Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.385
ES Eystein Skjolsvik, Øyvind H. Lie, M. Chivulescu, M. Ribe, Aic Anna Isotta Castrini, T. Edvardsen, K. Haugaa
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Norwegian Research Council [203489/030] Department of Cardiology, Research group for genetic cardiac diseases and sudden cardiac death, Oslo University Hospital, Rikshospitalet, Oslo, Norwa Lamin A/C disease is an inheritable cardiomyopathy characterized by conduction abnormalities, ventricular arrhythmias and end stage heart failure with complete age-related penetrance. To assess left ventricular structural and functional progression in patients with lamin A/C cardiomyopathy. We included and followed consecutive lamin A/C genotype positive patients with clinical examination and echocardiography at every visit. We evaluated progression of left- ventricular size and function by mixed model statistics. We included 101 consecutive lamin A/C genotype positive patients (age 44 [29-54] years, 39% probands, 51%female) with 576 echocardiographic exams during 4.9 (IQR 2.5-8.1) years of follow-up. LV ejection fraction (LVEF) declined from 50 ± 12% to 47 ± 13%, p < 0.001 (rate -0.5%/year). LV end diastolic volumes (LVEDV) remained stationary with no significant dilatation in the total population (136 ± 45ml to 138 ± 43ml, p = 0.60), (Figure). In the subgroup of patients >58 years, we observed a decline in LV volumes 148, SE 9 ml to 140, SE 9 ml p < 0.001 (rate -2.7 ml/year) towards end stage heart failure. LVEF deteriorated, while LV size remained unchanged during 4.9 years of follow-up in patients with lamin A/C cardiomyopathy. In patients <58 years, we observed a reduction in LV volumes. These findings represent loss of LV function without the necessary compensatory dilation to preserve stroke volume indicating high risk of decompensated end stage heart failure in lamin A/C. Abstract Figure.
经费来源类型:基金会。主要资金来源:这项工作得到了挪威研究委员会[203489/030]的支持，心脏病和心脏性猝死研究小组，奥斯陆大学医院，Rikshospitalet，奥斯陆，挪威Lamin A/C疾病是一种遗传性心肌病，以传导异常、室性心律失常和终末期心力衰竭为特征，具有完全的年龄相关外显率。评价纤层蛋白A/C型心肌病患者左室结构和功能进展。我们纳入并随访了连续的层粘连蛋白A/C基因型阳性患者，并在每次就诊时进行临床检查和超声心动图检查。我们用混合模型统计评估左心室大小和功能的进展。我们纳入101例连续的纤层蛋白A/C基因型阳性患者(年龄44[29-54]岁，39%为先证，51%为女性)，在4.9 (IQR 2.5-8.1)年的随访期间进行576次超声心动图检查。左室射血分数(LVEF)从50±12%下降到47±13%，p 58年，我们观察到左室容积下降148,SE 9 ml下降到140,SE 9 ml p < 0.001(率-2.7 ml/年)。在纤层蛋白A/C型心肌病患者的4.9年随访期间，LVEF恶化，而左室大小保持不变。在<58岁的患者中，我们观察到左室体积减小。这些结果表明，没有必要的代偿性扩张来保持卒中容量的左室功能丧失，表明在纤层蛋白A/C中失代偿终末期心力衰竭的高风险。抽象的图。
{"title":"Left ventricular systolic function decreases in lamin a/c cardiomyopathy wihout concomitant ventricular dilatation","authors":"ES Eystein Skjolsvik, Øyvind H. Lie, M. Chivulescu, M. Ribe, Aic Anna Isotta Castrini, T. Edvardsen, K. Haugaa","doi":"10.1093/EHJCI/JEAA356.385","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.385","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): This work was supported by the Norwegian Research Council [203489/030]\u0000 \u0000 \u0000 \u0000 Department of Cardiology, Research group for genetic cardiac diseases and sudden cardiac death, Oslo University Hospital, Rikshospitalet, Oslo, Norwa\u0000 \u0000 \u0000 \u0000 Lamin A/C disease is an inheritable cardiomyopathy characterized by conduction abnormalities, ventricular arrhythmias and end stage heart failure with complete age-related penetrance.\u0000 \u0000 \u0000 \u0000 To assess left ventricular structural and functional progression in patients with lamin A/C cardiomyopathy.\u0000 \u0000 \u0000 \u0000 We included and followed consecutive lamin A/C genotype positive patients with clinical examination and echocardiography at every visit. We evaluated progression of left- ventricular size and function by mixed model statistics.\u0000 \u0000 \u0000 \u0000 We included 101 consecutive lamin A/C genotype positive patients (age 44 [29-54] years, 39% probands, 51%female) with 576 echocardiographic exams during 4.9 (IQR 2.5-8.1) years of follow-up. LV ejection fraction (LVEF) declined from 50 ± 12% to 47 ± 13%, p < 0.001 (rate -0.5%/year). LV end diastolic volumes (LVEDV) remained stationary with no significant dilatation in the total population (136 ± 45ml to 138 ± 43ml, p = 0.60), (Figure). In the subgroup of patients >58 years, we observed a decline in LV volumes 148, SE 9 ml to 140, SE 9 ml p < 0.001 (rate -2.7 ml/year) towards end stage heart failure.\u0000 \u0000 \u0000 \u0000 LVEF deteriorated, while LV size remained unchanged during 4.9 years of follow-up in patients with lamin A/C cardiomyopathy. In patients <58 years, we observed a reduction in LV volumes. These findings represent loss of LV function without the necessary compensatory dilation to preserve stroke volume indicating high risk of decompensated end stage heart failure in lamin A/C.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81896366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.364
F. Ricci, L. Ceriello, M. Khanji, G. Dangas, C. Ducci, M. Mauro, A. Fedorowski, M. Zimarino, S. Gallina
Type of funding sources: None. Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance. We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS. Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity. We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance. CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology. Abstract Figure.
{"title":"Prognostic significance of cardiac amyloidosis in patients with aortic stenosis: a systematic review and meta-analysis","authors":"F. Ricci, L. Ceriello, M. Khanji, G. Dangas, C. Ducci, M. Mauro, A. Fedorowski, M. Zimarino, S. Gallina","doi":"10.1093/EHJCI/JEAA356.364","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.364","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance.\u0000 \u0000 \u0000 \u0000 We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS.\u0000 \u0000 \u0000 \u0000 Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity.\u0000 \u0000 \u0000 \u0000 We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance.\u0000 \u0000 \u0000 \u0000 CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82381038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.270
Minna M Kylmälä, S. Syvaranta, R. Halva, R. Orn, H. Rajala, M. Holmström, S. Kivistö, J. Lommi, S. Suihko, V. Uusitalo
Type of funding sources: None. Global longitudinal strain (GLS) by echocardiography is a sensitive method for measuring left ventricular (LV) function, and of better prognostic value in valvular heart disease than ejection fraction (EF). Cardiac magnetic resonance imaging (CMR) is the most accurate method for measuring LV volume and EF, but GLS has not been possible to measure by CMR until recently. This study compares GLS obtained by CMR and echocardiography in patients with severe aortic valve stenosis. Normal values for GLS by CMR are reported as well. GLS was measured in 32 patients with severe aortic valve stenosis with speckle tracking echocardiography, using GE Vivid E95 (n = 15) and Philips EPIQ (n = 17) ultrasound machines, as well as with CMR (Avanto 1.5T FIT, Siemens Medical Solutions). For normal values, GLS was measured by CMR in 9 healthy controls. Endo- and epicardial borders of two, three and four chamber cine images were traced for CMR GLS using dedicated software (Qstrain 2.0, Medis, NL). Both CMR and Vivid E95 measured midmyocardial strain, whereas the EPIQ AutoStrain method measures endomyocardial strain. Absolute values of GLS are reported. Pearson correlation coefficient was calculated and paired Student’s t-test was used for comparisons. A significant correlation (r = 0.45, p = 0.01) was found between echocardiographic and CMR GLS (Figure). GLS by Vivid E95 had a very good correlation with CMR GLS (r = 0.84, p = 0.0001), whereas GLS by Philips EPIQ did not correlate significantly (r = 0.14, p = 0.01). In patients with aortic stenosis and healthy controls, the average GLS by CMR was 18.3 ± 3% and 20.9 ± 2% respectively. The average GLS by CMR was comparable to that obtained by GE Vivid E95 (17.3 ± 4% vs. 17.2 ± 3%, p = 0.92), and higher than by Philips EPIQ (19.2 ± 2% vs. 15.4 ± 2%, p < 0.0001). This study shows that GLS by CMR is feasible and correlates with GLS obtained by echocardiography, especially when quantifying midmyocardial strain. Echocardiographic GLS values based on endomyocardial strain were lower. Patient characteristics Age 75 ± 14 y NYHA 1 1 (3 %) NYHA 2 20 (67 %) NYHA 3 8 (27 %) NYHA 4 1 (3 %) CMR EF 66 ± 8 % AVA 0.7 ± 0.2 cm² NYHA = NYHA class of symptoms, EF = ejection fraction by CMR, AVA = aortic valve area by echocardiography Abstract Figure. GLS by CMR vs. Echocardiography
{"title":"Global longitudinal strain in patients with severe aortic stenosis: a comparison between cardiac magnetic resonance imaging feature tracking and speckle tracking echocardiography","authors":"Minna M Kylmälä, S. Syvaranta, R. Halva, R. Orn, H. Rajala, M. Holmström, S. Kivistö, J. Lommi, S. Suihko, V. Uusitalo","doi":"10.1093/EHJCI/JEAA356.270","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.270","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Global longitudinal strain (GLS) by echocardiography is a sensitive method for measuring left ventricular (LV) function, and of better prognostic value in valvular heart disease than ejection fraction (EF). Cardiac magnetic resonance imaging (CMR) is the most accurate method for measuring LV volume and EF, but GLS has not been possible to measure by CMR until recently.\u0000 \u0000 \u0000 \u0000 This study compares GLS obtained by CMR and echocardiography in patients with severe aortic valve stenosis. Normal values for GLS by CMR are reported as well.\u0000 \u0000 \u0000 \u0000 GLS was measured in 32 patients with severe aortic valve stenosis with speckle tracking echocardiography, using GE Vivid E95 (n = 15) and Philips EPIQ (n = 17) ultrasound machines, as well as with CMR (Avanto 1.5T FIT, Siemens Medical Solutions). For normal values, GLS was measured by CMR in 9 healthy controls. Endo- and epicardial borders of two, three and four chamber cine images were traced for CMR GLS using dedicated software (Qstrain 2.0, Medis, NL). Both CMR and Vivid E95 measured midmyocardial strain, whereas the EPIQ AutoStrain method measures endomyocardial strain. Absolute values of GLS are reported. Pearson correlation coefficient was calculated and paired Student’s t-test was used for comparisons.\u0000 \u0000 \u0000 \u0000 A significant correlation (r = 0.45, p = 0.01) was found between echocardiographic and CMR GLS (Figure). GLS by Vivid E95 had a very good correlation with CMR GLS (r = 0.84, p = 0.0001), whereas GLS by Philips EPIQ did not correlate significantly (r = 0.14, p = 0.01). In patients with aortic stenosis and healthy controls, the average GLS by CMR was 18.3 ± 3% and 20.9 ± 2% respectively. The average GLS by CMR was comparable to that obtained by GE Vivid E95 (17.3 ± 4% vs. 17.2 ± 3%, p = 0.92), and higher than by Philips EPIQ (19.2 ± 2% vs. 15.4 ± 2%, p < 0.0001).\u0000 \u0000 \u0000 \u0000 This study shows that GLS by CMR is feasible and correlates with GLS obtained by echocardiography, especially when quantifying midmyocardial strain. Echocardiographic GLS values based on endomyocardial strain were lower.\u0000 Patient characteristics Age 75 ± 14 y NYHA 1 1 (3 %) NYHA 2 20 (67 %) NYHA 3 8 (27 %) NYHA 4 1 (3 %) CMR EF 66 ± 8 % AVA 0.7 ± 0.2 cm² NYHA = NYHA class of symptoms, EF = ejection fraction by CMR, AVA = aortic valve area by echocardiography Abstract Figure. GLS by CMR vs. Echocardiography\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82675009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.295
A. Seraphim, K. Knott, A. Beirne, J. Augusto, K. Menacho, G. Joy, J. Artico, A. Bhuva, R. Torii, T. Triebel, H. Xue, J. Moon, Daniel A. Jones, P. Kellman, C. Manisty
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Quantitative myocardial perfusion mapping using Cardiac Magnetic Resonance (CMR) imaging is used for evaluation of ischaemia in the context of native vessel coronary disease, but its diagnostic performance in patients with grafts is not well established. Perfusion defects are often detected in these patients, but whether these are a consequence of a technical limitation (delayed contrast arrival from graft conduits) or a true reflection of reduced myocardial blood flow is unclear. 39 patients undergoing stress perfusion CMR with previous coronary artery bypass graft (CABG) surgery, unobstructed left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery on coronary angiography and no CMR evidence of prior LAD infarction were included. Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were evaluated with quantitative perfusion mapping and the factors determining MBF in the LIMA-LAD territory (AHA segments 1,2,7,8,13,14), including the impact of delayed contrast arrival through the LIMA graft were evaluated. In 28 out of 39 cases a myocardial perfusion defect was reported on visual assessment in LIMA-LAD myocardial territory, despite the presence of unobstructed LIMA graft and no LAD infarction. Chronic total occlusion (CTO) of the native LAD was an independent predictor of stress MBF (B=-0.36, p =0.027) and the strongest predictor of MPR (B=-0.55, p 0.005) within the LIMA-LAD myocardial territory after adjusting for age, left ventricular (LV) ejection fraction, and presence of diabetes. CTO of the native LAD was associated with a reduction in stress MBF in the basal myocardial segments (-0.57ml/g/min, p = 0.002) but had no effect on the MBF of apical segments (-0.31ml/g/min, p = 0.084). Increasing the maximum value for allowable arterial delay (TA) of contrast in the quantitative mapping algorithm resulted in a small increase in myocardial blood flow in the LIMA-LAD territory both at stress (0.07 ± 0.08ml/g/min, p < 0.001) and rest (0.06 ± 0.05ml/g/min, p < 0.001). Perfusion defects detected in LIMA-LAD subtended territories are common despite graft patency. These defects are likely to represent genuine reduction in MBF, resulting from native LAD coronary occlusion. Prolonged contrast transit time associated with LIMA grafts results in small underestimation of MBF as measured by quantitative CMR perfusion mapping, but does not account for the degree of MBF reduction seen in these patients. Figure 1. Study patient with unobstructed LIMA to LAD graft and evidence of inducible perfusion defect in LIMA-LAD territories. (A): First pass perfusion CMR imaging. (B): Perfusion mapping showing reduced stress MBF in mid antero-septum (0.85ml/g/min) compared to the apical septum (1.65ml/g/min). (C): Late gadolinium enhancement showing no evidence of previous infarction. (D,E): Coronary angiograph
经费来源类型:基金会。主要资金来源:英国心脏基金会(British Heart Foundation)使用心脏磁共振(CMR)成像定量心肌灌注制图用于评估原发性血管冠状动脉疾病的缺血情况，但其在移植物患者中的诊断性能尚未得到很好的证实。在这些患者中经常发现灌注缺陷，但这是技术限制(移植物导管造影剂到达延迟)的结果还是心肌血流量减少的真实反映尚不清楚。39例患者接受应激灌注CMR，既往冠状动脉旁路移植术(CABG)，冠状动脉造影无阻塞左内乳动脉(LIMA)移植至左前降支(LAD)，无CMR证据既往LAD梗死。通过定量灌注作图评估心肌血流量(MBF)和心肌灌注储备(MPR)，评估影响LIMA- lad区域(AHA段1、2、7、8、13、14)MBF的因素，包括通过LIMA移植物延迟造影剂到达的影响。尽管存在通畅的LIMA移植物和无LAD梗死，39例中有28例在LIMA-LAD心肌区域的视觉评估中报告心肌灌注缺损。在调整年龄、左室射血分数和糖尿病后，原LAD慢性全闭塞(CTO)是应激性MBF的独立预测因子(B=-0.36, p =0.027)，也是LIMA-LAD心肌区域内MPR的最强预测因子(B=-0.55, p 0.005)。原生LAD的CTO与基底节段应激MBF的降低相关(-0.57ml/g/min, p = 0.002)，但对根尖节段的MBF没有影响(-0.31ml/g/min, p = 0.084)。在定量制图算法中增加造反差允许动脉延迟(TA)的最大值，在应激(0.07±0.08ml/g/min, p < 0.001)和休息(0.06±0.05ml/g/min, p < 0.001)时，LIMA-LAD区域的心肌血流量都有小幅增加。尽管移植物通畅，在LIMA-LAD覆盖区域检测到的灌注缺陷是常见的。这些缺陷很可能是由于原LAD冠状动脉闭塞导致的MBF的真正减少。通过定量CMR灌注成像测量，与LIMA移植物相关的造影剂传递时间延长导致MBF的轻微低估，但不能解释这些患者MBF降低的程度。图1所示。研究无阻碍的LIMA-LAD移植患者和LIMA-LAD区域诱导灌注缺陷的证据。(A):第一次灌注CMR成像。(B):灌注图显示，与顶端间隔(1.65ml/g/min)相比，中前间隔(0.85ml/g/min)的应激MBF减少。(C):晚期钆增强未显示既往梗死的证据。(D,E):冠状动脉造影显示LIMA移植物(D)和吻合部位(E)通畅。
{"title":"Use of quantitative myocardial perfusion mapping by CMR for characterisation of ischaemia in patients post coronary artery bypass graft surgery","authors":"A. Seraphim, K. Knott, A. Beirne, J. Augusto, K. Menacho, G. Joy, J. Artico, A. Bhuva, R. Torii, T. Triebel, H. Xue, J. Moon, Daniel A. Jones, P. Kellman, C. Manisty","doi":"10.1093/EHJCI/JEAA356.295","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.295","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): British Heart Foundation\u0000 \u0000 \u0000 \u0000 Quantitative myocardial perfusion mapping using Cardiac Magnetic Resonance (CMR) imaging is used for evaluation of ischaemia in the context of native vessel coronary disease, but its diagnostic performance in patients with grafts is not well established. Perfusion defects are often detected in these patients, but whether these are a consequence of a technical limitation (delayed contrast arrival from graft conduits) or a true reflection of reduced myocardial blood flow is unclear.\u0000 \u0000 \u0000 \u0000 39 patients undergoing stress perfusion CMR with previous coronary artery bypass graft (CABG) surgery, unobstructed left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) artery on coronary angiography and no CMR evidence of prior LAD infarction were included. Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) were evaluated with quantitative perfusion mapping and the factors determining MBF in the LIMA-LAD territory (AHA segments 1,2,7,8,13,14), including the impact of delayed contrast arrival through the LIMA graft were evaluated.\u0000 \u0000 \u0000 \u0000 In 28 out of 39 cases a myocardial perfusion defect was reported on visual assessment in LIMA-LAD myocardial territory, despite the presence of unobstructed LIMA graft and no LAD infarction. Chronic total occlusion (CTO) of the native LAD was an independent predictor of stress MBF (B=-0.36, p =0.027) and the strongest predictor of MPR (B=-0.55, p 0.005) within the LIMA-LAD myocardial territory after adjusting for age, left ventricular (LV) ejection fraction, and presence of diabetes. CTO of the native LAD was associated with a reduction in stress MBF in the basal myocardial segments (-0.57ml/g/min, p = 0.002) but had no effect on the MBF of apical segments (-0.31ml/g/min, p = 0.084). Increasing the maximum value for allowable arterial delay (TA) of contrast in the quantitative mapping algorithm resulted in a small increase in myocardial blood flow in the LIMA-LAD territory both at stress (0.07 ± 0.08ml/g/min, p < 0.001) and rest (0.06 ± 0.05ml/g/min, p < 0.001).\u0000 \u0000 \u0000 \u0000 Perfusion defects detected in LIMA-LAD subtended territories are common despite graft patency. These defects are likely to represent genuine reduction in MBF, resulting from native LAD coronary occlusion. Prolonged contrast transit time associated with LIMA grafts results in small underestimation of MBF as measured by quantitative CMR perfusion mapping, but does not account for the degree of MBF reduction seen in these patients.\u0000 Figure 1. Study patient with unobstructed LIMA to LAD graft and evidence of inducible perfusion defect in LIMA-LAD territories. (A): First pass perfusion CMR imaging. (B): Perfusion mapping showing reduced stress MBF in mid antero-septum (0.85ml/g/min) compared to the apical septum (1.65ml/g/min). (C): Late gadolinium enhancement showing no evidence of previous infarction. (D,E): Coronary angiograph","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89133310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.255
M. Shanmuganathan, A. Barlotti, R. Scarsini, C. Nikolaidou, E. Gara, M. Burrage, D. Terentes-Printzios, R. Kotronias, OxAMI Study Investigators, A. Lucking, R. Choudhury, G. L. Maria, A. Pitcher, K. Channon, V. Ferreira
{"title":"A CMR first strategy in patients with suspected NSTEMI may help identify MINOCA and infarct related artery","authors":"M. Shanmuganathan, A. Barlotti, R. Scarsini, C. Nikolaidou, E. Gara, M. Burrage, D. Terentes-Printzios, R. Kotronias, OxAMI Study Investigators, A. Lucking, R. Choudhury, G. L. Maria, A. Pitcher, K. Channon, V. Ferreira","doi":"10.1093/EHJCI/JEAA356.255","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.255","url":null,"abstract":"","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88799629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.046
D Trifunovic Zamaklar, G. Krljanac, M. Ašanin, L. Savic-Spasic, J. Vratonjic, N. Arnautovic, S. Aleksandric, V. Šulović, L. Čučić, I. Mrdovic
Type of funding sources: None. PREDICT-VT More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM. the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM. in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic. from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001). Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p < 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p < 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153). STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STE
资金来源类型:无。糖尿病(DM)患者更广泛的冠状动脉粥样硬化导致STEMI后较差的临床结果，但有数据表明，DM患者心肌功能受损，即使与心外膜冠状动脉病变严重程度无关，也可能产生不利影响，主要是对DM患者心力衰竭的发展。目的利用斑点跟踪超声心动图分析STEMI患者伴或不伴dm患者pPCI后心肌变形成像的左室和左室功能。在预测- vt研究中，连续307例患者在pPCI后5±2天进行早期超声心动图(pPCI后5±2天)，包括左室和多层左室变形分析，包括纵向(L)、径向(R)和周向(C)应变(S;%)和应变率(SR, 1/sec)，纵向应变(PSS LS)和周向应变(PSS CS)收缩后缩短的LV指数以及LV旋转力学分析。在完成1年随访的242例患者中，48例(20%)患有糖尿病。患有糖尿病的患者年龄较大(60±1.01 vs 57±10;p = 0.067)， SYNTAX评分(18.5±9.2 vs 15.8±9.8,p = 0.118)无显著性升高。然而，糖尿病患者的EF受损更严重(44.2±8.6 vs 49.2±9.8,p = 0.001)， E/A比(0.78±0.33 vs 0.90±0.34);p = 0.036)和MAPSE(1.18±0.32 vs 1.32±0.33;p = 0.001)。所有层的全局LV LS (endo: -13.6±4.0 vs-16.2±4.7;中:-11.9±3.5 vs -14.1±4.1;Epi: -10.4±3.1 vs -12.3±3.6;p < 0.005)，以及纵向收缩SR(-0.71±0.23 vs -0.84±0.24;p = 0.001)和舒张早期SR(0.65±0.26 vs 0.83±0.33,p < 0.001)。DM患者整个左室壁的纵向收缩后缩短更为明显(endo: 21.4±16.1 vs 13.7±13.3,p = 0.005;中期:21.9±16.1 vs 14.3±13.1,p = 0.006;epi: 22.4±16.5 vs 15.3±13.7,p = 0.010)和更高的LV机械弥散度(MDI: 71.3±38.3 vs 59.0±18.9,p = 0.037)。DM患者LA菌株明显受损(18.9±7.7 vs 22.6±10.0,p = 0.011)，舒张早期LA菌株率更严重(-0.73±0.48 vs -1.00±0.58,p = 0.002)。DM患者也有更多的左室整体(15.7±9.1 vs 19.8±10.4,p = 0.013)径向应变、左室整体周向应变，特别是中壁水平(-13.9±4.2 vs -16.0±4.3,p = 0.005)和周向SR E受损(1.25±0.44 vs 1.49±0.46,p = 0.003)。DM患者收缩末期左室心尖旋转受损更严重(4.7±5.1 vs 6.8±5.5,p= 0.022)。1年随访期间，糖尿病患者心力衰竭和全因死亡率更高(46.7% vs 35.2%， p = 0.153)。STEMI合并DM患者的左室收缩和舒张功能受损更严重，无论是传统参数还是先进的回声技术。这些结果可能，至少部分地解释了为什么STEMI后糖尿病患者的预后可能较差，即使没有更复杂的血管造影结果，指出了糖尿病本身心肌功能受损的重要性。
{"title":"Left ventricular and left atrial deformation imaging early after pPCI: does diabetes mellitus make any difference?","authors":"D Trifunovic Zamaklar, G. Krljanac, M. Ašanin, L. Savic-Spasic, J. Vratonjic, N. Arnautovic, S. Aleksandric, V. Šulović, L. Čučić, I. Mrdovic","doi":"10.1093/EHJCI/JEAA356.046","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.046","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 PREDICT-VT\u0000 More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM.\u0000 \u0000 \u0000 \u0000 the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM.\u0000 \u0000 \u0000 \u0000 in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic.\u0000 \u0000 \u0000 \u0000 from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001). Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p < 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p < 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153).\u0000 \u0000 \u0000 \u0000 STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STE","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86409152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.058
Lw Li, Huang, WH Lee, W. Tsai
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Executive Yuan, Taiwan Tricuspid regurgitation (TR) were traditionally classified as primary and secondary TR. Recently a new category of TR was developed and named as idiopathic TR. However, diagnosis and characteristics of idiopathic TR were not consisted. We tried to identify idiopathic TR by a new systemic approach and studied its characteristics. 207 consecutive patients (mean age 71.2 ± 14.7 years, 40.6% male) identified as significant TR (moderate and severe) by echocardiography were recruited. We classified TR by a new systemic approach. The classification process started from identified primary TR, then pacemaker related TR, left heart disease related TR, congenital heart related TR, right ventricular (RV) myopathy, pulmonary hypertension and, finally idiopathic TR step by step. There were 29 (14%) primary TR, 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Mean age of idiopathic TR was 72.9 ± 11.4 years and 39.5% was male which were not different from other groups. Atrial fibrillation was presented highest in patients with pacemaker related TR (77.8%) and left heart disease (55.6%), lowest in primary TR (24.1%) and pulmonary HT (25.9%), and modest in idiopathic TR (44.2%). Among the echocardiographic characteristics of right heart measurements, idiopathic TR had lowest TR maximal velocity (3.0 ± 0.3 m/s), pulmonary (41.2 ± 8.7 mmHg) and right atrium pressure (5.3 ± 0.3 mmHg; all p <0.001). Idiopathic TR had smallest RV wall thickness (4.5 ± 1.4 mm; p = 0.008), tricuspid annulus diameter (3.2 ± 0.7 cm; p = 0.001), and right atrial area (18.9 ± 8.4 cm2; p <0.001). RV function represented as tricuspid annulus velocity S’ (12.8 ± 3.3 cm/s; p = 0.011) and RV fractional area change FAC (42.6 ± 16.0 %; p <0.001) were best in idiopathic TR. RV dysfunction (FAC < 35%) was lowest (14%) in idiopathic TR. Idiopathic TR had better RV function then other types of TR. Idiopathic TR can be regarded as a unique disease category in studying TR.
{"title":"Characteristics of idiopathic tricuspid regurgitation","authors":"Lw Li, Huang, WH Lee, W. Tsai","doi":"10.1093/EHJCI/JEAA356.058","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.058","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Executive Yuan, Taiwan\u0000 \u0000 \u0000 \u0000 Tricuspid regurgitation (TR) were traditionally classified as primary and secondary TR. Recently a new category of TR was developed and named as idiopathic TR. However, diagnosis and characteristics of idiopathic TR were not consisted. We tried to identify idiopathic TR by a new systemic approach and studied its characteristics.\u0000 \u0000 \u0000 \u0000 207 consecutive patients (mean age 71.2 ± 14.7 years, 40.6% male) identified as significant TR (moderate and severe) by echocardiography were recruited. We classified TR by a new systemic approach. The classification process started from identified primary TR, then pacemaker related TR, left heart disease related TR, congenital heart related TR, right ventricular (RV) myopathy, pulmonary hypertension and, finally idiopathic TR step by step.\u0000 \u0000 \u0000 \u0000 There were 29 (14%) primary TR, 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Mean age of idiopathic TR was 72.9 ± 11.4 years and 39.5% was male which were not different from other groups. Atrial fibrillation was presented highest in patients with pacemaker related TR (77.8%) and left heart disease (55.6%), lowest in primary TR (24.1%) and pulmonary HT (25.9%), and modest in idiopathic TR (44.2%). Among the echocardiographic characteristics of right heart measurements, idiopathic TR had lowest TR maximal velocity (3.0 ± 0.3 m/s), pulmonary (41.2 ± 8.7 mmHg) and right atrium pressure (5.3 ± 0.3 mmHg; all p <0.001). Idiopathic TR had smallest RV wall thickness (4.5 ± 1.4 mm; p = 0.008), tricuspid annulus diameter (3.2 ± 0.7 cm; p = 0.001), and right atrial area (18.9 ± 8.4 cm2; p <0.001). RV function represented as tricuspid annulus velocity S’ (12.8 ± 3.3 cm/s; p = 0.011) and RV fractional area change FAC (42.6 ± 16.0 %; p <0.001) were best in idiopathic TR. RV dysfunction (FAC < 35%) was lowest (14%) in idiopathic TR.\u0000 \u0000 \u0000 \u0000 Idiopathic TR had better RV function then other types of TR. Idiopathic TR can be regarded as a unique disease category in studying TR.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78287345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.154
L. Fiorillo, C. Santoro, M. Scalise, V. Capone, L. L. Mura, Mec Mario Enrico Canonico, T. Fedele, O. Casciano, SO Silvia Orefice, F. Luciano, V. Cuomo, R. Esposito
Type of funding sources: None. Critical peripheral artery disease (PAD) is expression of systemic chronic atherosclerosis, it being often associated with cardiovascular events. The assessment of global longitudinal strain (GLS) at rest by speckle tracking echocardiography could be useful to unmask significant coronary artery disease (CAD) in asymptomatic PAD patients. To determine whether resting GLS is able to predict significant coronary artery stenosis in PAD patients selected for peripheral or carotid angiography. One-hundred three clinically relevant PAD patients (M/F = 76/27, age = 66.8 ± 10,2 years, 72 with significant lower limb artery stenosis and 31 with carotid artery stenosis ≥50%), asymptomatic for CAD, underwent standard echo-Doppler exam at rest, comprehensive of GLS analysis, prior peripheral and coronary angiography. Information on cardiovascular (CV) risk factors and comorbidities were collected. Patients with know CAD and previous myocardial infarction, left ventricular (LV) ejection fraction < 50% and inadequate echocardiographic imaging were excluded. According to the results of coronary angiography, patients were divided in two groups: with significant coronary artery stenosis (>50% of obstruction. n = 73) and without significant coronary artery lesions (n = 30). No intergroup difference in the prevalence of CV risk factors and comorbidities was found. Age, body mass index and blood pressure were comparable between the two groups. LV ejection fraction (59.9 ± 4.2% in patients with significant coronary stenosis vs. 60.2 ± 4.7% in those without coronary stenosis, p = 0.75) and wall motion score index (1.02 ± 0.09 vs 1.03 ± 0.09 respectively, p = 0.67) did not differ significantly. Conversely, GLS was lower in patients with significant coronary artery stenosis than in those without (21.6 ± 2.7% vs. 22.8 ± 2%, p < 0.02) (Figure 1). This difference remained significant comparing the carotid subgroup with coronary stenosis vs. those without (p < 0.05) whereas it did not achieve the statistical significance in patients with lower limb artery lesions (p = 0.42). In PAD patients, GLS at rest shoes the capability in identifying patients at higher probability of significant coronary artery stenosis. This involves in particular patients with carotid artery stenosis. GLS might be helpful to select patients who need to extend the peripheral angiographic evaluation to the coronary tree.
{"title":"Global longitudinal strain at rest predicts significant coronary artery stenosis in patients with peripheral arterial disease","authors":"L. Fiorillo, C. Santoro, M. Scalise, V. Capone, L. L. Mura, Mec Mario Enrico Canonico, T. Fedele, O. Casciano, SO Silvia Orefice, F. Luciano, V. Cuomo, R. Esposito","doi":"10.1093/EHJCI/JEAA356.154","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.154","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Critical peripheral artery disease (PAD) is expression of systemic chronic atherosclerosis, it being often associated with cardiovascular events. The assessment of global longitudinal strain (GLS) at rest by speckle tracking echocardiography could be useful to unmask significant coronary artery disease (CAD) in asymptomatic PAD patients.\u0000 \u0000 \u0000 \u0000 To determine whether resting GLS is able to predict significant coronary artery stenosis in PAD patients selected for peripheral or carotid angiography.\u0000 \u0000 \u0000 \u0000 One-hundred three clinically relevant PAD patients (M/F = 76/27, age = 66.8 ± 10,2 years, 72 with significant lower limb artery stenosis and 31 with carotid artery stenosis ≥50%), asymptomatic for CAD, underwent standard echo-Doppler exam at rest, comprehensive of GLS analysis, prior peripheral and coronary angiography. Information on cardiovascular (CV) risk factors and comorbidities were collected. Patients with know CAD and previous myocardial infarction, left ventricular (LV) ejection fraction < 50% and inadequate echocardiographic imaging were excluded. According to the results of coronary angiography, patients were divided in two groups: with significant coronary artery stenosis (>50% of obstruction. n = 73) and without significant coronary artery lesions (n = 30).\u0000 \u0000 \u0000 \u0000 No intergroup difference in the prevalence of CV risk factors and comorbidities was found. Age, body mass index and blood pressure were comparable between the two groups. LV ejection fraction (59.9 ± 4.2% in patients with significant coronary stenosis vs. 60.2 ± 4.7% in those without coronary stenosis, p = 0.75) and wall motion score index (1.02 ± 0.09 vs 1.03 ± 0.09 respectively, p = 0.67) did not differ significantly. Conversely, GLS was lower in patients with significant coronary artery stenosis than in those without (21.6 ± 2.7% vs. 22.8 ± 2%, p < 0.02) (Figure 1). This difference remained significant comparing the carotid subgroup with coronary stenosis vs. those without (p < 0.05) whereas it did not achieve the statistical significance in patients with lower limb artery lesions (p = 0.42).\u0000 \u0000 \u0000 \u0000 In PAD patients, GLS at rest shoes the capability in identifying patients at higher probability of significant coronary artery stenosis. This involves in particular patients with carotid artery stenosis. GLS might be helpful to select patients who need to extend the peripheral angiographic evaluation to the coronary tree.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91302321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.432
A. Marques, A. Briosa, A. R. Pereira, S. Alegria, J. Santos, I. Rangel, I. João, H. Pereira
Type of funding sources: None. on behalf of the investigators of the Portuguese Registry of Acute Coronary Syndromes The CHA2DS2-VASc score is used in clinical practice to stratify the risk of stroke in patients (pts) with atrial fibrillation (AF). Its usefulness in the population of pts with acute myocardial infarction without AF is not well known. To investigate whether CHA2DS2-VASc predicts ischemic stroke and death during hospital stay in pts with acute myocardial infarction without known AF. To determine independent predictors of ischemic stroke in this population. A multicentre, retrospective study was performed during 01/10/2010-04/09/2019 period, and included all pts admitted due to acute myocardial infarction. Pts with previous AF, AF rhythm in the electrocardiogram at admission or AF during hospital stay were excluded. Statistical analysis with Kaplan-Mayer and Cox regression was applied. Of 29851 pts admitted with acute myocardial infarction, were included in our study 19218 pts (74% male, mean age of 65 ± 14 years). During hospital stay, 78 (0.4%) pts had an ischemic stroke and 462 (2.4%) pts died. The event-free survival analysis showed significant differences according to the CHA2DS2-VASc score at admission (log rank test p = 0.015 for ischemic stroke; log rank test p < 0.001 for in-hospital mortality). (Figure) The CHA2DS2-VASc score demonstrated a good predictive accuracy for in-hospital mortality (area under the ROC curve 0.69; 95% CI 0.67-0.72; p < 0.001). The area under the ROC curve indicates that the CHA2DS2-VASc score performed modestly for ischemic stroke (0.62; 95% CI 0.56-0.68; p < 0.001). In univariate analysis, the factors that were positively associated with ischemic stroke during hospital stay were CHA2DS2-VASc, absence of previous therapy with statin, time between cardiac symptoms and hospital admission, absence of chest pain, Killip-Kimball class, cardiorespiratory arrest, complete left ventricular block and left ventricle ejection fraction <50% (p < 0.05). After multivariate analysis, CHA2DS2-VASc≥3 (HR 2.25; 95% CI 1.37-3.71; p = 0.001), absence of chest pain (HR 3.17; CI 1.44-6.14, p < 0.001) and previous therapy with statin (HR 0.39; 95% CI 0.22-0.67; p = 0.001) were independent predictors of ischemic stroke. Among patients with acute myocardial infarction without known atrial fibrillation, the CHA2DS2-VASc score was associated with risk of ischemic stroke and death during hospital stay. This score may be useful for estimating the risk of stroke and in-hospital mortality in these population without known atrial fibrillation. Abstract Figure.
资金来源类型:无。我代表葡萄牙急性冠状动脉综合征登记处的研究人员，CHA2DS2-VASc评分在临床实践中用于对房颤(AF)患者的卒中风险进行分层。它在无房颤的急性心肌梗死患者中的有用性尚不清楚。研究CHA2DS2-VASc是否能预测无房颤的急性心肌梗死患者住院期间缺血性卒中和死亡。确定该人群缺血性卒中的独立预测因子。在2010年10月1日至2019年9月4日期间进行了一项多中心回顾性研究，包括所有因急性心肌梗死入院的患者。排除既往房颤、入院时心电图房颤节律或住院期间房颤的患者。统计学分析采用Kaplan-Mayer和Cox回归。29851例急性心肌梗死患者纳入我们的研究，其中19218例(74%为男性，平均年龄65±14岁)。住院期间，78例(0.4%)患者发生缺血性卒中，462例(2.4%)患者死亡。入院时CHA2DS2-VASc评分的无事件生存分析显示差异有统计学意义(缺血性卒中的log rank检验p = 0.015;住院死亡率的Log rank检验p < 0.001)。(图)CHA2DS2-VASc评分对院内死亡率具有较好的预测准确性(ROC曲线下面积0.69;95% ci 0.67-0.72;p < 0.001)。ROC曲线下面积显示CHA2DS2-VASc评分对缺血性脑卒中表现一般(0.62;95% ci 0.56-0.68;p < 0.001)。在单因素分析中，住院期间缺血性卒中的正相关因素为CHA2DS2-VASc、既往未接受他汀类药物治疗、心脏症状至入院时间、无胸痛、killipp - kimball分级、心肺骤停、完全左室传导阻滞和左室射血分数<50% (p < 0.05)。多因素分析后，CHA2DS2-VASc≥3 (HR 2.25;95% ci 1.37-3.71;p = 0.001)，无胸痛(HR 3.17;CI 1.44-6.14, p < 0.001)和既往他汀类药物治疗(HR 0.39;95% ci 0.22-0.67;P = 0.001)是缺血性脑卒中的独立预测因子。在无房颤的急性心肌梗死患者中，CHA2DS2-VASc评分与住院期间缺血性卒中和死亡的风险相关。该评分可用于估计这些没有房颤的人群的卒中风险和住院死亡率。抽象的图。
{"title":"Assessment of the CHA2DS2-VASc score in predicting ischemic stroke and death in patients with acute myocardial infarction without atrial fibrillation","authors":"A. Marques, A. Briosa, A. R. Pereira, S. Alegria, J. Santos, I. Rangel, I. João, H. Pereira","doi":"10.1093/EHJCI/JEAA356.432","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.432","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 on behalf of the investigators of the Portuguese Registry of Acute Coronary Syndromes\u0000 \u0000 \u0000 \u0000 The CHA2DS2-VASc score is used in clinical practice to stratify the risk of stroke in patients (pts) with atrial fibrillation (AF). Its usefulness in the population of pts with acute myocardial infarction without AF is not well known.\u0000 \u0000 \u0000 \u0000 To investigate whether CHA2DS2-VASc predicts ischemic stroke and death during hospital stay in pts with acute myocardial infarction without known AF. To determine independent predictors of ischemic stroke in this population.\u0000 \u0000 \u0000 \u0000 A multicentre, retrospective study was performed during 01/10/2010-04/09/2019 period, and included all pts admitted due to acute myocardial infarction. Pts with previous AF, AF rhythm in the electrocardiogram at admission or AF during hospital stay were excluded. Statistical analysis with Kaplan-Mayer and Cox regression was applied.\u0000 \u0000 \u0000 \u0000 Of 29851 pts admitted with acute myocardial infarction, were included in our study 19218 pts (74% male, mean age of 65 ± 14 years). \u0000 During hospital stay, 78 (0.4%) pts had an ischemic stroke and 462 (2.4%) pts died. \u0000 The event-free survival analysis showed significant differences according to the CHA2DS2-VASc score at admission (log rank test p = 0.015 for ischemic stroke; log rank test p < 0.001 for in-hospital mortality). (Figure) \u0000 The CHA2DS2-VASc score demonstrated a good predictive accuracy for in-hospital mortality (area under the ROC curve 0.69; 95% CI 0.67-0.72; p < 0.001). The area under the ROC curve indicates that the CHA2DS2-VASc score performed modestly for ischemic stroke (0.62; 95% CI 0.56-0.68; p < 0.001). \u0000 In univariate analysis, the factors that were positively associated with ischemic stroke during hospital stay were CHA2DS2-VASc, absence of previous therapy with statin, time between cardiac symptoms and hospital admission, absence of chest pain, Killip-Kimball class, cardiorespiratory arrest, complete left ventricular block and left ventricle ejection fraction <50% (p < 0.05). \u0000 After multivariate analysis, CHA2DS2-VASc≥3 (HR 2.25; 95% CI 1.37-3.71; p = 0.001), absence of chest pain (HR 3.17; CI 1.44-6.14, p < 0.001) and previous therapy with statin (HR 0.39; 95% CI 0.22-0.67; p = 0.001) were independent predictors of ischemic stroke.\u0000 \u0000 \u0000 \u0000 Among patients with acute myocardial infarction without known atrial fibrillation, the CHA2DS2-VASc score was associated with risk of ischemic stroke and death during hospital stay. This score may be useful for estimating the risk of stroke and in-hospital mortality in these population without known atrial fibrillation.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87584542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.246
E. Perdreau, Z. Jalal, R. Walton, M. Sigler, H. Cochet, J. Naulin, B. Quesson, O. Bernus, J. Thambo
Type of funding sources: Other. Main funding source(s): National Research Agency (ANR) French Federation of Cardiology : “Aide à la recherche par équipe 2018, Cardiopathies de l’enfant” After percutaneous implantation of an atrial septal defect (ASD) occluder device, a complex healing process leads to the device coverage within several months. However, an unexplained incomplete device coverage is at risk of complications such as thrombosis or infectious endocarditis. The aim of the study was to assess the device coverage process of ASD occluder devices in a chronic sheep model using micro-CT technology. After percutaneous creation of an ASD by catheterization, 8 ewes (mean age 5.4 ± 0.7 yo and mean weight 55.6 ± 7.9 kg) were implanted with a 16-mm Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) and were followed for 1 month (N = 3) and 3 months (N =5). After heart explantation, a iodine contrast agent was used to enhance the tissue signal. The device coverage was then assessed by micro-CT and the results were compared to histology, used as the gold standard for healing evaluation. The micro-CT image resolution was 41.7 µm. Reconstruction was performed in 2D and 3D with Amira® software, allowing to obtain images that were exploited by a code to measure the surface for each disk of the analyzed devices. Histological study was performed after resin embedding and Richardson blue staining was used. The pathologist was blinded to the duration of animals’ follow-up and micro-CT results. ASD creation and device closure was successful in 100% animals without complications. Following heart explantation, macroscopic assessment of devices showed that the coverage was complete for the left-side disk regardless of the duration of the follow-up and variable for the right-side disk, depending of the protrusion of this disk. 2D and 3D micro-CT analysis allowed an accurate evaluation of device coverage of each disk and was overall well correlated to histology slices (cf Figure). Surface calculation from micro-CT images showed that the median surface of coverage was 93 ± 8% for the left-side disk and 55 ± 31% for the right-side disk. This preliminary study made the proof of concept that micro-CT is a reliable tool to assess the coverage of intra-cardiac occluders in vitro. The translation to clinical practice is challenging but would allow an individual follow-up, to avoid thrombotic or infective complications. Abstract Figure.
资金来源类型:其他。主要资金来源:国家研究机构(ANR)法国心脏病学联合会:“Aide la recherche par quipe 2018, Cardiopathies de l 'enfant”经皮植入房间隔缺损(ASD)闭塞器后，一个复杂的愈合过程导致该装置在几个月内覆盖。然而，不明原因的器械覆盖不全有并发症的风险，如血栓形成或感染性心内膜炎。本研究的目的是利用micro-CT技术评估慢性绵羊模型中ASD封堵器装置的覆盖过程。经皮置管造ASD后，8只母羊(平均年龄5.4±0.7岁，平均体重55.6±7.9 kg)植入16毫米镍封闭ASD- r封堵器(PFM medical, Cologne, Germany)，随访1个月(N = 3)和3个月(N =5)。心脏移植后，使用碘造影剂增强组织信号。然后通过micro-CT评估装置覆盖范围，并将结果与组织学进行比较，作为评估愈合的金标准。显微ct图像分辨率为41.7µm。使用Amira®软件在2D和3D中进行重建，允许通过代码获得图像，以测量分析设备的每个磁盘的表面。树脂包埋，理查德森蓝染色后进行组织学研究。病理学家对动物随访时间和显微ct结果不知情。ASD的产生和装置闭合100%成功，无并发症。心脏外植后，对装置的宏观评估显示，无论随访时间长短，左侧椎间盘的覆盖都是完整的，而右侧椎间盘的覆盖则是可变的，这取决于该椎间盘的突出程度。二维和三维微ct分析可以准确评估每个磁盘的设备覆盖范围，并且总体上与组织学切片具有良好的相关性(参见图)。显微ct图像的表面计算显示，左侧椎间盘的中位覆盖面为93±8%，右侧椎间盘的中位覆盖面为55±31%。这项初步研究证明了micro-CT是评估体外心脏内封堵器覆盖范围的可靠工具。转化为临床实践是具有挑战性的，但将允许个人随访，以避免血栓性或感染性并发症。抽象的图。
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