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1.
Clin Infect Dis ; 72(10): 1767-1781, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32270861

RESUMO

BACKGROUND: Infective endocarditis (IE) is a life-threatening bacterial infection of the heart valves, most often diagnosed in older persons and persons with prior cardiac surgery. It is also associated with injection drug use, a behavior that has increased in recent years along with the US opioid crisis. METHODS: We conducted a retrospective cohort analysis of commercial and Medicaid health insurance databases to estimate incident cases of IE in the United States in 2017, stratified by persons living with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and opioid use disorder (OUD). We also estimated annual percentage changes (EAPCs) in IE from 2007-2017 among persons with commercial insurance. RESULTS: The weighted incidence rate of IE was 13.8 cases per 100 000 persons among persons with commercial insurance, and 78.7 among those with Medicaid. The incidence rate of IE among commercially insured persons increased slightly from 2007-2017 (EAPC, 1.0%). It decreased among commercially insured persons living with HIV, from 148.0 in 2007 to 112.1 in 2017 (EAPC, -4.3%), and increased among those with HCV infection, from 172.4 in 2007 to 238.6 in 2017 (EAPC, 3.2%). Among persons aged 18-29 years with HCV infection, IE increased from 322.3 in 2007 to 1007.1 in 2017 (EAPC, 16.3%), and among those with OUD it increased from 156.4 in 2007 to 642.9 in 2017 (EAPC, 14.8%). CONCLUSIONS: The incidence rate of IE increased markedly among young persons with HCV infections or OUD. This increase appears to parallel the ongoing national opioid crisis. Harm reduction with syringe services programs, medications for opioid use disorder, and safe injection practices can prevent the spread of HIV, HCV, and IE.


Assuntos
Endocardite , Infecções por HIV , Hepatite C , Transtornos Relacionados ao Uso de Opioides , Idoso , Idoso de 80 Anos ou mais , Endocardite/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Humanos , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
2.
Echocardiography ; 37(11): 1757-1765, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33021343

RESUMO

OBJECTIVES: This study sought to evaluate a decision algorithm for the estimation of left ventricular filling pressure (LVFP) in patients with mitral annular calcification (MAC). BACKGROUND: In a single center study, Abudiab et al evaluated echocardiographic parameters to estimate LVFP in patients with MAC against invasive hemodynamic measurements and developed a decision algorithm which demonstrated high predictive accuracy. METHODS: Retrospectively, 55 patients (mean age 68.5 ± 11.5) with MAC and a left heart catheterization within 24 hours of an echocardiogram were identified. The decision algorithm was applied using echo data to classify patients as having normal or elevated LVFP which was then compared with the invasively obtained LVFP. RESULTS: The algorithm performed poorly at predicting pre-A LVFP as normal or high (P = .182). Accuracy for the algorithm was 0.59 [0.46, 0.72] (mean [95% CI]), sensitivity was 0.45 [0.28, 0.62], specificity was 0.73 [0.54, 0.86], false positive rate was 0.27 [0.14, 0.46], and false negative rate was 0.55 [0.38, 0.72]. E/A ratio, IVRT, and E/e'ratio showed no significant relationship to actual patient LVFP. CONCLUSIONS: The Abudiab et al algorithm failed to demonstrate comparable sensitivity, specificity, and accuracy in our sample. Additional study is necessary to refine this tool prior to more widespread use in clinical practice.


Assuntos
Cálcio , Disfunção Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Pressão Ventricular
3.
Echocardiography ; 37(6): 832-840, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32437588

RESUMO

AIMS: Despite three decades of study, it is still challenging to discriminate acute apical variant stress cardiomyopathy (AVSCM) from acute left anterior descending-myocardial infarction (LAD-MI) at the time of presentation. A biomarker or practical imaging modality that can differentiate these two entities is highly desirable. Our objective was to characterize left ventricular (LV) mechanical deformation using 2-dimensional (2D) echocardiographic strain imaging in an attempt to discriminate AVSCM from LAD-MI at presentation. METHODS AND RESULTS: We studied 108 women (60 AVSCM, 48 ST segment elevation LAD-MI). All underwent echocardiography within 48 hours of presentation. 2D longitudinal strain (LS) from an 18-segment LV model was performed, with global LS (GLS) taken as the average of all 18 segments. GLS was abnormal, but did not differentiate AVSCM from LAD-MI. Mean LS of the basal and mid-anterior, basal, and mid-anteroseptum segments were significantly lower in LAD-MI vs AVSCM group (-14 ± 9% vs -20 ± 8%; -11 ± 7% vs -14 ± 6%; -9 ± 8% vs -14 ± 8%; -9 ± 7% vs -13 ± 5%, respectively, all P ≤ .05). Mean LS of the basal inferior and inferolateral segments was significantly higher in the LAD-MI vs. AVSCM group (-19 ± 9% vs -13 ± 7%; -23 ± 11% vs -18 ± 7%, respectively, all P ≤ .05). Using ROC curve analysis, segmental strain ratio of average basal inferior and inferolateral segments LS to average mid- and basal anterior and anteroseptum segments LS of ≥1.58 was 90% specific for LAD-MI [area under the curve (AUC) 0.87; P < .001]. CONCLUSION: Longitudinal strain patterns are useful in discriminating AVSCM from LAD-MI patients at presentation and may be valuable in stratifying patients for invasive evaluation.


Assuntos
Infarto Miocárdico de Parede Anterior , Cardiomiopatias , Cardiomiopatia de Takotsubo , Disfunção Ventricular Esquerda , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Cardiomiopatia de Takotsubo/diagnóstico por imagem
4.
Echocardiography ; 35(2): 204-210, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29178134

RESUMO

OBJECTIVES: To assess the effects of submassive pulmonary embolism (SMPE) on right atrial (RA) anatomy and function. BACKGROUND: Right ventricular dysfunction (RVD) is associated with adverse outcomes in SMPE. However, the effects of SMPE on the structure and function of the RA have received much less attention. METHODS: Fifty patients with SMPE documented by CT angiography (SMPE group) and evidence of RVD on two-dimensional echocardiography were retrospectively identified and compared to 50 controls (control group). Both RA and RV areas, volumes and fractional area change (FAC) were measured. Pulmonary artery systolic pressures were estimated. RA and RV longitudinal strains were obtained using vector velocity imaging (VVI). RESULTS: Compared with controls, RA and RV FACs were significantly reduced and associated with higher chamber volumes in the SMPE group. Global longitudinal RA strain was reduced in the SMPE group (29% + 11% vs 55% + 16%; P < .01), as was global RV longitudinal strain (-12% + 5% vs -20% + 5%, P < .01), when compared to the controls. A linear relationship existed between RV and RA strain in both groups; however, the curve was shifted downward among those with SMPE. Furthermore, ROC curve analysis suggests RA area performs better than RV area as a marker of SMPE. CONCLUSIONS: RA structure and function are adversely affected in SMPE, similar to the effects observed in RV. Lower RA strain appears to be a novel quantitative indicator of SMPE, and RA area may be a more sensitive marker of this condition and may provide additional prognostic information in this condition.


Assuntos
Ecocardiografia/métodos , Embolia Pulmonar/complicações , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico por imagem , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Disfunção Ventricular Direita/fisiopatologia
5.
Echocardiography ; 35(1): 39-46, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29178212

RESUMO

OBJECTIVE: We undertook this study of echocardiographic classification of diastolic function by three different algorithms to determine: (1) how frequently each algorithm classified patients and (2) how well the results agreed with one another. BACKGROUND: Several algorithms exist to grade diastolic function (DF), the Mayo Clinic scheme of Redfield et al (Mayo 2003) and the 2 ASE guideline documents of 2009 and 2016 (ASE 2009 and ASE 2016). METHODS: A total of 200 consecutive echocardiograms were retrospectively analyzed; mean age of patients 60.3 ± 3.5 years, 45% male. Echocardiograms were performed using Intersocietal Accreditation Commission guidelines. Diastolic function was assessed by Mayo 2003 and ASE 2009 and 2016. Coexisting conditions affecting DF analysis, such as mitral annular calcification (MAC), were tabulated. Data were compared using a paired t-test. Concordance between algorithms was assessed using the Kappa statistic. RESULTS: A total of 117 of 200 studies (58.5%) were excluded for the presence of coexisting conditions (51.5%), poor image quality (2.5%), or incomplete data (4.5%). Thirty-three of the remaining 83 studies (40%) received the same grade of DF based on assessments made using the Mayo 2003 and ASE 2016 algorithms; the Kappa statistic was 0.20. 36 of the 83 studies (43%) received the same grade of DF based on assessments made using the ASE 2009 and ASE 2016 algorithms; the Kappa statistic was 0.25. CONCLUSION: Assessment of diastolic function via echocardiography cannot be reliably accomplished in approximately 50% of patients using current guidelines. Further, when studies are suitable for assessment, widely used guidelines yield discordant results.


Assuntos
Algoritmos , Ecocardiografia/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Diástole , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Echocardiography ; 35(12): 1974-1981, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30431175

RESUMO

BACKGROUND: Nonagenarians (NON) are a growing segment of the population and have a high prevalence of cardiac disease. Many findings encountered on their echocardiograms are also found in younger individuals with valvular or myocardial disease. Therefore, the purpose of this study was to describe this distinct echocardiographic phenotype. METHODS: We identified our study population by querying our echo database to identify unique septuagenarians (SEPT) and nonagenarians (NON) who underwent a transthoracic echocardiogram (TTE) from January 1, 2010 to December 31, 2014. Exclusion criteria were LVEF < 50%, any akinetic wall segment, aortic stenosis, moderate-severe AR and/or severe MR, coronary revascularization within 60 days of study echo, and prior valve surgery. RESULTS: The mean age of SEPT was 73.0 ± 2.0 and NON was 92.0 ± 2.1 (P < 0.001). There was no gender difference between groups. NON had significantly smaller LV end-diastolic diameters than SEPT (41.6 ± 5.7 mm vs 48.0 ± 7.0 mm, P < 0.001). NON had a greater relative wall thickness (0.51 ± 0.10 vs 0.40 ± 0.08, P < 0.001) and more frequently had concentric remodeling or hypertrophy. NON had higher E/Ea ratios and estimated LA pressures (P < 0.01). 48% of NON had moderate-severe mitral annular calcification compared to 25.0% of SEPT (P < 0.01). CONCLUSIONS: Herein, we provide the first comprehensive echocardiographic description of 'presbycardia'; concentric LVH, asymmetric septal hypertrophy, mitral and aortic valve calcification, and increased epicardial fat thickness. This pattern of findings may be increasingly seen as the population ages.


Assuntos
Ecocardiografia Doppler/métodos , Doenças das Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Idoso , Idoso de 80 Anos ou mais , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos
7.
J Cardiovasc Electrophysiol ; 27(12): 1411-1419, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27569695

RESUMO

INTRODUCTION: Although catheter ablation (CA) for atrial fibrillation (AF) is commonly used to improve symptoms, AF recurrence is common and new tools are needed to better inform patient selection for CA. Left atrial function index (LAFI), an echocardiographic measure of atrial mechanical function, has shown promise as a noninvasive predictor of AF. We hypothesized that LAFI would relate to AF recurrence after CA. METHODS AND RESULTS: All AF patients undergoing index CA were enrolled in a prospective institutional AF Treatment Registry between 2011 and 2014. LAFI was measured post hoc from pre-ablation clinical echocardiographic images in 168 participants. Participants were mostly male (33% female), middle-aged (60 ± 10 years), obese and had paroxysmal AF (64%). Mean LAFI was 25.9 ± 17.6. Over 12 months of follow-up, 78 participants (46%) experienced a late AF recurrence. In logistic regression analyses adjusting for factors known to be associated with AF, lower LAFI remained associated with AF recurrence after CA [OR 0.04 (0.01-0.67), P = 0.02]. LAFI discriminated AF recurrence after CA slightly better than CHADS2 (C-statistic 0.60 LAFI, 0.57 CHADS2). For participants with persistent AF, LAFI performed significantly better than CHADS2 score (C statistic = 0.79 LAFI, 0.56 CHADS2, P = 0.02). CONCLUSION: LAFI, an echocardiographic measure of atrial function, is associated with AF recurrence after CA and has improved ability to discriminate AF recurrence as compared to the CHADS-2 score, especially among persistent AF patients. Since LAFI can be calculated using standard 2D echocardiographic images, it may be a helpful tool for predicting AF recurrence.


Assuntos
Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Ablação por Cateter , Ecocardiografia , Átrios do Coração/cirurgia , Idoso , Área Sob a Curva , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Ablação por Cateter/efeitos adversos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Recidiva , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Echocardiography ; 33(8): 1166-77, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27109429

RESUMO

BACKGROUND: The purpose of this investigation was to: (1) determine incidence and predictors of mitoxantrone-induced early cardiotoxicity and (2) study left ventricular mechanics before and after receiving mitoxantrone. METHOD AND RESULTS: We retrospectively analyzed 80 subjects diagnosed with acute myeloid leukemia (AML) who underwent chemotherapy with bolus high-dose mitoxantrone. Echocardiographic measurements were taken at baseline and at a median interval of 55 days after receiving mitoxantrone. Thirty-five (44%) of the patients developed clinically defined early cardiotoxicity, 29 (36%) of which developed heart failure. There was a significant decrease in the ejection fraction (EF) not only in the cardiotoxicity group (17.6 ± 14.8%, P < 0.001) but also in the noncardiotoxicity group (5.3 ± 8.4%, P < 0.001). Decrease in global longitudinal strain (GLS) (-3.7 ± 4.5, P < 0.001 vs. -2.4 ± 4.3, P = 0.01) and global circumferential strain (GCS) (-5.6 ± 9, P = 0.003 vs. -5.3 ± 8.7, P < 0.001) was significant in both the cardiotoxicity and noncardiotoxicity group, respectively. A multivariate model including baseline left ventricular end-systolic diameter, baseline pre-E/A ratio, and baseline pre-E/e' ratio was found to be the best-fitted model for prediction of mitoxantrone-induced early clinical cardiotoxicity. CONCLUSION: High-dose mitoxantrone therapy is associated with an excellent remission rate but with a significantly increased risk of clinical and subclinical early cardiotoxicity and heart failure. Mitoxantrone-induced systolic dysfunction is evident from reduction in EF, increase in Tei index, and significant reduction in GLS and GCS. Baseline impaired ventricular relaxation evident from higher E/e' ratio and lower E/A ratio independently predicts increased risk of mitoxantrone-induced early cardiotoxicity.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/mortalidade , Mitoxantrona/efeitos adversos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Causalidade , Comorbidade , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Técnicas de Imagem por Elasticidade/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Humanos , Incidência , Masculino , Massachusetts/epidemiologia , Mitoxantrona/uso terapêutico , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Volume Sistólico/efeitos dos fármacos , Taxa de Sobrevida , Resultado do Tratamento
9.
Circulation ; 129(16): 1659-67, 2014 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-24503950

RESUMO

BACKGROUND: Stress cardiomyopathy (SCM) is a peculiar form of reversible left ventricular dysfunction seen predominantly in women and occurs in response to emotional or physical stress. Because dysfunction in SCM is reversible and that of acute myocardial infarction (MI) is not, we hypothesized that these fundamental mechanistic differences between SCM and MI would be associated with different systolic and diastolic properties. METHODS AND RESULTS: We examined 3 groups, all women: patients with SCM (n=24; mean age, 63±12 years), those with left anterior (LAD) ST-segment-elevation MI (n=36; mean age, 63±10 years), and referent control subjects (n=30; mean age, 62±8 years). All underwent angiography, ventriculography, and pressure measurements within 48 hours of presentation. Left ventricular volumes, diastolic pressures, and diastolic stiffness were higher in SCM and LAD MI patients than in control subjects but no different from each other. Similarly, left ventricular diastolic pressures and diastolic stiffness were elevated in the SCM and LAD MI groups compared with the control group. Left ventricular ejection fraction in SCM and LAD MI were 40.8±12.3% and 49.6±5.6%, respectively, versus 70.4±9.4% in control subjects (P<0.001), and stroke work less than half the value of control subjects. Indexes of contractility and ventricular-arterial coupling were similarly abnormal in SCM and LAD MI. CONCLUSIONS: SCM and LAD MI show severe diastolic dysfunction. At similar left ventricular volumes, their diastolic pressures are more than twice as high as in control subjects, and systolic dysfunction is equally reduced in SCM and LAD MI. Despite a completely different pathophysiology in terms of systolic and diastolic function, SCM is indistinguishable from acute LAD-territory MI.


Assuntos
Diástole/fisiologia , Sístole/fisiologia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Cateterismo Cardíaco/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Cardiomiopatia de Takotsubo/terapia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
10.
Eur Heart J ; 34(9): 676-83, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22963833

RESUMO

AIMS: To investigate the effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency in early-stage hypertension. METHODS AND RESULTS: We studied 527 participants from two clinical trials assessing the effect of blood pressure lowering on diastolic function. Participants were aged ≥45 years with early-stage hypertension, no heart failure, ejection fraction (EF) ≥50%, and diastolic dysfunction using Doppler echocardiography. Effective arterial afterload and its components were assessed along with measures of left ventricular (LV) structure and function prior to and after 24-38 weeks of antihypertensive therapy. Systolic blood pressure decreased from 154 ± 18 to 137 ± 15 mmHg at follow-up. Blood pressure reduction was associated with decreases in ventricular and arterial stiffness, improvements in systemic arterial compliance and resistance, enhanced LV ejection, and reduction in cardiac work (all P < 0.001). Changes in Ea/Ees ratio were inversely correlated with those in EF (r = -0.25; P < 0.001), stroke work index (r = -0.13; P = 0.007), and LV efficiency (r = -0.98; P < 0.001); and directly related to changes in mitral E/e' (r = 0.12; P = 0.01). Adjusting for age and blood pressure change, women and obese individuals had less enhancement in ventricular-arterial coupling and efficiency compared with men and non-obese individuals (P = 0.04 and 0.007, respectively). CONCLUSION: Antihypertensive therapy reduces arterial and ventricular stiffness, enhances ventricular-arterial coupling, reduces cardiac work, and improves LV efficiency, systolic, and diastolic function. Attenuated responses in women and among obese subjects suggest that structure-function changes may be less reversible in these groups, possibly explaining their greater susceptibility to ultimately develop heart failure.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Fatores Etários , Idoso , Artérias/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Volume Sistólico/efeitos dos fármacos , Rigidez Vascular/efeitos dos fármacos , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos
11.
Int J Cardiovasc Imaging ; 40(4): 733-743, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38289428

RESUMO

BACKGROUND: Mitral annular calcification (MAC) poses many challenges to the evaluation of diastolic function using standard echocardiography. Left atrial (LA) strain and left ventricular early diastolic strain rate (DSr) measured by speckle-tracking echocardiography (STE) are emerging techniques in the noninvasive evaluation of diastolic function. We aim to evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC and compare their effectiveness to ratio of mitral inflow velocity in early and late diastole (E/A). METHODS: We included adult patients with MAC who presented between January 1 and December 31, 2014 and received a transthoracic echocardiogram (TTE) and cardiac catheterization with measurement of LVFP within a 24-h period. We used Spearman's rank correlation coefficient to assess associations of LA reservoir strain and average early DSr with LVFP. Receiver operating characteristic (ROC) curves were computed to assess the effectiveness of LA strain and DSr in discriminating elevated LVFP as a dichotomized variable and to compare their effectiveness with E/A ratio categorized according to grade of diastolic dysfunction. RESULTS: Fifty-five patients were included. LA reservoir strain demonstrated poor correlation with LVFP (Spearman's rho = 0.03, p = 0.81) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.54, 95% CI 0.38-0.69). Categorical E/A ratio alone also demonstrated poor discriminatory ability (AUC = 0.53, 95% CI 0.39-0.67), and addition of LA reservoir strain did not significantly improve effectiveness (AUC = 0.58, 95% CI 0.42-0.74, p = 0.56). Average early DSr also demonstrated poor correlation with LVFP (Spearman's rho = -0.19, p = 0.16) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.59, 95% CI 0.44-0.75). Addition of average early DSr to categorical E/A ratio failed to improve effectiveness (AUC = 0.62, 95% CI 0.46-0.77 vs. AUC = 0.54, 95% CI 0.39-0.69, p = 0.38). CONCLUSIONS: In our sample, LA reservoir strain and DSr do not accurately predict diastolic filling pressure. Further research is required before LA strain and early DSr can be routinely used in clinical practice to assess filling pressure in patients with MAC.


Assuntos
Função do Átrio Esquerdo , Calcinose , Diástole , Valva Mitral , Valor Preditivo dos Testes , Disfunção Ventricular Esquerda , Função Ventricular Esquerda , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/diagnóstico por imagem , Idoso , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Calcinose/fisiopatologia , Calcinose/diagnóstico por imagem , Reprodutibilidade dos Testes , Pressão Ventricular , Cateterismo Cardíaco , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/complicações , Área Sob a Curva , Estudos Retrospectivos , Fenômenos Biomecânicos , Ecocardiografia Doppler
12.
Eur J Intern Med ; 120: 3-10, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37865559

RESUMO

More than 90 % of patients developing heart failure (HF) have hypertension. The most frequent concomitant conditions are type-2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and non-steroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). Subsequently, they have been investigated in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) of mostly hypertensive etiology, and with modest benefits largely assessed on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Patients with HFpEF may have diastolic dysfunction but also systolic dysfunction visualized by lack of longitudinal shortening. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.


Assuntos
Insuficiência Cardíaca , Hipertensão , Humanos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico , Função Ventricular Esquerda , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico
13.
Am J Hypertens ; 37(1): 1-14, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37551929

RESUMO

BACKGROUND: More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension. METHODS: HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. RESULTS: For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. CONCLUSIONS: Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.


Assuntos
Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Hipertensão , Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico/fisiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Função Ventricular Esquerda , Antagonistas de Receptores de Angiotensina/uso terapêutico , Antagonistas de Receptores de Angiotensina/farmacologia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico
14.
Echocardiography ; 30(3): E61-3, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23305160

RESUMO

Systolic pulmonary and hepatic vein flow reversals can typically be seen with severe atrioventricular (AV) valve regurgitation and during atrial fibrillation (AF). We report the case of a 67-year-old woman who presented with recent-onset exertional dyspnea. Her pacemaker was near end-of-life and reverted to a VVI mode from the preset DDDR mode. Electrocardiography demonstrated retrograde 1:1 ventriculoatrial (VA) conduction and spectral Doppler analysis revealed prominent systolic pulmonary and hepatic vein flow reversals. Symptoms, electrocardiogram (ECG) findings, and the spectral Doppler abnormalities resolved completely following a generator replacement and resumption of DDDR pacing.


Assuntos
Veias Hepáticas/diagnóstico por imagem , Marca-Passo Artificial/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/etiologia , Artéria Pulmonar/diagnóstico por imagem , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico por imagem , Taquicardia por Reentrada no Nó Atrioventricular/etiologia , Idoso , Remoção de Dispositivo , Ecocardiografia/métodos , Análise de Falha de Equipamento , Feminino , Humanos , Doença Arterial Periférica/prevenção & controle , Taquicardia por Reentrada no Nó Atrioventricular/prevenção & controle
15.
Echocardiography ; 30(3): 309-16, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23237327

RESUMO

BACKGROUND: Two-dimensional speckle tracking imaging (STI) has recently been applied to the study of left atrial (LA) reservoir function. We utilized STI to analyze LA function in diastolic dysfunction (DD), hypothesizing that LA strain abnormality is part of the pathogenesis of diastolic dysfunction. METHODS: We applied STI to 50 patients with Grade 1-2 DD, comparing these results to 100 normal controls. Complete Doppler analysis of filling was made using peak E, peak A and tissue Doppler e' velocities; E/e' was used as a surrogate for LA pressure and LA stiffness index was calculated. RESULTS: In analysis of covariance, adjusting for age and gender, compared with controls, DD patients had higher E/e', greater LA volume and greater LA stiffness, but lower E/A ratio and global LA strain. LA strain appears to be inversely related to LA volume, but not to other indices of LV diastolic function. In subgroup analysis, LA strain was significantly lower, and stiffness significantly higher in DD, even after correction for differences in LA volume and E/A ratio. Analysis of ROC curves suggests that abnormal LA strain is a better marker for diastolic dysfunction than LA enlargement. CONCLUSION: LA strain by STI is significantly reduced in early diastolic dysfunction and is related to higher LA stiffness and LA size. Reduction in LA strain is partially independent of LA volume; accordingly we hypothesize that reduced atrial strain indicates impaired atrial distensibility.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Módulo de Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
16.
Clin Exp Hypertens ; 35(6): 401-11, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23134254

RESUMO

To evaluate whether the evolution of compensated pressure overload hypertrophy (POH) to overt heart failure (HF) is better predicted by systolic versus diastolic dysfunction, serial echocardiography was performed 1, 2, 4, 8, and 10 weeks after suprarenal aortic banding in 52 rats. One week after banding, at comparable extent of left ventricular hypertrophy and geometry, myocardial and chamber systolic performance, a restrictive filling pattern was well evident only in rats which eventually developed overt HF, according to postmortem lung weight. In experimental POH, early assessment of transmitral flow velocity allows to predict a faster progression toward HF.


Assuntos
Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/fisiopatologia , Animais , Diástole/fisiologia , Progressão da Doença , Ecocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Contração Miocárdica , Ratos , Ratos Sprague-Dawley , Sístole/fisiologia
17.
Prog Cardiovasc Dis ; 79: 80-88, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37442358

RESUMO

Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for half of all HF diagnoses, and its prevalence is increasing at an alarming rate. Lately, it has been recognized as a clinical syndrome due to diverse underlying etiology and pathophysiological mechanisms. The classic echocardiographic features of HFpEF have been well described as preserved ejection fraction (≥50%), left ventricular hypertrophy, and left atrial enlargement. However, echocardiography can play a key role in identifying the principal underlying mechanism responsible for HFpEF in the individual patient. The recognition of different phenotypic presentations of HFpEF (infiltrative, metabolic, genetic, and inflammatory) can assist the clinician in tailoring the appropriate management, and offer prognostic information. The goal of this review is to highlight several key phenotypes of HFpEF and illustrate the classic clinical scenario and echocardiographic features of each phenotype with real patient cases.


Assuntos
Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Volume Sistólico/fisiologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Ecocardiografia , Fenótipo , Função Ventricular Esquerda/fisiologia
18.
J Am Soc Echocardiogr ; 36(7): 746-759, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36791831

RESUMO

BACKGROUND: Pressure/volume (P/V) loops provide useful information on left ventricular performance and prognosis in patients with heart failure (HF) but do not lend themselves to routine clinical practice. The authors developed a noninvasive method to compute individualized P/V loops to predict adverse clinical outcomes in patients with stable HF, which the authors believe can be used clinically. METHODS: A derivation cohort (n = 443 patients) was used to develop an echocardiography P/V loop model, using brachial arterial pressure and trans-thoracic two-dimensional Doppler echocardiographic data. Each patient's P/V loop was depicted as an irregular pentagon, and a centroid was derived for each loop. The centroid distance (CD) from a reference centroid (derived from 101 healthy control subjects) was computed. This model was prospectively applied to 435 patients who constituted the validation cohort. The study end point was a composite of cardiac death or hospitalization for HF among study patients. RESULTS: In the derivation cohort, CD was threefold greater among patients who experienced adverse events than those who did not. During a follow-up period of 30 months (15-45 months), event rates were 35% (72 of 206 patients) and 12% (29 of 237 patients P < .001), respectively, among patients with CD > 33 mL/mm Hg and those with CD ≤33 mL/mm Hg (prognostic cutoff derived by receiver operating characteristic analysis). Multivariate Cox analysis identified CD as an independent predictor of adverse outcome (hazard ratio, 1.61; 95% CI, 1.03-2.50) independently of left ventricular end-diastolic volume, pulmonary capillary wedge pressure, and left ventricular ejection fraction. These conclusions were confirmed in the validation cohort. CONCLUSIONS: The authors propose a method to create a noninvasive P/V loop and its centroid. These data provide useful pathophysiologic and prognostic information in patients with HF.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Humanos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Prognóstico , Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico por imagem
19.
J Am Soc Echocardiogr ; 36(12): 1266-1289, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37549797

RESUMO

The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax. In addition to reviewing basic cardiac anatomy, the authors take advantage of these correlations with computed tomography and cardiac magnetic resonance imaging to better understand the issue of foreshortening, a common pitfall in transthoracic echocardiography. The authors also highlight an important role that three-dimensional echocardiography can potentially play in the future, especially as advances in image processing permit higher fidelity multiplanar reconstruction images.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia , Humanos , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Pericárdio/diagnóstico por imagem
20.
Cardiovasc Ultrasound ; 10: 48, 2012 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-23199055

RESUMO

BACKGROUND: Echocardiographic left atrial (LA) strain parameters have been associated with atrial fibrillation (AF) in prior studies. Our goal was to determine if strain measures [peak systolic longitudinal strain (LAS) and stiffness index (LASt)] changed after cardioversion (CV); and their relation to AF recurrence. METHODS AND RESULTS: 46 participants with persistent AF and 41 age-matched participants with no AF were recruited. LAS and LASt were measured before and immediately after CV using 2D speckle tracking imaging (2DSI). Maintenance of sinus rhythm was assessed over a 6-month follow up. Mean LAS was lower, and mean LASt higher, in participants with AF before CV as compared to control group (11.9±1.0 vs 35.7±1.7, p<0.01 and 1.31±0.17 vs 0.23±0.01, p<0.01, respectively). There was an increase in the mean LAS immediately after CV (11.9±1.0 vs 15.9±1.3, p<0.01), whereas mean LASt did not change significantly after CV (p=0.62). Although neither LAS nor LASt were independently associated with AF recurrence during the follow-up period, change in LAS after cardioversion (post-CV LAS-pre-CV LAS) was significantly higher among individuals who remained in sinus rhythm when compared to individuals with recurrent AF (3.6±1.1 vs 0.4±0.8, p=0.02). CONCLUSIONS: LAS and LASt differed between participants with and without AF, irrespective of the rhythm at the time of echocardiographic assessment. Baseline LAS and LASt were not associated with AF recurrence. However, change in LAS after CV may be a useful predictor of recurrent arrhythmia.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Ecocardiografia Doppler , Cardioversão Elétrica , Idoso , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recidiva , Resultado do Tratamento
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