RESUMO
Diastolic wall strain (DWS), an echocardiographic index based on linear elasticity theory, has been identified as a predictor of heart failure (HF) in patients with sinus rhythm. However, its effectiveness in atrial fibrillation (AF) patients remains uncertain. This study aims to assess DWS as a predictor of HF in AF patients with preserved ejection fraction. We analysed a prospective database of AF patients undergoing transthoracic echocardiography. AF patients with reduced left ventricular ejection fraction (< 50%), posterior wall motion abnormality, hypertrophic cardiomyopathy, valvular heart disease, pericardial disease, congenital heart disease, or history of pacemaker/implantable cardioverter-defibrillator implantation or cardiac surgery were excluded. The study followed patients until HF development, death, or last visit. Follow-up for patients who underwent catheter ablation was censored on the date of their procedure. HF was ascertained based on the Framingham criteria. DWS was calculated using a validated formula: DWS = (PWs -PWd)/PWs, where PWs is the posterior wall thickness at end-systole and PWd is the posterior wall thickness at end-diastole. Among 411 study patients (mean age 69.6 years, 66% men), 20 (5%) was underwent catheter ablation and 57 (14%) developed HF during a mean follow-up of 82 months. Cox-proportional hazards demonstrated that low DWS (≤ 0.33) significantly predicted HF events (hazard ratio [HR] 3.28, 95% confidence interval [CI]) 1.81-5.94, P < 0.0001), independent of age (per 10 years; HR 1.99, 95% CI 1.35-2.93, P < 0.001), indexed left ventricular mass (per 10 g/m2; HR 1.16, 95% CI 1.05-1.27, P < 0.01), and indexed left atrial volume (per 10 mL/m2; HR 1.14, 95% CI 1.04-1.24, P < 0.01). Additionally, global log-likelihood ratio chi-square statistics indicated that DWS incrementally predicts HF development beyond age, indexed left ventricular mass, and left atrial volume (P < 0.001).
RESUMO
It was reported that the H2ARDD score (organic heart diseases = 2 points, anemia = 1 point, renal dysfunction = 1 point, diabetes = 1 point, and diuretic use = 1point; range 0 to 6 points) may help identify patients with AF at high risk for HF events. However, this score has not been externally validated. The objective of this study was to evaluate the usefulness of H2ARDD score in predicting HF events in patients with AF. We used a prospective database of patients with AF, and Cox-proportional hazards models were used to assess the risk of HF events. The outcome of interest was defined as HF events including new-onset HF and death from HF. Of 562 AF patients, 518 (mean 69.7 ± 9.7 years-old, 64.9% men) met study criteria, and 84 (16.2%) developed HF events during a mean follow-up of 54 ± 42 months. In multivariable analyses, H2ARDD score was shown as a significant predictor for HF events [hazard ratio (HR): 1.56, 95% confidence interval (CI): 1.36-1.79], independent of age (per 10 years, HR: 1.35, 95% CI: 1.03-1.78). In the Kaplan-Meier analyses stratified by H2ARDD score categories (0-2, 3-4, 5-6), the patients with higher H2ARDD scores had significantly worse HF event-free survival (log-rank P < 0.0001). The area under the ROC curve was 0.71 (95% CI: 0.65-0.77, P < 0.0001). The sensitivity and specificity at a cut-off score of ≥ 3 were 60% and 71%, respectively. In conclusion, the H2ARDD score may be feasible for HF risk stratification in patients with AF.
Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Masculino , Humanos , Criança , Pessoa de Meia-Idade , Idoso , Feminino , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Prognóstico , Volume Sistólico , Modelos de Riscos Proporcionais , Fatores de RiscoRESUMO
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and has unfavorable consequences such as stroke, heart failure (HF), and death. HF is the most common adverse event following AF and the leading cause of death. Therefore, identifying the association between AF and HF is important to establish risk stratification for HF in AF. Recent studies suggested that left atrial and ventricular fibrosis is an important link between AF and HF, and the prognostic impact may differ with respect to HF subtype, stratified with left ventricular ejection fraction (EF). Mortality risk in patients with concurrent AF and HF with reduced EF (HFrEF) appears slightly higher compared with those with concurrent AF and HF with preserved EF (HFpEF). On the other hand, the prognostic impact of HF in AF is similar between HFrEF and HFpEF. Further, left atrial size, as well as left atrial and left ventricular functional assessment, are reported to be useful for the prediction of HF in AF, incremental to the conventional risk factors. In this review, we focus on the epidemiological, pathophysiological, and prognostic associations between AF and HF, and review the clinical and echocardiographic predictors for HF in AF.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Fatores de Risco de Doenças Cardíacas , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Função Ventricular EsquerdaRESUMO
Diastolic wall strain (DWS) was reported as a simple and feasible echocardiographic index in assessing left ventricular (LV) diastolic stiffness. We sought to evaluate whether DWS predicts age-related cardiovascular events. Patients referred for transthoracic echocardiogram, those with preserved LV ejection fraction and no clinical heart failure were studied. Cardiovascular events were ascertained using Framingham criteria (myocardial infarction, coronary insufficiency, stroke, transient ischemic attack, congestive heart failure, or cardiovascular death). DWS was calculated with a validated formula. Cox proportional hazards modeling was used to assess the risk of cardiovascular events. Of a total number of 962 patients (mean age 60.9 ± 14.9 years, 48.0% men), 69 (7.2%) developed at least 1 cardiovascular event during a mean follow-up of 43 ± 32 months. After adjusting for cardiovascular comorbidities in a multivariable model, low DWS (â¦â0.33) was a significant independent predictor of cardiovascular events [hazard ratio (HR): 1.87, 95% confidential interval (CI) 1.04-3.36, P = 0.04]. Echocardiographic assessment of DWS may help in identifying the patients at increased risk for future age-related cardiovascular events.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Ecocardiografia , Função Ventricular Esquerda , Idoso , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos ProporcionaisRESUMO
A 70-year-old man with dyspnea was admitted to our department and received standard therapy for recurrent heart failure. He was diagnosed with polycystic kidney disease (PKD) in his thirties and received hemodialysis for 4 years before undergoing renal transplantation at age 45. Although his left ventricular ejection fraction (LVEF) was preserved in his 50s, LVEF decreased progressively from 61% to 24%, while left ventricular diastolic dimension (LVDd) increased from 54 mm to 65 mm between 63 and 69 years of age. Right ventricular endomyocardial biopsy demonstrated myocardial disarray and interstitial fibrosis. Genetic analysis identified a heterozygous frameshift mutation in PKD1, which encodes polycystin-1, a major causative gene of PKD. We detected PKD1 protein expression in myocardial tissue by immunostaining. Recent epidemiological studies and animal models have clarified the pathological correlation between ventricular contractile dysfunction and PKD1 function. Here, we present a case of old-age onset progressive cardiac contractile dysfunction with a PKD1 gene mutation.
Assuntos
Mutação da Fase de Leitura/genética , Cardiopatias/fisiopatologia , Miocárdio/metabolismo , Doenças Renais Policísticas/complicações , Doenças Renais Policísticas/genética , Idoso , Ecocardiografia , Fibrose/patologia , Cardiopatias/etiologia , Cardiopatias/genética , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/genética , Humanos , Transplante de Rim , Masculino , Contração Miocárdica/genética , Miocárdio/patologia , Doenças Renais Policísticas/terapia , Volume Sistólico/fisiologia , Canais de Cátion TRPPRESUMO
BACKGROUND: It has been reported that the clinical characteristics of infective endocarditis are changing during the course of the decades. However, most of the available data are obtained in the early 2000s or earlier. We therefore evaluated the more recent clinical spectrum of infective endocarditis. METHODS: Fifty-four consecutive patients diagnosed as infective endocarditis based on the Duke criteria at our hospital from January 2006 to December 2010 were evaluated. RESULTS: Of 54 cases, 31 (57%) were male and 23 (43%) were female, with mean age of 57 +/- 17 years. Twenty-three (43%) patients were older than 65 years. The number of patients with diabetes mellitus or undergoing chronic hemodialysis, or cancer were 9 (17%), 5 (9%), and 5 (9%), respectively. In 25 patients (46%), endocarditis occurred without any underlying cardiac disease. The frequencies of streptococcal endocarditis and staphylococcal endocarditis were almost identical [18 (33%) vs. 17 (32%)]. Methicillin resistant staphylococcus aureus was found in 6 patients (11%). CONCLUSIONS: A survey of patients with infective endocarditis from 2006 to 2010 revealed a trend towards increased staphylococcal endocarditis in compromised patients without prior cardiac disorders.
Assuntos
Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Adulto , Fatores Etários , Idoso , Complicações do Diabetes/epidemiologia , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Diálise Renal/estatística & dados numéricos , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Fatores de TempoRESUMO
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, which has been increasing dramatically. AF has unfavorable consequences, such as stroke, heart failure, and cardiovascular death. Of these, stroke has been considered to be the serious complication. Recently, direct oral anticoagulation or new technologies, such as the WATCHMAN left atrium (LA) appendage closure device, have emerged to prevent stroke. Therefore, the accurate estimation of thromboembolic risk and appropriate prevention are essential for high-risk patients with AF. Although CHADS2 and CHA2DS2-VASc scores has been widely used to predict the risk of stroke in patients with AF, some researchers showed that there was no relationship between CHADS2 and CHA2DS2-VASc scores and LA appendage thrombus formation. Recent studies have reported that combination of echocardiographic parameters to CHADS2 or CHA2DS2-VASc scores can stratify high risk groups for LA appendage thrombus formation and onset of stroke. In this review, we focus on the epidemiological, pathophysiological, and prognostic associations between AF and stroke, and review the clinical and echocardiographic predictors for stroke in patients with AF.
Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Trombose , Ecocardiografia/efeitos adversos , Átrios do Coração/diagnóstico por imagem , Humanos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Trombose/etiologiaRESUMO
BACKGROUND: Infective endocarditis is a serious septic disease, and the epidemiological profile has changed over the last decade. However, there is a paucity of data regarding the current outcome and predictor of in-hospital mortality in patients with infective endocarditis. METHODS: Consecutive patients diagnosed as infective endocarditis based on the modified Duke criteria at Kansai Medical University hospital from January 2006 to June 2019 were prospectively included. The primary outcome was in-hospital mortality. Cox proportional hazards modelling was used to assess risk factors of in-hospital mortality. RESULTS: Of 137 consecutive patients with infective endocarditis (age 60 ± 17 years-old, 62% men, 65% underlying cardiac disease, 11% chronic haemodialysis), 18 (13%) died during hospitalisation. Age and sex were not associated with in-hospital mortality. Patients on chronic haemodialysis exhibited significantly higher in-hospital mortality rate than those without (47 vs. 9%). After adjusting for comorbidities in a multivariate Cox proportional hazards model, chronic haemodialysis was a significant predictor of in-hospital mortality [hazard ratio (HR) 4.22, 95% confidential interval (CI): 1.49-12.0, p < 0.01], independently of C-reactive protein (per 1 mg/dl; HR 1.07, 95%CI: 1.02-1.12, p < 0.05). CONCLUSIONS: Infective endocarditis in patients on chronic haemodialysis is a serious life-threatening condition that requires early diagnosis and an effective therapeutic approach.
Assuntos
Endocardite Bacteriana , Endocardite , Infecções Estafilocócicas , Adulto , Idoso , Endocardite/diagnóstico , Endocardite/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de RiscoRESUMO
Left atrial (LA) volume is known as a robust predictor of heart failure (HF) development in patients with sinus rhythm. However, among patients with atrial fibrillation (AF), the utility of LA volume for prediction of HF development has not been determined. The objective of this study was to investigate the utility of LA volume for prediction of HF development in patients with AF. Among adult patients who were referred for transthoracic echocardiography, those with AF at the baseline echocardiography were included and prospectively followed up to new-onset HF events. Patients who had significant valvular heart disease, congenital heart disease, or reduced left ventricular (LV) ejection fraction were excluded. Cox-proportional hazards models were used to assess the risk of HF development. Of a total of 562 patients, 422 (mean age 69.6 ± 9.7 years, 66.1% men) met study criteria, and 52 (12.3%) developed HF during a mean follow-up of 55 ± 43 months. Patients with HF events had larger indexed LA volume, compared with those without HF events (69 ± 46 vs 50 ± 23 ml/m2, p <0.0001). In a multivariable analysis adjusted for other co-morbidities, LA volume was a significant predictor for HF development [per 10 ml/m2; hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.06 to 1.22, p <0.001], independently of age (per 10 years; HR 1.71, 95% CI 1.16 to 2.52, p <0.01), LV ejection fraction (per 10%; HR 0.67, 95% CI 0.52 to 0.86, p <0.01), and indexed LV mass (per 10 g/m2; HR 1.13, 95% CI 1.03 to 1.24, p <0.05). Also, LA volume had an incremental effect for prediction of HF development to these conventional risk factors (p <0.0001). In conclusion, LA volume provides prognostic information for the prediction of future HF events in patients with AF.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Ecocardiografia , Feminino , Átrios do Coração/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Tamanho do Órgão , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Volume SistólicoAssuntos
Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia Tridimensional/métodos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Hipóxia/diagnóstico , Hipóxia/etiologia , Idoso , Sistemas Computacionais , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/métodos , Humanos , MasculinoAssuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Valvuloplastia com Balão , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Valvuloplastia com Balão/efeitos adversos , Ecocardiografia Transesofagiana , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Both obesity and left ventricular (LV) diastolic dysfunction are associated with an increased risk of cardiovascular morbidity and mortality. There is a paucity of data as to whether obesity is independently associated with LV diastolic dysfunction. METHODS: Adult patients with sinus rhythm referred for a transthoracic echocardiography between July, 2007, and December, 2007, were prospectively included. Exclusion criteria were patient who had a history of congenital or valvular heart disease, treatment with pacemaker implantation or implantable cardioverter defibrillator, myocardial infarction, or impaired LV systolic function. Diastolic function was classified by an algorithm incorporating data from mitral and pulmonary venous flow indices, and Doppler tissue imaging. Body mass index (BMI) was evaluated as a categorical variable (normal weight <25.0 kg/m(2); overweight 25.0 to <30.0 kg/m(2); and obese ≥30 kg/m(2)). Logistic models were used to assess the risk of abnormal LV diastolic function associated with BMI categories. RESULTS: Of a total number of 692 patients who met all study criteria (mean 59 ± 15 year-old; 50% women, 48% hypertension, 16% diabetes, 26% overweight, 8% obese), 538 (78%) had abnormal LV diastolic function. In multivariate analyses adjusting for age, sex, and cardiovascular risk factors, obesity was independently associated with LV diastolic dysfunction (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.12-7.88; P = 0.03) compared to normal weight. LV mass did not weaken this association (OR: 2.88, 95% CI: 1.08-7.68; P = 0.04). Overweight was not independently associated with LV diastolic dysfunction. CONCLUSION: Obesity was associated with LV diastolic dysfunction independent of cardiovascular risk factors and LV mass.
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Although some atypical types of transient left ventricular apical ballooning syndrome have been reported, only a few atypical types of transient mid-ventricular ballooning have been reported. A 70-year-old female underwent surgery for urothelial carcinoma. At day 5 after the surgery, she was admitted to our department without cardiac symptoms because of ST elevation in leads I, II, III, aVF and V1-V6 indicating acute coronary syndrome. She was diagnosed with stress induced cardiomyopathy based on an angiographically normal coronary artery, newly developed extensive wall motion abnormality (hyperbasal contraction and akinesis from the mid-left ventricle to the apex without hypercontraction of the small area adjacent to the apex) based on left ventriculography, and a small elevation of myocardial enzymes incongruous with the area of contraction abnormality. Myocardial scintigraphy with 99mTc-tetrofosmin showed a severely reduced myocardial perfusion in an extensive mid-ventricular area without a left ventricular base and top of apex, in accord with a wall motion abnormality different from typical apical ballooning or typical mid-ventricular ballooning previously diagnosed in our hospital. This is the first report presenting an atypical mid-ventricular ballooning based on the myocardial atypical perfusion findings.
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AIM: To evaluate the effects of eicosapentaenoic acid (EPA) on regional arterial stiffness assessed by strain rate using tissue Doppler imaging. METHODS: Nineteen eligible patients were prospectively studied (mean age 62 ± 8 years, 68% men). Subjects with large vessel complications and/or diabetes mellitus were excluded. The strain rate of the ascending aorta was measured by tissue Doppler imaging as an index of regional arterial stiffness, and brachial-ankle pulse wave velocity (baPWV) was measured as an index of degree of systemic arteriosclerosis. These indices were compared before and after administration of EPA at 1800 mg/d for one year. RESULTS: The plasma concentration of EPA increased significantly after EPA administration (3.0% ± 1.1% to 8.5% ± 2.9%, P < 0.001). There were no significant changes in baPWV (1765 ± 335 cm/s to 1745 ± 374 cm/s), low-density lipoprotein cholesterol levels (114 ± 29 mg/dL to 108 ± 28 mg/dL), or systolic blood pressure (131 ± 16 mmHg to 130 ± 13 mmHg) before and after EPA administration. In contrast, the strain rate was significantly increased by administration of EPA (19.2 ± 5.6 s(-1), 23.0 ± 6.6 s(-1), P < 0.05). CONCLUSION: One year of administration of EPA resulted in an improvement in regional arterial stiffness which was independent of blood pressure or serum cholesterol levels.