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OBJECTIVE: To analyze the function of the left heart in patients with different courses of gout, the independent influencing factors for left heart functional changes, and interactions between left atrial and left ventricular functions. METHODS: Patients with gout (n = 171) were selected; 87 patients with a disease course <10 years were included in Group I, and 84 patients with a disease course ≥10 years were included in Group II. Ninety-four healthy volunteers comprised the control group. RESULTS: The intergroup differences in cardiac strain parameters were statistically significant (p < .05). Moreover, the differences gradually declined with disease progression. Multivariate logistic regression analysis showed that uric acid was an independent predictor of decreased left ventricular global longitudinal strain (LVGLS). Moreover, LVGLS had a positive effect on the left atrial systolic rate (LASr) and the left atrial systolic contraction time (LASct) but no interaction with the left atrial systolic contraction duration (LAScd). CONCLUSION: The course of the disease significantly affected the function of the left heart in gout patients, and uric acid was observed to be an independent predictor of decreased LVGLS in gout patients.
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Gota , Humanos , Masculino , Femenino , Gota/fisiopatología , Gota/complicaciones , Estudios Prospectivos , Persona de Mediana Edad , Ecocardiografía/métodos , Progresión de la Enfermedad , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Ácido Úrico/sangre , Adulto , Función Ventricular Izquierda/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatologíaAsunto(s)
Glucemia , Diabetes Mellitus Tipo 2 , Triglicéridos , Disfunción Ventricular Izquierda , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Triglicéridos/sangre , Glucemia/metabolismo , Masculino , Femenino , Ecocardiografía/métodos , Persona de Mediana EdadRESUMEN
BACKGROUND: The aim of this study was to investigate the clinical implication of incidentally induced atrial fibrillation (AF) during programmed electrical stimulation (PES) in patients with left ventricular systolic dysfunction (≤40%) after an acute myocardial infarction (MI). METHODS: In this study, we included 231 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with left ventricular ejection fraction ≤40% and no prior history of AF. These patients underwent PES 6 weeks post-MI as part of the study protocol. Patients all received an implantable cardiac monitor (ICM) 3-21 days post-MI and were continuously monitored for cardiac arrhythmias for 2 years. Induction of AF was unwanted but reported if this incidentally occurred. RESULTS: A total of 61 patients (26%) developed AF within 2 years of follow-up, in which n = 10 (29%) had incidental AF during PES at baseline. The overall risk of AF was not significantly increased in patients with incidental AF (n = 34) during PES compared to patients without incidental AF (n = 197) (HR 1.6 [0.9-3.0], p = 0.14). The risk of bradyarrhythmia (HR = 0.2 [0.0-1.2], p = 0.07), ventricular arrhythmias (HR = 0.7 [0.1-5.8], p = 0.77), and major cardiovascular events (MACE) (HR 0.5 [0.2-1.7], p = 0.28) was not significantly different in patients with versus without incidental AF. CONCLUSIONS: Incidentally induced AF during PES in post-MI patients with reduced LVEF was not significantly associated with a higher risk of long-term atrial fibrillation, other cardiac arrhythmias, or major cardiac events. TRIAL REGISTRATION: NCT00145119.
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Fibrilación Atrial , Infarto del Miocardio , Disfunción Ventricular Izquierda , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Electrocardiografía Ambulatoria/métodos , Estudios de Seguimiento , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/complicacionesRESUMEN
OBJECTIVES: Cardiac diastolic dysfunction (left ventricular diastolic dysfunction [LVDD]) is a well-known predictor of heart failure. We hypothesized that sarcopenia is independently associated with diastolic dysfunction. We aimed to investigate the association of the most recent consensus definition of sarcopenia with LVDD. METHODS: We included 121 older participants admitted to a cardiology outpatient clinic. We followed the European Working Group on Sarcopenia in Older People 2 definition of confirmed sarcopenia (presence of low muscle mass and low muscle strength). We estimated skeletal muscle mass with bioimpedance analysis and muscle strength by hand grip strength via a Jamar hydraulic hand dynamometer. Skeletal muscle mass was adjusted by body mass index. LVDD was determined by echocardiographic parameters measured per American Society of Echocardiography recommendations. We ran multivariate logistic regression analyses adjusted for well-known risk factors for diastolic dysfunction (i.e., age, sex, obesity, smoking, diabetes mellitus, hypertension, and ischemic heart disease) to detect whether sarcopenia was independently associated with diastolic dysfunction. We gave results in odds ratio (OR) and 95% confidence interval (CI). RESULTS: Mean age was 69.9 ± 5.8 years, and 38.8% of participants were male. Confirmed sarcopenia was detected in 34.7%, and diastolic dysfunction was detected in 19.8%. In univariate analyses, sarcopenia was associated with diastolic dysfunction (OR, 6.7, 95% CI, 2.4-18.9). Regression analyses showed that two parameters, sarcopenia (OR, 7.4, 95% CI, 2.1-26.6, P = 0.002) and obesity (OR, 5.0, 95% CI, 1.03-24.6, P = 0.046), were associated with diastolic dysfunction. CONCLUSIONS: This study revealed sarcopenia to be a new risk factor for diastolic dysfunction, adding to its known risk factors. Future longitudinal studies are needed to clarify the factors underlying their copresence.
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Sarcopenia , Disfunción Ventricular Izquierda , Humanos , Sarcopenia/fisiopatología , Sarcopenia/complicaciones , Sarcopenia/epidemiología , Masculino , Femenino , Anciano , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Factores de Riesgo , Fuerza de la Mano , Diástole , Ecocardiografía/métodos , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Estudios Transversales , Modelos Logísticos , Índice de Masa CorporalRESUMEN
BACKGROUND: Clinical complications of anorexia nervosa (AN) include cardiac structural and functional alterations. Available evidence on impaired myocardial deformation in AN patients without overt systolic dysfunction as assessed by left ventricular ejection fraction (LVEF) is scanty and based on a few studies. The aim of the present meta-analysis was to provide comprehensive and updated information on this issue. METHODS: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to 31 January 2024. Searches were limited to clinical investigations published in English reporting data on left ventricular (LV) mechanics (i.e. global longitudinal strain) in patients with anorexia and controls. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and global longitudinal strain (GLS) was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) by using random-effects models. RESULTS: Five studies including 171 AN and 147 healthy normal-weight individuals were considered for the analysis. Pooled average LVEF values were 63.2â±â0.4% in the healthy control group and 64.6â±â1.0% in the AN group (SMD -0.08â±â0.11, CI: -0.15/0.30, P â=â0.51); the corresponding values of GLS were -20.1â±â0.9% and -20.2â±â0.9% (SMD 0.07â±â0.3, CI: -0.46/0.60, P â=â0.80). Unlike GLS, apical strain (data from three studies) was higher in AN than in controls (-23.1â±â1.8 vs. -21.3â±â1.8; SMD: -0.42â±â0.17, CI: -0.08/-0.76, P â=â0.01). CONCLUSIONS: The results of the present meta-analysis do not support the view that myocardial deformation as assessed by GLS is impaired in patients with AN and preserved LVEF. The role of STE in detecting subclinical cardiac damage in this clinical condition deserves to be evaluated in future studies including regional LV strain.
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Anorexia Nerviosa , Ecocardiografía , Volumen Sistólico , Función Ventricular Izquierda , Anorexia Nerviosa/fisiopatología , Anorexia Nerviosa/complicaciones , Anorexia Nerviosa/diagnóstico por imagen , Humanos , Ecocardiografía/métodos , Femenino , Adulto , Valor Predictivo de las Pruebas , Masculino , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Adulto Joven , Adolescente , Persona de Mediana EdadRESUMEN
BACKGROUND: Type 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD) are both metabolic disorders that negatively impact the cardiovascular system. This study comprehensively analyzed the additive effect of MAFLD on left ventricular function and global strain in T2DM patients by cardiac magnetic resonance (CMR). METHODS: Data of 261 T2DM patients, including 109 with and 152 without MAFLD, as well as 73 matched normal controls from our medical center between June 2015 and March 2022 were retrospectively analyzed. CMR-derived parameters, including LV function and global strain parameters, were compared among different groups. Univariate and multivariate linear regression analyses were conducted to investigate the impact of various factors on LV function and global strain. RESULTS: Our investigation revealed a progressive deterioration in LV functional parameters across three groups: control subjects, T2DM patients without MAFLD, and T2DM patients with MAFLD. Statistically significant increases in left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular mass index (LVMI) were observed, along with decreases in left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI). Among these three groups, significant reductions were also noted in the absolute values of LV global radial, circumferential, and longitudinal peak strains (GRPS, GCPS, and GLPS), as well as in peak systolic (PSSR) and peak diastolic strain rates (PDSR). MAFLD was identified as an independent predictor of LVEF, LVMI, LVGFI, GRPS, GCPS, and GLPS in multivariate linear analysis. Besides, the incidence of late gadolinium enhancement was higher in MAFLD patients than in non-MAFLD patients (50/109 [45.9%] vs. 42/152 [27.6%], p = 0.003). Furthermore, escalating MAFLD severity was associated with a numerical deterioration in both LV function parameters and global strain values. CONCLUSIONS: This study thoroughly compared CMR parameters in T2DM patients with and without MAFLD, uncovering MAFLD's adverse impact on LV function and deformation in T2DM patients. These findings highlight the critical need for early detection and comprehensive management of cardiac function in T2DM patients with MAFLD.
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Diabetes Mellitus Tipo 2 , Imagen por Resonancia Cinemagnética , Valor Predictivo de las Pruebas , Disfunción Ventricular Izquierda , Función Ventricular Izquierda , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Diabetes Mellitus Tipo 2/epidemiología , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Anciano , Factores de Riesgo , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Volumen Sistólico , Adulto , Cardiomiopatías Diabéticas/fisiopatología , Cardiomiopatías Diabéticas/diagnóstico por imagen , Cardiomiopatías Diabéticas/etiología , Fenómenos BiomecánicosRESUMEN
BACKGROUND: Cushing's syndrome (CS) is associated with increased risk for heart failure, which often initially manifests as left ventricular diastolic dysfunction (LVDD). In this study, we aimed to explore the potential risk factors of LVDD in CS by incorporating body composition parameters. METHODS: A retrospective study was conducted on patients diagnosed with endogenous CS no less than 18 years old. The control group consisted of healthy individuals who were matched to CS patients in terms of gender, age, and BMI. LIFEx software (version 7.3) was applied to measure epicardial adipose tissue volume (EATV) on non-contrast chest CT, as well as abdominal adipose tissue and skeletal muscle mass at the first lumbar vertebral level. Echocardiography was used to evaluate left ventricular (LV) diastolic function. Body compositions and clinical data were examined in relation to early LVDD. RESULTS: A total of 86 CS patients and 86 healthy controls were enrolled. EATV was significantly higher in CS patients compared to control subjects (150.33 cm3 [125.67, 189.41] vs 90.55 cm3 [66.80, 119.84], p < 0.001). CS patients had noticeably increased visceral fat but decreased skeletal muscle in comparison to their healthy counterparts. Higher prevalence of LVDD was found in CS patients based on LV diastolic function evaluated by E/A ratio (p < 0.001). EATV was proved to be an independent risk factor for LVDD in CS patients (OR = 1.015, 95%CI 1.003-1.026, p = 0.011). If the cut-point of EATV was set as 139.252 cm3 in CS patients, the diagnostic sensitivity and specificity of LVDD were 84.00% and 55.60%, respectively. CONCLUSION: CS was associated with marked accumulation of EAT and visceral fat, reduced skeletal muscle mass, and increased prevalence of LVDD. EATV was an independent risk factor for LVDD, suggesting the potential role of EAT in the development of LVDD in CS.
This study explored the potential risk factors of LVDD in endogenous CS by incorporating body composition parameters. EATV was identified as an independent risk factor for LVDD. Targeted therapeutic interventions to reduce excessive cortisol-induced EAT accumulation may be promising to mitigate the risk of LVDD development in patients with CS.
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Tejido Adiposo , Síndrome de Cushing , Ecocardiografía , Pericardio , Disfunción Ventricular Izquierda , Humanos , Masculino , Síndrome de Cushing/fisiopatología , Síndrome de Cushing/complicaciones , Síndrome de Cushing/epidemiología , Femenino , Estudios Retrospectivos , Adulto , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/etiología , Pericardio/diagnóstico por imagen , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/fisiopatología , Persona de Mediana Edad , Diástole , Factores de Riesgo , Estudios de Casos y Controles , Tomografía Computarizada por Rayos X , Tejido Adiposo EpicárdicoRESUMEN
BACKGROUND: The adverse prognostic impact of diabetes on hypertrophic cardiomyopathy (HCM) is poorly understood. We sought to explore the underlying mechanisms in terms of structural and functional remodelling in HCM patients with coexisting diabetes (HCM-DM). METHODS: A total of 45 HCM-DM patients were retrospectively included. Isolated HCM controls (HCM patients without diabetes) were matched to HCM-DM patients in terms of maximal wall thickness, age, and gender distribution. Left ventricular (LV) and atrial (LA) performance were evaluated using cardiac magnetic resonance feature tracking strain analyses. The associations between diabetes and LV/LA impairment were investigated by univariable and multivariable linear regression. RESULTS: Compared with the isolated HCM controls, the HCM-DM patients had smaller end-diastolic volume and stroke volume, lower ejection fraction, larger mass/volume ratio and impaired strains in all three directions (all P < 0.05). In terms of the LA parameters, HCM-DM patients presented impaired LA reservoir and conduit strain/strain rate (all P < 0.05). Among all HCM patients, comorbidity with diabetes was independently associated with a low LV ejection fraction (ß = - 6.05, P < 0.001) and impaired global longitudinal strain (ß = 1.40, P = 0.007). Moreover, compared with the isolated HCM controls, HCM-DM patients presented with more myocardial fibrosis according to late gadolinium enhancement, which was an independent predictor of impaired LV global radial strain (ß = - 45.81, P = 0.008), LV global circumferential strain (ß = 18.25, P = 0.003), LA reservoir strain (ß = - 59.20, P < 0.001) and strain rate (ß = - 2.90, P = 0.002). CONCLUSIONS: Diabetes has adverse effects on LV and LA function in HCM patients, which may be important contributors to severe manifestations and outcomes in those patients. The present study strengthened the evidence of the prevention and management of diabetes in HCM patients.
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Función del Atrio Izquierdo , Cardiomiopatía Hipertrófica , Diabetes Mellitus , Imagen por Resonancia Cinemagnética , Valor Predictivo de las Pruebas , Volumen Sistólico , Función Ventricular Izquierda , Remodelación Ventricular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/fisiopatología , Cardiomiopatía Hipertrófica/complicaciones , Estudios Retrospectivos , Anciano , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/diagnóstico , Factores de Riesgo , Adulto , Pronóstico , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Comorbilidad , Remodelación AtrialRESUMEN
BACKGROUND: Septic shock is associated with increases in end-diastolic volume (EDV) and decreases in ejection fraction that reverse within 10 days. Nonsurvivors do not develop EDV increases. The mechanism is unknown. METHODS AND RESULTS: Purpose-bred beagles (n=33) were randomized to receive intrabronchial Staphylococcus aureus or saline. Over 96 hours, cardiac magnetic resonance imaging and echocardiograms were performed. Tissue was obtained at 66 hours. From 0 to 96 hours after bacterial challenge, septic animals versus controls had significantly increased left ventricular wall edema (6%) and wall thinning with loss of mass (15%). On histology, the major finding was nonocclusive microvascular injury with edema in myocytes, the interstitium, and endothelial cells. Edema was associated with significant worsening of biventricular ejection fractions, ventricular-arterial coupling, and circumferential strain. Early during sepsis, (0-24 hours), the EDV decreased; significantly more in nonsurvivors (ie, greater diastolic dysfunction). From 24 to 48 hours, septic animals' biventricular chamber sizes increased; in survivors significantly greater than baseline and nonsurvivors, whose EDVs were not different from baseline. Preload, afterload, or heart rate differences did not explain these differential changes. CONCLUSIONS: The cardiac dysfunction of sepsis is associated with wall edema. In nonsurvivors, at 0 to 24 hours, sepsis induces a more severe diastolic dysfunction, further decreasing chamber size. The loss of left ventricular mass with wall thinning in septic survivors may, in part, explain the EDV increases from 24 to 48 hours because of a potentially reparative process removing damaged wall tissue. Septic cardiomyopathy is most consistent with a nonocclusive microvascular injury resulting in edema causing reversible systolic and diastolic dysfunction with more severe diastolic dysfunction being associated with a decreased EDV and death.
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Modelos Animales de Enfermedad , Choque Séptico , Volumen Sistólico , Animales , Perros , Choque Séptico/fisiopatología , Choque Séptico/complicaciones , Imagen por Resonancia Magnética , Edema Cardíaco/fisiopatología , Edema Cardíaco/patología , Edema Cardíaco/diagnóstico por imagen , Función Ventricular Izquierda , Factores de Tiempo , Humanos , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/fisiopatología , Ecocardiografía , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , MasculinoRESUMEN
Sickle cell disease (SCD) is characterized by chronic anemia and recurrent ischemia-reperfusion episodes, which can lead to high-output heart failure. The impact of SCD on cardiac structure and function remains underinvestigated. We conducted a single-institution retrospective analysis of clinical and echocardiographic data from patients with hemoglobin SS SCD (SCD-SS) between January 2016 and June 2022. Patients with known heart failure, left ventricular (LV) ejection fraction <50%, moderate or severe valvular heart disease, congenital heart disease, established coronary artery disease, diabetes mellitus, hypertension, or coexistent lung disease were excluded. Compared with healthy controls (n = 28), patients with SCD-SS (n = 66) had a significantly higher left atrial (LA) volume index (35.7 vs 23.9 ml/m², p <0.001) and average E/e' (7.4 vs 6.5, p = 0.003) but lower average e' (12.3 vs 13.6 cm/s, p = 0.047) and LA reservoir strain (32.9% vs 42.4%, p <0.001). Patients with SCD-SS had higher LV end-diastolic (132.5 vs 104.1 ml, p <0.001) and LV end-systolic volumes (51.0 vs 43.8 ml, p = 0.017) with reduced LV global longitudinal strain (17.6% vs 20.0%, p <0.001). In addition, patients with SCD-SS showed reduced right ventricular (RV) global longitudinal strain (19.7% vs 22.8%, p <0.001) in the setting of normal RV tricuspid annular plane systolic excursion. Maximal systolic tricuspid regurgitation velocity (231 vs 202 cm/s, p <0.001) and right atrial area (16.6 vs 12.8 cm², p <0.001) were statistically greater in SCD-SS. Hemoglobin and hematocrit negatively correlated with LA volume index, average E/e', LV end-diastolic and LV end-systolic volumes. In conclusion, patients with SCD-SS had notable differences in cardiac chamber size and impaired LV, RV, and LA strain compared with healthy controls. Further investigations are needed to assess the impact of these variables on SCD clinical course and prognosis.
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Anemia de Células Falciformes , Ecocardiografía , Humanos , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/fisiopatología , Masculino , Femenino , Estudios Retrospectivos , Adulto , Ecocardiografía/métodos , Volumen Sistólico/fisiología , Persona de Mediana Edad , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Función Ventricular Izquierda/fisiologíaRESUMEN
BACKGROUND: Recent studies show Silent Myocardial Infarction (SMI) as a quite frequent event. However, regarding severe tertiary care patients that frequently present consequences of Coronary Artery Disease (CAD) and Left Ventricular Dysfunction (LVD), the occurrence of this manifestation is unexpected and its associated factors aren't clear in the literature. AIM: To compare clinical, laboratorial, ventricular and angiographic factors between silent and classical presentation of MI in patients with CAD and LVD. METHODS: Patients with multivessel CAD with over 70 % obstructive lesions and LVD with EF less than 35 % were evaluated for MASS VI trial and later included in the present study. The ventricular function and coronary assessment were measured by echocardiography and SYNTAX score, respectively. The population was stratified in a SMI group and Clinically Manifested Myocardial Infarction (CMMI) group based on MI presentation for a comparison of medical parameters. RESULTS: From 132 patients, 47 (35.6 %) were classified as SMI and 85 (64.4 %) as CMMI. No differences were observed between groups regarding age, sex, diabetes mellitus, SYNTAX score, or collateral circulation. Higher proportion of NYHA II classification, inferior wall MI and lower creatinine clearance were found in SMI group. After multivariate analysis, peripheral diabetic neuropathy (OR = 4.6 [1.1â12.7] p = 0.032) and inferior wall MI (OR = 4.1 [1.5â11.4] p = 0.007) were significantly associated with SMI. CONCLUSION: Peripheral diabetic neuropathy and inferior wall MI were associated with SMI presentation. Overall, associated factors tend to be similar comparing SMI and CMMI, but in the specific population of diabetic patients with chronic neuropathy a special care should be taken.
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Angiografía Coronaria , Insuficiencia Cardíaca , Infarto del Miocardio , Humanos , Femenino , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Estudios de Casos y Controles , Anciano , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Factores de Riesgo , Ecocardiografía , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico por imagenRESUMEN
BACKGROUND AND AIM: Type 2 diabetes mellitus (T2DM) frequently presents subclinical left ventricular systolic dysfunction. The TyG index is a surrogate indicator of insulin resistance and is closely related to heart failure (HF). This study aimed to evaluate subclinical systolic dysfunction in T2DM by combining myocardial work (MW) and the TyG index and to investigate the risk factors for MW. METHODS: This study included 102 diabetic patients and 78 healthy control subjects, and the diabetic group was divided into three subgroups based on the TyG index. LV global longitudinal strain (GLS), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global myocardial work efficiency (GWE) were measured in all subjects. GLS and MW were compared between the diabetic and control groups and between subgroups. Regression models were applied to analyze the risk factors for MW in diabetic patients. RESULTS: GLS, GWI, GCW, and GWE significantly increased, and GWW significantly decreased in the diabetic group (all p < .01). GWI and GCW were significantly lower in the T3 subgroup than in the T1 and T2 subgroups (all p < .05). The TyG index, sex (female), BMI, systolic blood pressure (SBP), and total cholesterol (TC) were independent risk factors for GWI and GCW, and HbA1c was an independent risk factor for GWI. CONCLUSIONS: MW accurately revealed subtle changes in subclinical LV systolic dysfunction in T2DM patients. An elevated TyG index was strongly associated with decreased GWI and GCW. The TyG index, sex (female), BMI, SBP, and TC were independent risk factors for GWI and GCW, and HbA1c was an independent risk factor for GWI.
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Glucemia , Diabetes Mellitus Tipo 2 , Triglicéridos , Disfunción Ventricular Izquierda , Humanos , Masculino , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Persona de Mediana Edad , Triglicéridos/sangre , Glucemia/análisis , Glucemia/metabolismo , Ecocardiografía/métodos , Factores de Riesgo , Sístole , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatologíaRESUMEN
Type 2 diabetes mellitus is one of the most common non-infectious diseases in the world. Among people with type 2 diabetes, patients of the older age group. An in understanding of the early cardiovascular manifestations of diabetes occupies an important place in international research and prevention programs, given that cardiac vascular complications are the cause of death in patients with diabetes. Recent studies evaluating left ventricular diastolic dysfunction as a characteristic predictor of diabetic cardiomyopathy by echocardiography. In accordance with the recommendations for diastolic dysfunction, have shown that the algorithm of the informative algorithm is used to determine left ventricular diastolic dysfunction in patients with prognosis in predicting cardiovascular complications.
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Diabetes Mellitus Tipo 2 , Cardiomiopatías Diabéticas , Diástole , Disfunción Ventricular Izquierda , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico , Cardiomiopatías Diabéticas/fisiopatología , Cardiomiopatías Diabéticas/etiología , Cardiomiopatías Diabéticas/diagnóstico , Diástole/fisiología , Ecocardiografía/métodos , Pronóstico , Función Ventricular Izquierda/fisiología , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagenRESUMEN
Cardiac function is known to play critical role in the pathophysiological progression and ultimate clinical outcome of patients with congenital diaphragmatic hernia (CDH). While often anatomically normal, the fetal and neonatal heart in CDH can suffer from both right and left ventricular dysfunction. Here we explore the abnormal fetal heart, early postnatal right and left ventricular dysfunction, the interplay between cardiac dysfunction and pulmonary hypertension, evaluation and echocardiographic assessment of the heart, and therapeutic strategies for managing and supporting the pathophysiologic heart and CDH. Further, we take a common clinical scenario and provide clinically relevant guidance for the diagnosis and management of this complex process.
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Hernias Diafragmáticas Congénitas , Humanos , Hernias Diafragmáticas Congénitas/diagnóstico , Hernias Diafragmáticas Congénitas/fisiopatología , Hernias Diafragmáticas Congénitas/complicaciones , Hernias Diafragmáticas Congénitas/terapia , Recién Nacido , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico , Ecocardiografía , Disfunción Ventricular Derecha/fisiopatología , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/diagnóstico , Corazón Fetal/diagnóstico por imagen , Corazón Fetal/fisiopatologíaRESUMEN
BACKGROUND AND OBJECTIVES: This study aimed to assess the utility of Doppler echocardiography in evaluating left ventricular diastolic function, and prognosis in patients with systemic lupus erythematosus (SLE). PATIENTS AND METHODS: A total of 286 SLE patients were selected along with 100 age- and gender-matched healthy individuals who underwent physical examinations. Clinical baseline characteristics were collected. Various Doppler echocardiographic parameters were measured and analyzed, including left ventricular posterior wall thickness (LVPWT), interventricular septal diameter (IVSD), left ventricular mass (LVM), LVM index (LVMI), and others. RESULTS: Compared to the control group, SLE patients exhibited significantly higher levels of C-reactive protein and lower levels of complement (C) 3 and C4 (p < .001). Doppler echocardiographic parameters showed significant differences between SLE patients and healthy controls, including increased LVPWT, IVSD, LVM, LVMI, peak A, PWI + Tei, E/e', TDI-Tei, and decreased e' and E/A (p < .001). Subgroup analyses indicated more severe ventricular diastolic dysfunction in patients with higher SLE activity and those who experienced cardiovascular events. Correlation analysis revealed positive associations of PWI + Tei, TDI-Tei, and GLS with SLE activity and cardiovascular events (p < .01). Multivariate logistic regression analysis identified LVMI, PWI + Tei, TDI-Tei, and GLS as significant predictors of cardiovascular events (p < .05). CONCLUSION: Doppler echocardiography is a valuable tool for the early diagnosis of left ventricular diastolic dysfunction in SLE patients. Key echocardiographic parameters, including LVMI, PWI + Tei, TDI-Tei, and GLS, are effective in predicting cardiovascular events, underscoring the importance of comprehensive cardiac function assessments in these patients.
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Ecocardiografía Doppler , Lupus Eritematoso Sistémico , Valor Predictivo de las Pruebas , Disfunción Ventricular Izquierda , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/fisiopatología , Lupus Eritematoso Sistémico/diagnóstico por imagen , Femenino , Masculino , Adulto , Ecocardiografía Doppler/métodos , Persona de Mediana Edad , Estudios de Casos y Controles , Pronóstico , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/diagnóstico por imagen , Proteína C-Reactiva/análisis , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , DiástoleRESUMEN
Systolic dysfunction has been observed following isolated moderate-severe traumatic brain injury (Ims-TBI). However, early risk factors for the development of systolic dysfunction after Ims-TBI and their impact on the prognosis of patients with Ims-TBI have not been thoroughly investigated. A prospective observational study among patients aged 16 to 65 years without cardiac comorbidities who sustained Ims-TBI (Glasgow Coma Scale [GCS] score ≤12) was conducted. Systolic dysfunction was defined as left ventricular ejection fraction <50% or apparent regional wall motion abnormality assessed by transthoracic echocardiography within 24 hours after admission. The primary endpoint was the incidence of systolic dysfunction after Ims-TBI. The secondary endpoint was survival on discharge. Clinical data and outcomes were assessed within 24 hours after admission or during hospitalization. About 23 of 123 patients (18.7%) developed systolic dysfunction after Ims-TBI. Higher admission heart rate (odds ratios [ORs]: 1.05, 95% confidence interval [CI]: 1.02-1.08; Pâ =â .002), lower admission GCS score (OR: 0.77, 95% CI: 0.61-0.96; Pâ =â .022), and higher admission serum high-sensitivity cardiac troponin T (Hs-cTnT) (OR: 1.14, 95% CI: 1.06-1.22; Pâ <â .001) were independently associated with systolic dysfunction among patients with Ims-TBI. A combination of heart rate, GCS score, and serum Hs-cTnT level on admission improved the predictive performance for systolic dysfunction (area under curveâ =â 0.85). Duration of mechanical ventilation, intensive care unit length of stay, and in-hospital mortality of patients with systolic dysfunction was higher than that of patients with normal systolic function (Pâ <â .05). Lower GCS (OR: 0.66, 95% CI: 0.45-0.82; Pâ =â .001), lower admission oxygen saturation (OR: 0.82, 95% CI: 0.69-0.98; Pâ =â .025), and the development of systolic dysfunction (OR: 4.85, 95% CI: 1.36-17.22; Pâ =â .015) were independent risk factors for in-hospital mortality in patients with Ims-TBI. Heart rate, GCS, and serum Hs-cTnT level on admission were independent early risk factors for systolic dysfunction in patients with Ims-TBI. The combination of these 3 parameters can better predict the occurrence of systolic dysfunction.
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Lesiones Traumáticas del Encéfalo , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Factores de Riesgo , Estudios Prospectivos , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/mortalidad , Adulto Joven , Adolescente , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Escala de Coma de Glasgow , Ecocardiografía , Pronóstico , Troponina T/sangre , Frecuencia Cardíaca/fisiología , SístoleRESUMEN
Cardiac relaxation is a complex process that involves various interconnected characteristics and, along with contractile properties, determines stroke volume. Perioperative ischemia-reperfusion injury and left ventricular diastolic dysfunction (DD) are characterized by the left ventricle's inability to receive a sufficient blood volume under adequate preload. Baseline DD and perioperative DD have an impact on postoperative complications, length of hospital stay, and major clinical outcomes in a variety of cardiac pathologies. Several baseline and perioperative factors, such as age, female sex, hypertension, left ventricle hypertrophy, diabetes, and perioperative ischemia-reperfusion injury, contribute to the risk of DD. The recommended diagnostic criteria available in guidelines have not been validated in the perioperative settings and still need clarification. Timely diagnosis of DD might be crucial for effectively treating postoperative low cardiac output syndrome. This implies the need for an individualized approach to fluid infusion strategy, cardiac rate and rhythm control, identification of extrinsic causes, and administration of drugs with lusitropic effects. The purpose of this review is to consolidate scattered information on various aspects of diastolic dysfunction in cardiac surgery and provide readers with well-organized and clinically applicable information.
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Procedimientos Quirúrgicos Cardíacos , Disfunción Ventricular Izquierda , Humanos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , DiástoleRESUMEN
BACKGROUND: The aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in patients with ß-thalassemia major (ß-TM). METHOD: We considered 266 ß-TM patients (134 females, 37.08 ± 11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project and 80 healthy controls (50 females, mean age 39.77 ± 11.29 years). The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, the T2* technique for the assessment of myocardial iron overload, and late gadolinium enhancement (LGE) technique. RESULTS: In comparison to the healthy control group, ß-TM patients showed impaired GLS, GCS, and GRS values. Among ß-TM patients, sex was identified as the sole independent determinant of all LV strain parameters. All LV strain parameters displayed a significant correlation with LV end-diastolic volume index, end-systolic volume index, mass index, and ejection fraction, and with the number of segments exhibiting LGE. Only GLS exhibited a significant correlation with global heart T2* values and the number of segments with T2* < 20 ms. Patients with cardiac complications exhibited significantly impaired GLS compared to those without cardiac complications. CONCLUSION: In patients with ß-TM, GLS, GCS, and GRS were impaired in comparison with control subjects. Among LV strain parameters, only GLS demonstrated a significant association with cardiac iron levels and complications.
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Sobrecarga de Hierro , Imagen por Resonancia Cinemagnética , Talasemia beta , Humanos , Talasemia beta/complicaciones , Talasemia beta/diagnóstico por imagen , Femenino , Masculino , Estudios Transversales , Adulto , Imagen por Resonancia Cinemagnética/métodos , Sobrecarga de Hierro/diagnóstico por imagen , Sobrecarga de Hierro/etiología , Persona de Mediana Edad , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda/fisiología , Hierro/metabolismo , Tensión Longitudinal GlobalRESUMEN
BACKGROUND: We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET). RESULTS: A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue. CONCLUSION: The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
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Puente de Arteria Coronaria , Isquemia Miocárdica , Función Ventricular Izquierda , Humanos , Cardiomiopatías/fisiopatología , Cardiomiopatías/cirugía , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/complicaciones , Ecocardiografía de Estrés/métodos , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/cirugía , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/complicaciones , Miocardio/patología , Supervivencia Tisular , Tomografía Computarizada de Emisión de Fotón Único , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Función Ventricular Izquierda/fisiologíaRESUMEN
BACKGROUND: The link between diabetes mellitus and chronic hepatitis C infection remains well established. It is estimated that up to one third of chronic hepatitis C patients have type II diabetes mellitus. Hepatitis C virus infection is one of the main global health burdens. Sofosbuvir and Daclatasvir are used as effective antiviral inhibitors of hepatitis C virus. The cardiovascular effects of those drugs are not well studied. We used electrocardiography and echocardiography with global longitudinal strain assessment by speckle tracking to detect their effect on cardiac function. METHODS AND RESULTS: One hundred diabetic patients with hepatitis C infection were included in the study. Abdominal ultrasound and laboratory work up were carried out for all participants. Left ventricular systolic and diastolic function were assessed by 2D-echocardiography and global longitudinal strain, before and 3 months after treatment. Results showed significant decrease in global longitudinal strain 3 months after therapy (-21 ± 4 vs. -18 ± 7; P < 0.001) but other echocardiographic findings showed no significant changes. CONCLUSIONS: Sofosbuvir and Daclatasvir were associated with early left ventricular systolic dysfunction as assessed by global longitudinal strain in diabetic patients. More deterioration in left ventricular systolic function was detected among those with Child-Pough class B. Further long-term follow-up may be required.