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- Backman, Christer, et al.
(author)
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Unusual arrhythmogenic myocardial disease
- 2014
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In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:4, s. 195-196
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Journal article (peer-reviewed)
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| 4. |
- Berisha, Gëzim, et al.
(author)
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Impaired left atrial reservoir function in metbolic syndrome predicts symptoms in HFpEF patients
- 2015
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In: International Cardiovascular Forum Journal. - : Barcaray Publishing. - 2410-2636 .- 2409-3424. ; 4, s. 37-42
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Journal article (peer-reviewed)abstract
- Background and Aim. The Metabolic Syndrome (MetS) has been shown to be independently associated with increased risk for incident heart failure (HF) and coronary artery disease. The aim of this study was to investigate the additional effect of MetS on LA dysfunction in a group of patients with HF and preserved ejection fraction (HFpEF) and its relationship with symptoms.Methods. This study included 194 consecutive patients (age 62 ± 9 years) with stable HFpEF. LV dimensions, ejection fraction (EF), mitral annulus peak systolic excursion (MAPSE), myocardial velocities (s’, e’ and a’), LA dimensions and volumes were measured. Total LA emptying fraction (LA EF) was measured by Simpson rule volumes. Based on the NCEP-ATP III criteria, patients were divided into two groups; MetS (n=95) and non-MetS (n=108) and were compared with 34 age and gender matched controls.Results. Age and gender were not different between patients and control neither between MetS and non-Met. LV dimensions, EF and longitudinal function indices were also not different. The MetS patients had higher LV mass index (p=0.038), lower septal and lateral e’ (p=0.003 and p=0.001, respectively) velocities, larger LA minimal volume (p=0.007) and lower LA EF (p<0.001) compared with the non-MetS patients. Age, LA EF and MetS independently predicted the NYHA class.Conclusions. Despite no difference in LV systolic function, patients with HFpEF and MetS have worse LA emptying fraction, compared with HFpEF and non-MetS patients. In addition, LA reservoir function impairment and MetS independently predict patients limiting symptoms, thus add to a better understanding of HFpEF.
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| 5. |
- Caruana, Maryanne, et al.
(author)
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Quality of life in Maltese adults with congenital heart disease: a second look – An APPROACH-IS substudy
- 2017
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In: International Cardiovascular Forum Journal. - : International Cardiovascular Forum Journal. - 2410-2636 .- 2409-3424. ; 12, s. 18-23
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Journal article (peer-reviewed)abstract
- Background: A first quality of life (QOL) study among Maltese adults with congenital heart disease (ACHD) in 2016 found no significant differences when compared to the general population. The aims of the present study were to (1) compare QOL between Maltese and other European ACHD patients and (2) investigate medical predictors (i.e. number of surgical/non-surgical interventions, heart failure, arrhythmias, pacemaker/implantable cardioverter-defibrillator, cardiac hospitalisation during preceding year, follow-up frequency, other medical conditions, mood/anxiety/psychiatric disorders) of QOL in Maltese patients.Methods: Data collected during “Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease–International Study” (APPROACH-IS) was used. QOL was measured using linear analog scale (LAS) and Satisfaction With Life Scale (SWLS). QOL in 109 Maltese and 1510 European participants was compared. Multivariable logistic regression was used to test the predictive value of medical factors on QOL in Maltese patients.Results: There were no significant differences in QOL between the two cohorts [mean LAS Malta 80.51 (95% CI 77.96,83.07) vs. European 79.43 (95% CI 78.65,80.21) (p=0.776); mean SWLS Malta 26.00 (95% CI 24.94,27.06) vs. European 26.26 (95% CI 25.95,26.57) (p=0.288)] and no significant differences when cohorts were divided by gender and age. Only a mood/anxiety/other psychiatric disorder significantly predicted poorer QOL on both scales in Maltese patients (LAS (ß=-.389, p<0.001), SWLS (ß=-.352, p=0.001)). Conclusions: Maltese ACHD patients have a good QOL comparable to that of European counterparts. Mood, anxiety and other psychiatric disorders can negatively impact Maltese patients’ QOL. Better access to clinical psychology services should be ensured.
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| 6. |
- Grönlund, Christer, 1975-, et al.
(author)
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Significant beat-to-beat variability of E/e’ irrespective of respiration
- 2013
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In: International cardiovascular forum. - : Barcaray Publishing. - 2409-3424 .- 2410-2636. ; 1:2, s. 88-89
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Journal article (peer-reviewed)abstract
- The E/e’ ratio is commonly used in Doppler echocardiographic examinations to estimate the pulmonary capillary wedge pressure. The rationale of using this ratio is to combine left ventricular (LV) filling (E) and relaxation (e’) velocities to indirectly assess left atrial pressure. However, the accuracy of this index has recently been questioned, particularly in patients with controlled heart failure. Likewise, the potential beat-to-beat variability of such measurements remains undetermined. The cardiovascular system is subject to several oscillations with the potential of influencing LV function and its intra-cavitary pressures, hence measurements of its filling and relaxation velocities. The aim of this pilot study was to assess the beat-to-beat variability of the E/e’ ratio in one minute long examination in healthy subjects, and patients with various severity of amyloid heart disease. The results show that despite critical application of the standard echocardiographic recording recommendations, E/e’ beat-to-beat variability was 36 % (22 to 50%) in healthy subjects and 17 % (11-26%) in patients, and where the most severe amyloid heart disease had the least variability. Thus, clinical use of a single or few cardiac beats might not necessarily reflect an accurate ratio between the two velocities, and hence casts doubt over their diagnostic value.
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| 7. |
- Hamoudi, Zainab, et al.
(author)
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Comparative assessment of non-invasive imaging in detecting coronary artery disease
- 2014
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In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:5, s. 218-225
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Research review (peer-reviewed)abstract
- Coronary artery disease (CAD) has an important impact on the morbidity and mortality in the West and health service resources worldwide. It is therefore crucial to accurately diagnose CAD early, in an attempt to limit its burden on patients and society, potentially by optimum risk stratification, accurate diagnosis and management. Invasive coronary angiography (ICA) is the conventional gold standard imaging investigation for the coronary circulation and assessment of disease severity. However, it is an invasive procedure and is associated with risks, although rare. In addition, it detects luminal stenosis but not the functional importance of those anatomical lesions. Therefore, a wide variety of non-invasive imaging developed to evaluate the presence and severity of CAD, including anatomical techniques e.g. coronary CT that assesses coronary stenosis, and quantifies coronary calcium, hence the burden of atherosclerotic plaques and functional imaging e.g. stress echocardiography, nuclear imaging by SPECT and PET and stress CMR. Selection of the most appropriate imaging, therefore, is challenging and requires knowledge of patients' pre-test probability and prevalence of disease, their advantages and limitations, cost and availability. This review attempts to provide an overview of the current supporting evidence of the role of non-invasive imaging in diagnosing CAD, in addition to its prognostic value, limitations and advantages.
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| 8. |
- Hellman, Urban
(author)
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Hyaluronan, a beneficial glycosaminoglycan that may affect the phenotype of cardiac hypertrophy : a hypothesis
- 2014
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In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:5, s. 226-229
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Journal article (peer-reviewed)abstract
- Myocardial hypertrophy contribute to ventricular diastolic dysfunction and can lead to heart failure, arrhythmia and evensudden death. It have been shown that during development of hypertrophy the concentration of the glycosaminoglycanhyaluronan increases. The increased concentration correlates to the increased gene expression of fetal and extracellularmatrix genes that is associated with cardiac remodeling.Moreover it has been shown that high molecular weight hyaluronan depolarize the membrane potential of cells.The increase of hyaluronan in cardiac hypertrophy could hypothetically affect the resting membrane potential incardiomyocytes and thus affect the conduction through the heart.Hypothesis. The role of hyaluronan as a molecule adapting the extracellular matrix when the heart is growing could potentiallydevelop to be harmful to cardiomyocyte resting membrane potential and hence contribute to the risk of arrhythmia.
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| 9. |
- Ibrahimi, Pranvera, et al.
(author)
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Global dyssynchrony correlates with compromised left ventricular filling and stroke volume but not with ejection fraction or QRS duration in HFpEF
- 2014
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In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:3, s. 147-151
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Journal article (peer-reviewed)abstract
- Background and Aim: Mechanical global left ventricular (LV) dyssynchrony reflected as prolonged total isovolumic time(t-IVT) has been introduced as a potential mechanism behind compromised stroke volume in heart failure (HF). It has alsobeen shown to be superior to other markers of dyssynchrony in predicting response to cardiac resynchronization therapy(CRT), but its application in HF with preserved ejection fraction (HFpEF) remains unknown. The aim of this study was toassess the role of t-IVT in explaining symptoms in HFpEF.Methods: In 55 symptomatic HFpEF patients (age 60±9 years, NYHA class II-IV; LV EF ≥45%) and 24 age and gendermatched controls, a complete Doppler echocardiographic study was performed including mitral annulus peak systolicexcursion (MAPSE) and myocardial velocities as well as LV filling, outflow tract velocity time integral (VTI) and stroke volumemeasurements. Global LV dyssynchrony was assessed by t-IVT [in s/min; calculated as: 60 - (total ejection time + total fillingtime)], Tei index (t-IVT/ejection time) and pre-ejection time difference between LV and RV.Results: Patients had reduced lateral and septal MAPSE (p=0.009 and p=0.01, respectively) lower lateral and septal s’(p=0.002 and p=0.04, respectively) and e’ (p<0.001, for both) velocities and higher E/e’ ratio (p=0.01) compared to controls.They also had longer t-IVT (p<0.001), higher Tei index (p=0.04), but similar pre-ejection time difference and LVEF to controls.T-IVT correlated with LV filling time (r=0.44, p<0.001), stroke volume (r=-0.41; p=0.002), MAPSE (lateral: r=-0.36, p=0.007 andseptal: r=-0.31; p=0.02), but not with LV mass index, LVEF, E/e’ ratio or QRS duration.Conclusion: Patients with HFpEF have exaggerated global mechanical dyssynchrony shown by prolonged t-IVT, comparedwith healthy age and gender matched controls. The relationship between t-IVT, LV filling and stroke volume suggests anassociation, more important than with ejection fraction or electrical dyssynchrony. These results support the importance ofthe individualistic approach for optimum HFpEF patient management.
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| 10. |
- Ibrahimi, Pranvera, et al.
(author)
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Predictors of exercise capacity in heart failure : combined right ventricular dysfunction and raised left ventricular filling pressures predict limited exercise capacity in heart failure with reduced ejection fraction (HFrEF)
- 2013
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In: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:1, s. 37-42
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Journal article (peer-reviewed)abstract
- Background and Aim: Compromised exercise capacity is a major symptom in patients with heart failure (HF) and reduced left ventricular (LV) ejection fraction (EF). Six-minute walk test (6-MWT) is popular for the objective assessment of exercise capacity in these patients but is largely confined to major heart centres. The aim of this study was to prospectively examine functional parameters that predict 6-MWT in patients with HF and reduced LVEF.Methods: In 111 HF patients (mean age 60±12 years, 56% male), a 6-MWT and an echo-Doppler study were performed in the same day. In addition to conventional ventricular function measurements, global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 – (total ejection time – total filling time)], and Tei index (t-IVT/ejection time). Also, LV and right ventricular function were assessed by mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE, respectively). Based on the 6-MWT distance, patients were divided into 2 groups: Group I: ≤300m and Group II: >300m.Results: The 6-MWT distance correlated with t-IVT and Tei index (r=-0.37, p<0.001, for both), lateral and septal e' velocities (r=0.41, p<0.001, and r=0.46, p<0.001, respectively), E/e' ratio (r=-0.37, p<0.001) and TAPSE (r=0.45, p<0.001), but not with the other clinical or echo parameters. Group I patients had longer t-IVT, lower E/e' ratio, TAPSE and lateral e' (p<0.001 for all) compared with Group II. In multivariate analysis, TAPSE [0.076 (0.017-0.335), p=0.001], E/e' [1.165 (1.017-1.334), p=0.027], t-IVT [1.178 (1.014-1.370), p=0.033] independently predicted poor 6-MWT performance (<300m). Sensitivity and specificity for TAPSE ≤1.9 cm were 66% and 77%, (AUC 0.78, p<0.001); E/e' ≥10.7 were 66% and 62% (AUC 0.67, p=0.002) and t-IVT ≥13 s/min were 64% and 60% (AUC 0.68, p=0.002) in predicting poor 6-MWT. Combined TAPSE and E/e' had a sensitivity of 68% but specificity of 92% in predicting 6-MWT. Respective values for combined TAPSE and t-IVT were 71% and 85%.Conclusion: In patients with HF, the limited exercise capacity assessed by 6-MWT, is multifactorial being related both to the severity of right ventricular systolic dysfunction as well as to raised LV filling pressures and global dyssynchrony.
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