ≥ 18 mls/m2 (hazard ratio 3.15 [95% confidence interval 1.70 to 5.54], p <0.001) and LAVImax ≥ 34 mls/m2 (hazard ratio 1.79 [95% confidence interval 1.02 to 3.14], p = 0.041) were independent predictors of MACE, LAVImin showed a stronger association. Intermodel comparisons of the model chi-square and Harrell's C-statistic confirmed better prognostication with LAVImin. In the invasive cohort, because LAVImin and LAVImax had a similar correlation with LVEDP ≥ 15 mm Hg (r = 0.41 [p <0.001] vs r = 0.42 [p <0.001]), LAVmin ≥ 18 mls/m2 had a greater sensitivity for LVEDP ≥ 15 mm Hg than LAVImax ≥ 34 mls/m2 (sensitivity 59.4% vs 34.4%). In conclusion, utilizing thresholds of ≥18 and ≥34 mls/m2, respectively, LAVImin was a better predictor of survival than LAVImax, the pathophysiologic basis of which relates to a better sensitivity for elevated left ventricular filling pressures with LAVImin at these thresholds. There may be incremental clinical value in measuring LAVImin alongside LAVImax.


Assuntos
Átrios do Coração/diagnóstico por imagem , Infarto do Miocárdio/terapia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Cateterismo Cardíaco , Doenças Cardiovasculares/mortalidade , Diástole/fisiologia , Ecocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sensibilidade e Especificidade
4.
Cardiovasc Ultrasound ; 17(1): 6, 2019 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954080

RESUMO

BACKGROUND: The contractile response of patients with heart failure (HF) may be assessed by exercise stress echocardiography (ESE)-derived indexes. We sought to test whether ESE parameters are useful to identify the risk of adverse left ventricular (LV) remodeling in patients with chronic HF and reduced or mildly reduced LV ejection fraction (EF). METHODS: We enrolled 155 stabilized patients (age: 62 ± 11 years, 17% female, coronary artery disease 47%) with chronic HF, LV EF ≤50% and LV end-diastolic volume index > 75 ml/m2. All patients underwent a symptom-limited graded bicycle semi-supine ESE, with evaluation of peak stress LV EF, end-systolic pressure-volume relation (ESPVR, i.e. LV elastance) and cardiac power output to LV mass (CPOM). A complete echocardiographic study was performed at baseline and after 6 ± 3 months. Adverse LV remodeling was defined as the association of eccentric LV hypertrophy (LV mass: ≥115 g/m2 for male and ≥ 95 g/m2 for women, and relative wall thickness < 0.32) with an increase in LV end-systolic volume index ≥10% at six months. RESULTS: Adverse LV remodeling was detected in 34 (22%) patients. After adjustment for clinical, biochemical and echocardiographic data, peak ESPVR resulted in the most powerful independent predictor of adverse LV remodeling (OR: 12.5 [95% CI 4.5-33]; p < 0.0001) followed by ischemic aetiology (OR: 2.64 [95% 1.04-6.73]; p = 0.04). CONCLUSION: In patients with HF and reduced or mildly reduced EF, a compromised ESE-derived peak ESPVR, that reflects impaired LV contractility, resulted to be the most powerful predictor of adverse LV remodeling.


Assuntos
Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico , Volume Sistólico/fisiologia , Pressão Ventricular/fisiologia , Remodelação Ventricular/fisiologia , Idoso , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Função Ventricular Esquerda/fisiologia
5.
Am J Cardiol ; 123(9): 1464-1469, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30819432

RESUMO

Although several tissue-Doppler imaging (TDI) models for pulmonary capillary wedge pressure (PCWP) estimation have been reported, their reliability remains uncertain. Our previous theoretical and experimental analyses suggest that right atrial pressure (RAP) corrected by tissue-Doppler imaging tricuspid/mitral annular peak systolic velocities (ST/SM) (RAP × ST/SM) reliably predicts elevated PCWP. We sought to investigate its clinical usefulness for predicting elevated PCWP in heart failure (HF) patients. Ninety-eight patients admitted with HF who underwent right heart catheterization were prospectively studied. RAP and PCWP were measured by right heart catheterization. Simultaneously, ST/SM, early diastolic transmitral flow velocity to mitral annular velocity ratio (E/Ea), and diameter of inferior vena cava at inspiration (IVCDi), a noninvasive surrogate for RAP, were measured by echocardiography. RAP correlated with IVCDi (R2 = 0.57). A significantly stronger correlation was observed between IVCDi corrected by ST/SM (IVCDi × ST/SM) and PCWP than between E/Ea and PCWP (R2 = 0.47 vs 0.18). Receiver-operating characteristic analyses indicated that IVCDi × ST/SM >16 mm predicted PCWP >18 mm Hg with 90% sensitivity and 77% specificity, and the area under the curve was 0.86, which was significantly larger than that of E/Ea (area under the curve=0.72). In conclusions, IVCDi × ST/SM is a new useful noninvasive model to predict elevated PCWP in HF patients.


Assuntos
Ecocardiografia Doppler/métodos , Insuficiência Cardíaca/diagnóstico , Pressão Propulsora Pulmonar/fisiologia , Função Ventricular Direita/fisiologia , Pressão Ventricular/fisiologia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Volume Sistólico/fisiologia
6.
Int J Cardiol ; 281: 62-68, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30718133

RESUMO

AIMS: The current algorithm in transthoracic echocardiography (TTE) proposed in the 2016 ASE/EACVI recommendation for the estimation of left ventricular filling pressure (LVFP) is quite complex and time-consuming. B-lines, in lung ultrasonography (LUS), could constitute an interesting tool for LVFP evaluation in clinical practice, although data regarding their association with invasive haemodynamics are lacking. The purpose of this study was to explore the diagnostic accuracy of B-lines in identifying elevated left ventricular end-diastolic pressure (LVEDP). METHOD AND RESULTS: 81 adults with significant dyspnoea (NYHA ≥ 2) were prospectively analyzed by LUS in four areas in each hemithorax and a complete TTE within four hours prior to coronary angiography. Twenty-eight patients had elevated LVEDP. Clinical variables yielded a C-index of 79% to identify elevated LVEDP. The number of total B-lines was higher in the elevated LVEDP group (1.0vs17.0, p < 0.0001) and significantly increased the diagnostic accuracy (C-index increase = 10.5%, p = 0.002) and net reclassification index (NRI = 145.4, 113.0-177.9, p < 0.0001) on top of clinical variables. CONCLUSION: This study demonstrates the substantial diagnostic capacity of B-lines to identify elevated LVEDP, which appears superior to that of classical echocardiographic strategies. This tool should be considered in a multi-parametric approach in patients with heart failure.


Assuntos
Pulmão/diagnóstico por imagem , Ultrassonografia de Intervenção/normas , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Dispneia/diagnóstico por imagem , Dispneia/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Clin Res Cardiol ; 108(8): 931-939, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30737530

RESUMO

BACKGROUND: Controversy exists about the pathophysiology of different hemodynamic subgroups of AS. In particular, the mechanism of the paradoxical low-flow, low-gradient (PLFLG) AS with preserved ejection fraction (EF) is unclear. METHODS: A total of 41 patients with severe, symptomatic AS were divided into the following 4 subgroups based on the echocardiographically determined hemodynamics: (1) normal-flow, high-gradient (NFHG) AS; (2) low-flow, high-gradient AS; (3) paradoxical low-flow, low-gradient (PLFLG) AS with preserved EF and (4) low-flow, low-gradient (LFLG) AS with reduced EF. As part of the comprehensive invasive examinations, the analyses of the PV loops were performed with the IntraCardiac Analyzer (CD-Leycom, The Netherlands). RESULTS: PLFLG was characterized by small left ventricular volumes as well as a decreased cardiac index, a decreased systolic contractility and a lower stroke work, than the conventional NFHG AS. Alterations in effective arterial elastance (2.36 ± 0.67 mmHg/ml in NFHG versus 3.01 ± 0.79 mmHg/ml in PLFLG, p = 0.036) and end-systolic elastance (3.72 ± 1.84 mmHg/ml in NFHG versus 5.53 ± 2.3 mmHg/ml in PLFLG, p = 0.040) indicated impaired vascular function and increased chamber stiffness. CONCLUSIONS: The present study suggests that the hemodynamics of PLFLG AS can be explained by two mechanisms: (1) stiffness of the small left ventricle with reduced contractility, and (2) increased afterload due to the impairment of vascular function. Both mechanisms have similarities to those of heart failure with preserved EF. This type of remodeling may explain the poor prognosis of PLFLG AS.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença
8.
Congenit Heart Dis ; 14(1): 42-45, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811799

RESUMO

Management of the patent ductus arteriosus (PDA) in the premature infant has been a point of controversy for decades as smaller and earlier gestational age infants have been surviving. Increasing experience with catheter-based device closure has generated a new wave of interest in this subject. In this era, echocardiography plays a central role for collaboration within a multispecialty team. Reliability of echocardiography is improved by applying an institutionally derived standard approach to imaging, data collection, and reporting. The key aspects of both the physiology and anatomy of the PDA to distinguish infants that may benefit from intervention are described.


Assuntos
Permeabilidade do Canal Arterial/diagnóstico , Canal Arterial/diagnóstico por imagem , Ecocardiografia/métodos , Recém-Nascido Prematuro , Pressão Ventricular/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Cateterismo Cardíaco/métodos , Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Reprodutibilidade dos Testes
9.
Congenit Heart Dis ; 14(4): 609-613, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30698332

RESUMO

BACKGROUND: Increased ventricular end-diastolic pressure (VEDP) is a known risk factor for morbidity and mortality in patients with single right ventricle (RV) physiology. Previous studies have shown mixed results correlating echocardiographic measurements with catheter-derived VEDP in this population. Goal of this study was to evaluate if echocardiographic systolic/diastolic ratio (S/D) correlated with VEDP. METHODS: Patients with single RV physiology who underwent simultaneous echocardiography and catheterization were evaluated. Systolic and diastolic durations were measured using tricuspid inflow durations from Doppler analysis to calculate the S/D ratio. VEDP was obtained from the catheterization report. RESULTS: Twenty-seven studies were performed on patients with single RV physiology. Median age at time of catheterization was 11.4 months (range, 0-132 months). Mean VEDP was 9.9 ± 4.5 mm Hg. S/D ratio was 1.8 ± 0.5. S/D ratio significantly correlated with VEDP (r = 0.63, P < .01). Optimum value of S/D ratio for discriminating between patients with high (>10 mm Hg) vs low EDP was found to be 1.9. High S/D ratio had an area under the curve of 0.82 (0.65, 1.0), with 75% sensitivity and 89% specificity for predicting elevated VEDP. CONCLUSION: In patients with single RV physiology, S/D significantly correlated with VEDP. S/D ratio is a simple technique that may be useful in both estimating and discriminating between high and low VEDP in this complex patient population.


Assuntos
Pressão Sanguínea/fisiologia , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/anormalidades , Pressão Ventricular/fisiologia , Determinação da Pressão Arterial , Cateterismo Cardíaco , Pré-Escolar , Diástole , Ecocardiografia Doppler , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Morbidade/tendências , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Sístole , Estados Unidos/epidemiologia
10.
Eur Radiol ; 29(5): 2360-2368, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30631923

RESUMO

OBJECTIVES: This study aims to validate the reliability of cardiac magnetic resonance (CMR) parameters for estimating left ventricular end diastolic pressure (LVEDP) in heart failure patients with preserved ejection fraction (HFpEF) and compare their accuracy to conventional echocardiographic ones, with reference to left heart catheterisation. METHODS: Sixty patients with exertional dyspnoea (New York Heart Association function class II to III) were consecutively enrolled. CMR-derived time-volume curve and deformation parameters, conventional echocardiographic diastolic indices as well as LVEDP evaluated by left heart catheterisation were collected and analysed. RESULTS: Fifty-one patients, who accomplished all three examinations, were divided into HFpEF group and non-HFpEF group based on LVEDP measurements. Compared to the non-HFpEF group, CMR-derived time-volume curve showed lower peak filling rate adjusted for end diastolic volume (PFR/EDV, p = 0.027), longer time to peak filling rate (T-PFR, p < 0.001), and increased T-PFR in one cardiac cycle (%T-PFR, p < 0.001) in HFpEF group. In multivariable linear regression analysis, %T-PFR (ß = 0.372, p = 0.024), left ventricular global peak longitudinal diastolic strain rate (LDSR, ß = -0.471, p = 0.006), and E/e' (ß = 0.547, p = 0.001) were independently associated with invasively measured LVEDP. The sensitivity and specificity of E/e' and LDSR for predicting the elevated LVEDP were 76%, 92% and 76%, 89%, respectively. CONCLUSIONS: These findings suggest that CMR-derived time-volume curve and strain indices could predict HFpEF patients. Not only E/e' assessed by echocardiography but also the CMR-derived %T-PFR and LDSR correlated well with LVEDP. These non-invasive parameters were validated to evaluate the left ventricular diastolic function. KEY POINTS: • The abnormal time-volume curve revealed insufficient early diastole in HFpEF patients. • Non-invasive parameters including E/e', %T-PFR, and LDSR correlated well with LVEDP.


Assuntos
Volume Cardíaco/fisiologia , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Idoso , Cateterismo Cardíaco , Diástole , Ecocardiografia , Feminino , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
11.
Am J Cardiol ; 123(7): 1173-1179, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30683420

RESUMO

Our aim was to evaluate the temporal changes in left ventricular (LV) diastolic filling in relation to other LV parameters using cardiac MRI (CMR) in patients with HER2 positive breast cancer receiving trastuzumab therapy. Fourty-one women with early stage HER2+ breast cancer underwent serial CMR (baseline, 6, 12, and 18 months) after initiation of trastuzumab therapy. A single, blinded observer measured LV parameters on de-identified CMRs in random order. Linear mixed models were used to investigate temporal changes. Compared to baseline, there were significant decreases in systolic function as measured by both left ventricular ejection fraction (LVEF) (p <0.001 at 6 and 12 months) and peak ejection rate corrected for end-diastolic volume (PER/LVEDV) (p = 0.008 at 6 months, p = 0.01 at 12 months). However, these differences were no longer significant at 18 months. In contrast, significant reductions in diastolic function as measured by LV peak filling rate corrected for end-diastolic volume (PFR/LVEDV) were observed at 6 months (p = 0.012), 12 months (p = 0.031), and up to 18 months (p = 0.034). There were no significant temporal changes in the time to peak filling rate corrected for cardiac cycle (TPF/RR). The reduction in PFR/LVEDV at 18 months was no longer significant when corrected for heart rate. In conclusion, there were significant subclinical deleterious effects on both LV systolic and diastolic function among patients receiving trastuzumab. While there was recovery in LV systolic function after therapy cessation at 18 months, reduction in PFR/LVEDV appeared to persist. Thus, diastolic dysfunction may serve as a marker of trastuzumab-induced cardiotoxicity that needs to be confirmed in a larger study.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Trastuzumab/efeitos adversos , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/diagnóstico , Diástole , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Volume Sistólico/fisiologia , Sístole , Trastuzumab/uso terapêutico , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda/efeitos dos fármacos
12.
Crit Care Med ; 47(4): e317-e324, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30664009

RESUMO

OBJECTIVES: First, to validate bedside estimates of effective arterial elastance = end-systolic pressure/stroke volume in critically ill patients. Second, to document the added value of effective arterial elastance, which is increasingly used as an index of left ventricular afterload. DESIGN: Prospective study. SETTING: Medical ICU. PATIENTS: Fifty hemodynamically stable and spontaneously breathing patients equipped with a femoral (n = 21) or radial (n = 29) catheter were entered in a "comparison" study. Thirty ventilated patients with invasive hemodynamic monitoring (PiCCO-2; Pulsion Medical Systems, Feldkirchen, Germany), in whom fluid administration was planned were entered in a " dynamic" study. INTERVENTIONS: In the "dynamic" study, data were obtained before/after a 500 mL saline administration. MEASUREMENTS AND MAIN RESULTS: According to the "cardiocentric" view, end-systolic pressure was considered the classic index of left ventricular afterload. End-systolic pressure was calculated as 0.9 × systolic arterial pressure at the carotid, femoral, and radial artery level. In the "comparison" study, carotid tonometry allowed the calculation of the reference effective arterial elastance value (1.73 ± 0.62 mm Hg/mL). The femoral estimate of effective arterial elastance was more accurate and precise than the radial estimate. In the "dynamic" study, fluid administration increased stroke volume and end-systolic pressure, whereas effective arterial elastance (femoral estimate) and systemic vascular resistance did not change. Effective arterial elastance was related to systemic vascular resistance at baseline (r = 0.89) and fluid-induced changes in effective arterial elastance and systemic vascular resistance were correlated (r = 0.88). In the 15 fluid responders (cardiac index increases ≥ 15%), fluid administration increased end-systolic pressure and decreased effective arterial elastance and systemic vascular resistance (each p < 0.05). In the 15 fluid nonresponders, end-systolic pressure increased (p < 0.05), whereas effective arterial elastance and systemic vascular resistance remained unchanged. CONCLUSIONS: In critically ill patients, effective arterial elastance may be reliably estimated at bedside (0.9 × systolic femoral pressure/stroke volume). We support the use of this validated estimate of effective arterial elastance when coupled with an index of left ventricular contractility for studying the ventricular-arterial coupling. Conversely, effective arterial elastance should not be used in isolation as an index of left ventricular afterload.


Assuntos
Estado Terminal , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Pressão Arterial , Estudos de Casos e Controles , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pressão Ventricular/fisiologia
13.
Heart Lung Circ ; 28(4): 647-654, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29588110

RESUMO

BACKGROUND: Although flexible-ring annuloplasty is more inclined to increase the transmitral gradient over time, its effect on the tricuspid annulus is unknown. This study was conducted to evaluate serial changes in mean pressure gradient (mPG) across tricuspid and mitral valves after simultaneous dual implantation of flexible bands. METHODS: Seventy-one (71) patients (median age, 61.6 years; IQR: 50.8-69.0 years) underwent simultaneous mitral/tricuspid annuloplasties using St. Jude Tailor rings. Serial mPGs across mitral and tricuspid valves were evaluated at three postoperative time points: predischarge, 3 years, and 5 years. To gauge the effects and clinical outcomes of prophylactic intervention, patients were categorised as tricuspid regurgitation (TR)≥moderate or TR

Assuntos
Anuloplastia da Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Estenose da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Pressão Ventricular/fisiologia , Idoso , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologia , Monitorização Fisiológica/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/fisiopatologia
14.
Heart Vessels ; 34(2): 296-306, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30155660

RESUMO

Although the suction force that moves blood into the left ventricle during early diastole is thought to play an important role in diastolic function, there have been a few studies of this phenomenon in normal children. Suction force is measured as the intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG), which is calculated as IVPD divided by left ventricular length. The purpose of this study was to determine the suction force in infants, children, and adolescents using IVPD and IVPG. We included 120 normal children categorized into five groups based on age: G1 (0-2 years), G2 (3-5 years), G3 (6-8 years), G4 (9-11 years), and G5 (12-16 years). The total, basal, and mid-apical IVPD and IVPG were calculated using color M-mode Doppler imaging of the mitral valve inflow using the Euler equation. The total IVPD increased with age from G1 to G5 (1.75 + 0.51 vs. 2.95 + 0.72 mmHg, respectively; p < 0.001), due to an increase in mid-apical IVPD with constant basal IVPD. Although total IVPG was constant, mid-apical IVPG was larger in G5 than in G1 (0.21 + 0.06 vs. 0.16 + 0.07 mmHg/cm, respectively; p = 0.006). Total, basal, and mid-apical IVPDs were significantly correlated with age and the parameters of heart size and mitral annular e'. Mid-apical IVPG correlated with age and e' positively, but basal IVPG did with age negatively and did not with e'. The suction force increased at the mid-apical segment, correlating with increasing heart size and developing left ventricular relaxation, even after adjustment for left ventricular length.


Assuntos
Função do Átrio Esquerdo/fisiologia , Ecocardiografia Doppler em Cores/métodos , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Adolescente , Criança , Pré-Escolar , Diástole , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Valores de Referência
15.
J Ultrasound Med ; 38(5): 1167-1177, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30218456

RESUMO

OBJECTIVES: Intraventricular pressure (IVP) is one of the most important measurements for evaluating cardiac function, but this measurement is not currently easily assessable in the clinic. The primary reason for this is the absence of a noninvasive technique for measuring IVP. In this study, we investigate the relationship between IVP and dynamic myocardial stiffness measured by shear wave elasticity imaging (SWEI) and assess the feasibility of measuring IVP using SWEI. METHODS: In 8 isolated working rabbit hearts, IVP was recorded in the left ventricle using a pressure catheter. Simultaneously, myocardial stiffness was recorded by SWEI. Using the peak values for IVP and SWEI measured stiffness, SWEI measurements were calibrated and converted to IVP. RESULTS: A linear relationship with zero intercept was observed between IVP and SWEI, with the average slope of 0.318 kPa/mm Hg, R2 = 0.89. Using one point on the IVP/SWEI curve, SWEI measurements were converted to IVP. Estimated pressure using SWEI and IVP were linearly correlated with the slope of 0.95, R2 = 0.88 (mean end diastolic pressure by pressure catheter = 12.716 mm Hg and by SWEI=14.726 mm Hg), indicating the near equivalence of the 2 measurements. CONCLUSION: We have shown that SWEI measurements are linearly related to IVP; therefore, pressure-based indices could potentially be derived from SWEI ultrasound elastography. The feasibility of using SWEI to estimate IVP with a single point calibration was also shown in this study.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Coração/diagnóstico por imagem , Coração/fisiologia , Pressão Ventricular/fisiologia , Animais , Estudos de Viabilidade , Coração/fisiopatologia , Modelos Animais , Coelhos
16.
Ann Thorac Surg ; 107(1): 151-156, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30248319

RESUMO

BACKGROUND: Poor left ventricular (LV) growth and diastolic dysfunction long after simple total anomalous pulmonary venous connection (TAPVC) repair has been well documented and is believed to originate from insufficient preoperative volume preload. The objective of the study was to confirm these findings. METHODS: Of 61 patients undergoing simple TAPVC repair between 1996 and 2016, 42 patients undergoing postoperative catheter examinations were enrolled. The mean age at the time of repair was 39 ± 117 days. Postoperative catheter examinations were conducted at a mean duration of 1.1 years after the repair. LV end-diastolic volume (LVEDV) was calculated by biplane cineangiography with the use of Simpson's method as a Graham modification. RESULTS: LV ejection fraction, LV end-diastolic pressure (LVEDP), and cardiac index were 72% ± 5%, 10.3 ± 2.7 mm Hg, and 4.0 ± 0.7 L •·min-1 • m-2, respectively. LVEDV was 102% ± 16% of the predictive normal value, and it strongly correlated with the predictive normal value of LV end-diastolic diameter (LVEDd) calculated by two-dimensional echocardiography (R2 = 0.29, p = 0.005). LVEDd maintained a normal range thereafter during the entire follow-up period. LVEDP correlated linearly with age at the time of TAPVC repair (R2 = 0.18, p = 0.007) but not with LVEDV (p = 0.67). CONCLUSIONS: LV size maintained a normal range after the repair of simple TAPVC. High LVEDP was frequently observed a year after repair; it did not correlate with LV size but had a strong negative correlation with age at the time of repair.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Recuperação de Função Fisiológica/fisiologia , Síndrome de Cimitarra/cirurgia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Anastomose Cirúrgica/métodos , Cineangiografia , Diástole , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Período Pós-Operatório , Veias Pulmonares/cirurgia , Pressão Propulsora Pulmonar , Estudos Retrospectivos , Síndrome de Cimitarra/diagnóstico , Síndrome de Cimitarra/fisiopatologia , Resultado do Tratamento
17.
J Cardiothorac Vasc Anesth ; 33(4): 1090-1104, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30269893

RESUMO

Right ventricular (RV) dysfunction is a cause of increased morbidity and mortality in both cardiac surgery and noncardiac surgery and in the intensive care unit. Early diagnosis of this condition still poses a challenge. The diagnosis of RV dysfunction traditionally is based on a combination of echocardiography, hemodynamic measurements, and clinical symptoms. This review describes the method of using RV pressure waveform analysis to diagnose and grade the severity of RV dysfunction. The authors describe the technique, optimal use, and pitfalls of this method, which has been used at the Montreal Heart Institute since 2002, and review the current literature on this method. The RV pressure waveform is obtained using a pulmonary artery catheter with the capability of measuring RV pressure by connecting a pressure transducer to the pacemaker port. The authors describe how RV pressure waveform analysis can facilitate the diagnosis of systolic and diastolic RV dysfunction, the evaluation of RV-arterial coupling, and help diagnose RV outflow tract obstruction. RV pressure waveform analysis also can be used to guide pharmacologic treatment and fluid resuscitation strategies for RV dysfunction.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Monitorização Intraoperatória/métodos , Assistência Perioperatória/métodos , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Pressão Ventricular/fisiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Disfunção Ventricular Direita/cirurgia , Função Ventricular Direita/fisiologia
18.
Ann Thorac Surg ; 107(1): 84-91, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30273567

RESUMO

BACKGROUND: The elevated preoperative ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') as an echocardiographic index of left ventricular filling pressure is known to be associated with poor postoperative outcomes. We investigated the association between preoperative and postoperative E/e' elevation and clinical outcomes after cardiac operations. METHODS: The study divided 1,353 patients who underwent cardiac operations into four groups: preoperative and postoperative E/e' ≤15 (low-low), preoperative E/e' ≤15 but postoperative E/e' >15 (low-high), preoperative E/e' >15 but postoperative E/e' ≤15 (high-low), and preoperative and postoperative E/e' >15 (high-high). Cox proportional hazard analysis was performed. Kaplan-Meier curve analysis was performed before and after propensity score matching. RESULTS: The four perioperative E/e' categories were independently associated with 5-year mortality (hazard ratio, high-high vs low-low: 3.58; low-high vs low-low: 3.75; high-low vs low-low: 1.18). Kaplan-Meier curves showed that mortality was significantly different between the groups (log-rank test: high-high vs. low-low, p < 0.001; low-high vs low-low, p < 0.001). Postoperative intensive care unit and hospital lengths of stay, incidence of acute kidney injury, and 1-year mortality were significantly different. However, after propensity score matching, mortality and the incidence of postoperative acute kidney injury were significantly different only between postoperative E/e' ≤15 and E/e' >15, but not between preoperative E/e' ≤15 and E/e' >15. CONCLUSIONS: Postoperative E/e' >15 was more strongly associated with mortality and acute kidney injury than preoperative E/e' >15. Measurement of the postoperative E/e' ratio may help in assessing the risk of these patients.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/etiologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Ecocardiografia , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento
19.
Int J Cardiol ; 274: 342-347, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287055

RESUMO

BACKGROUND: A reason for concentric left ventricular (LV) remodelling predicting cardiovascular outcomes independent of conventional risk factors and LV mass (LVM) has not been provided. We hypothesized that independent of LVM, concentric LV remodelling is associated with inflammatory changes rather than a pressure load on the LV. METHODS: In 764 randomly selected community participants, we assessed relations between several inflammatory markers (ELISA) and LV relative wall thickness (RWT) (echocardiography), LV mass index (LVMI), and indexes of diastolic function. RESULTS: No independent relations were noted between circulating concentrations of inflammatory markers and LVM index (LVMI) (p > 0.13 for all). However, independent of confounders including LVMI and blood pressure (BP), circulating tumour necrosis factor-α (TNF-α) (partial r = 0.14, p < 0.0005) and to a lesser degree interleukin-6 (partial r = -0.09, p < 0.02) were associated with RWT. The impact (standardized ß-coefficient) of TNF-α on RWT (0.12 ±â€¯0.03, p < 0.0005) was at least as strong as age (0.13 ±â€¯0.05, p < 0.005), and second only to LVMI (0.27 ±â€¯0.04, p < 0.0001), whilst neither office, 24-hour, central aortic BP, nor aortic stiffness were associated with RWT independent of LVMI. With adjustments, as compared to participants with a normal LVMI and geometry (12.7 ±â€¯0.8), circulating TNF-α concentrations (pg/ml) were increased as much in participants with concentric LV remodelling (16.8 ±â€¯1.5, p < 0.05) as in those with concentric LV hypertrophy (LVH) (17.0 ±â€¯1.3, p < 0.005), whilst eccentric LVH (13.7 ±â€¯0.9) was not. No independent relations between inflammatory markers and LV diastolic function (trans-mitral and tissue Doppler) were noted. CONCLUSIONS: Independent of LVMI, a pro-inflammatory state rather than BP load is strongly associated with LV concentric remodelling.


Assuntos
Citocinas/sangue , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Inflamação/sangue , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Remodelação Ventricular/fisiologia , Adulto , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Diástole , Ecocardiografia , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/diagnóstico , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Int J Cardiol ; 284: 28-32, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30503185

RESUMO

BACKGROUND: Diastolic dysfunction is felt to be part of the natural history of patients with prior Fontan operation. Despite that, data on noninvasive assessment of diastolic function and ventricular filling pressures in Fontan patients are limited. METHODS: We included 45 adult Fontan patients who underwent right heart catheterization with pulmonary artery wedge pressure (PAWP) measurement and transthoracic echo-Doppler assessment within 7 days. Offline measurement of systemic atrioventricular valve pulsed-wave (PW) and medial/lateral atrioventricular annular tissue Doppler velocities was performed and correlated to PAWP. RESULTS: Median age was 31.4 years (IQR 24.8-37); 51% of patients were females. Median ventricular ejection fraction was 55% (IQR 50.3-57.5) and median PAWP was 10 mm Hg (IQR 8-11). PW Doppler E velocity (r = 0.64, p ≤ 0.0001), deceleration time (r = -0.40, p = 0.008), and E/A ratio (r = 0.33, p = 0.03) correlated with PAWP. Median medial and lateral E/e' ratios also correlated to PAWP (r = 0.71, p = 0.002 and r = 0.75, p < 0.0001; respectively). An E velocity >75 cm/s had 88% sensitivity and 86% specificity [97% negative predictive value (NPV); 58% positive predictive value (PPV)], E/A ratio >1.7 had 100% sensitivity and 61% specificity (100% NPV; 26% PPV), and deceleration time <135 ms had 88% sensitivity and 83% specificity (97% NPV; 58% PPV) for predicting PAWP >12 mm Hg. CONCLUSION: Our data suggest that PW Doppler atrioventricular E velocity, E/A ratio, and deceleration time could be used to identify adult Fontan patients with normal filling pressures. However, PPVs for PAWP >12 mm Hg were poor. Further studies, particularly prospective, simultaneous echo-catheterization correlation, are critically needed.


Assuntos
Ecocardiografia Doppler/métodos , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular/fisiologia , Adulto , Diástole , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Período Pós-Operatório , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
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