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- Cameli, Matteo, et al.
(författare)
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Left ventricular twist in clinically stable heart transplantation recipients : a speckle tracking echocardiography study
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 168:1, s. 357-361
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIM: Cavity twist is an integral part of LV function and its pattern in transplanted hearts is not well known. This study aimed at exploring LV twist in clinically stable heart transplant (HT) recipients with no evidence for rejection.METHODS: We studied 32 HT patients (54±24months after HT), 34 other cardiac surgery (CS) patients and compared them with 35 health controls using speckle tracking echocardiography, measuring peak twist angle, time-to-peak twist, and untwist rate.RESULTS: LV twist angle was smaller in the HT group (6.2±3.3°) in comparison with the CS group and controls (13.2±3.5° and 13.1±4.5°, respectively; p<0.0001 for all) and untwist rate was reduced (HT group: -74±30°/s; CS group: -118±43°/s; controls: -116±39°/s; p<0.0001 for all). Time-to-peak twist was not different between groups. Time after HT was the main independent predictor of both LV twist angle and untwist rate (β=0.8, p<0.0001).CONCLUSION: Though clinically stable, LV twist dynamics are significantly impaired in HT recipients, even in comparison with patients who underwent other cardiac surgery.
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- Mondillo, Sergio, et al.
(författare)
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Assessment of left ventricular diastolic events interrelations : An integrated approach.
- 2010
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 145:3, s. 426-431
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Left ventricular (LV) diastolic function represents a complex performance that involves long axis displacement, myocardial lengthening velocities as well as cavity filling. The aim of this study was to assess the various diastolic event interrelations in a group of patients with different degrees of diastolic dysfunction. METHODS: 128 consecutive subjects with various degrees of diastolic impairment were studied by Doppler echocardiography. The amplitude of early diastolic (E(l)) and late diastolic (A(l)) long axis lengthening was measured by M-mode and corresponding myocardial velocities (E(a) and A(a)) by Tissue Doppler. LV filling velocities were also acquired by spectral pulsed wave Doppler. RESULTS: Early diastolic long axis amplitudes and velocities correlated (r=0.73, P<0.0001) as did late diastolic ones (r=0.67, P<0.0001). E(l) of17.3 cm/s/mm had 94.1% sensitivity and 87.4% specificity for predicting an E/E(a) ratio >15, a marker for raised LV filling pressures. E(l)14.2 cm/s/mm were the best criteria to discriminate between normal diastolic function and pseudonormal/restrictive LV filling. CONCLUSION: Diastolic LV components of motion, amplitude and velocities are not independent, neither from each other nor from filling pressures. An integrated approach towards using them all in assessing diastolic function, particularly in patients with raised filling pressure should be of great clinical value.
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- Nistri, Stefano, et al.
(författare)
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Effect of Echocardiographic Grading of Left Ventricular Diastolic Dysfunction by Different Classifications in Primary Care
- 2015
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Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 116:7, s. 1144-1152
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Tidskriftsartikel (refereegranskat)abstract
- The presence of left ventricular (LV) diastolic dysfunction (DD) as characterized by Doppler echocardiography is associated with worse overall mortality both in symptomatic and asymptomatic patients. However, available data on this topic come from referral centers and have been obtained by different, validated algorithms for each single study. Thus, we aimed at determining the feasibility of comprehensive evaluation of LVDD in a primary care outpatient setting and at testing the concordance of different methodological approaches in grading diastolic dysfunction. Eight hundred eighty-five consecutive outpatients, in sinus rhythm, prospectively underwent Doppler echocardiography according to a predetermined protocol. Feasibility of each LV diastolic index and concordance between 3 methods to determine the degree of LVDD, namely the American Society of Echocardiography/European Association of Echocardiography (ASE/EAE) reconunendations, the Olmstead County, and the Canberra Study protocols, were tested. Feasibility of all diastolic indexes was high, ranging from 93% of Valsalva maneuver to 99% for mitral inflow and tissue Doppler parameters. Diastolic function was not classifiable in 6% to 19% of patients. The concordance for LV diastolic dysfunction degree was fair when comparing the classification of the ASE/EAE with those from Olinstead County (kappa = 0.25; reclassification rate 51%) and Canberra Study (kappa = 0.27; reclassffication rate 43.7%), and was good for the comparison betvveen the Olmstead County and Canberra classifications (kappa = 0.68, reclassification rate 27%). In conclusion, feasibility of LV diastolic function measurements is very high and grading diastolic dysfunction is possible in most patients in primary care settings. Substantial differences, however, exist when concordance is tested among 3 documented criteria, resulting in poor concordance of data interpretation and hence patient stratification and clinical management.
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- Setti, Martina, et al.
(författare)
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Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms-A Primary Care Study
- 2020
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Ingår i: Diagnostics (Basel). - : MDPI. - 2075-4418. ; 10:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a'-ratio (LAVi/a') over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a', with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a' emerges as a simple and effective approach to this aim.
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