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1
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Edenfield KM, Dillon MC, Clugston JR. COVID myocarditis in a collegiate athlete: Timeline and return to play. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 34:100323. [PMID: 38510953 PMCID: PMC10946044 DOI: 10.1016/j.ahjo.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 03/22/2024]
Abstract
Background Studies in collegiate athletes have demonstrated a prevalence of cardiac involvement between 0.5 and 3 % after SARS-CoV-2 infection. When post-COVID cardiac involvement occurs in athletes, the ideal return to play timeline and many possible long-term sequela or complications are unknown. Case summary A 20 yo female collegiate athlete tested positive for SARS-CoV-2 and underwent routine cardiac screening prior to her return to play (RTP). Evaluation demonstrated an elevated high-sensitivity troponin-I and an ECG showed some mild T wave changes. She had a normal transthoracic echocardiogram, and her Cardiac magnetic imaging (CMR) met Lake Louise Criteria for acute myocarditis. She was diagnosed with acute myocarditis and restricted from sports. CMR was repeated at 3.5 months after normalization of troponin I HS and demonstrated continued active inflammation. She continued to be restricted from exertion. A third CMR was obtained at 6.5 months and showed resolution of active inflammation but a small area of fibrosis, and the remainder of her cardiac testing was normal. She was allowed to slowly progress back into sport and returned to competition at 9 months and successfully completed her season. Discussion CMR is not typically repeated prior to RTP after a diagnosis of myocarditis in athletes, but in this case, repeat CMR at 3.5 months initially demonstrated continued active inflammation, and a second repeat CMR at 6.5 months demonstrated abnormal cardiac fibrosis. This may suggest utility in repeating CMR and raises questions about possible long-term implications of cardiac fibrosis once the acute inflammation of myocarditis has resolved.
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Affiliation(s)
- Katherine M. Edenfield
- University of Florida, Community Health and Family Medicine, Gainesville, FL, United States of America
| | - Michael C. Dillon
- The Cardiac and Vascular Institute, Gainesville, FL, United States of America
| | - James R. Clugston
- University of Florida, Community Health and Family Medicine, Gainesville, FL, United States of America
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2
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D’Andrea A, Sperlongano S, Russo V, D’Ascenzi F, Benfari G, Renon F, Palermi S, Ilardi F, Giallauria F, Limongelli G, Bossone E. The Role of Multimodality Imaging in Athlete's Heart Diagnosis: Current Status and Future Directions. J Clin Med 2021; 10:5126. [PMID: 34768646 PMCID: PMC8584488 DOI: 10.3390/jcm10215126] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022] Open
Abstract
"Athlete's heart" is a spectrum of morphological and functional changes which occur in the heart of people who practice physical activity. When athlete's heart occurs with its most marked expression, it may overlap with a differential diagnosis with certain structural cardiac diseases, including cardiomyopathies, valvular diseases, aortopathies, myocarditis, and coronary artery anomalies. Identifying the underlying cardiac is essential to reduce the potential for sudden cardiac death. For this purpose, a spectrum of imaging modalities, including rest and exercise stress echocardiography, speckle tracking echocardiography, cardiac magnetic resonance, computed tomography, and nuclear scintigraphy, can be undertaken. The objective of this review article is to provide to the clinician a practical step-by-step approach, aiming at distinguishing between extreme physiology and structural cardiac disease during the athlete's cardiovascular evaluation.
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Affiliation(s)
- Antonello D’Andrea
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.); (F.R.); (G.L.)
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy;
| | - Simona Sperlongano
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.); (F.R.); (G.L.)
| | - Vincenzo Russo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.); (F.R.); (G.L.)
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy;
| | - Giovanni Benfari
- Department of Cardiology, Section of Medicine, University of Verona, 37129 Verona, Italy;
| | - Francesca Renon
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.); (F.R.); (G.L.)
| | - Stefano Palermi
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy;
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy;
| | - Giuseppe Limongelli
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.); (F.R.); (G.L.)
| | - Eduardo Bossone
- Cardiology Division, Department of Internal Medicine, A. Cardarelli Hospital, 80131 Naples, Italy;
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3
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Haland TF, Edvardsen T. The role of echocardiography in management of hypertrophic cardiomyopathy. J Echocardiogr 2019; 18:77-85. [PMID: 31858431 PMCID: PMC7244607 DOI: 10.1007/s12574-019-00454-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common non-ischemic cardiomyopathy, characterized by increased left ventricular wall thickness. Echocardiographic studies are essential for establishing the diagnosis, evaluating the extent of disease, and risk stratification. Echocardiography is also recommended in regular screening of the genotype-positive relatives. Two-dimensional, M-mode, and Doppler echocardiography are standard modalities in HCM diagnosis. Newer echocardiographic techniques as tissue Doppler, strain, and three-dimensional echocardiography are now widely used and can reveal subtle changes in the HCM patients. Echocardiography has given us a better understanding of the disease. In this review, we briefly profile the echocardiographic management of HCM in a clinical perspective.
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Affiliation(s)
- Trine F Haland
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, PO Box 4950, 0424, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, PO Box 4950, 0424, Oslo, Norway. .,University of Oslo, Oslo, Norway. .,European Association of Cardiovascular Imaging, Sophia Antipolis, France.
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4
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Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, D'Andrea A, D'Ascenzi F, Di Paolo FM, Edvardsen T, Gati S, Galderisi M, Heidbuchel H, Nchimi A, Nieman K, Papadakis M, Pisicchio C, Schmied C, Popescu BA, Habib G, Grobbee D, Lancellotti P. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J 2019; 39:1949-1969. [PMID: 29029207 DOI: 10.1093/eurheartj/ehx532] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/23/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Stefano Caselli
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Jeroen J Bax
- Departmentt of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fernando M Di Paolo
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Thor Edvardsen
- Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Hein Heidbuchel
- Jessa Hospital, Hasselt University and Heart Center Hasselt, Hasselt, Belgium
| | | | - Koen Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cataldo Pisicchio
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Bogdan A Popescu
- Institute of Cardiovascular Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Gilbert Habib
- Department of Cardiology, Hôpital La Timone, Marseille, France
| | - Diederick Grobbee
- Department of Epidemiology, University Medical Center, Utrecht, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, Belgium
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5
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Popa-Fotea NM, Micheu MM, Bataila V, Scafa-Udriste A, Dorobantu L, Scarlatescu AI, Zamfir D, Stoian M, Onciul S, Dorobantu M. Exploring the Continuum of Hypertrophic Cardiomyopathy-From DNA to Clinical Expression. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:299. [PMID: 31234582 PMCID: PMC6630598 DOI: 10.3390/medicina55060299] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022]
Abstract
The concepts underlying hypertrophic cardiomyopathy (HCM) pathogenesis have evolved greatly over the last 60 years since the pioneering work of the British pathologist Donald Teare, presenting the autopsy findings of "asymmetric hypertrophy of the heart in young adults". Advances in human genome analysis and cardiac imaging techniques have enriched our understanding of the complex architecture of the malady and shaped the way we perceive the illness continuum. Presently, HCM is acknowledged as "a disease of the sarcomere", where the relationship between genotype and phenotype is not straightforward but subject to various genetic and nongenetic influences. The focus of this review is to discuss key aspects related to molecular mechanisms and imaging aspects that have prompted genotype-phenotype correlations, which will hopefully empower patient-tailored health interventions.
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Affiliation(s)
- Nicoleta Monica Popa-Fotea
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Vlad Bataila
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Alexandru Scafa-Udriste
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
| | - Lucian Dorobantu
- Cardiomyopathy Center, Monza Hospital, Tony Bulandra Street 27, 021968 Bucharest, Romania.
| | - Alina Ioana Scarlatescu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Diana Zamfir
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Monica Stoian
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Sebastian Onciul
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
| | - Maria Dorobantu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
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6
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Radmilovic J, D'Andrea A, D'Amato A, Tagliamonte E, Sperlongano S, Riegler L, Scarafile R, Forni A, Muscogiuri G, Pontone G, Galderisi M, Russo MG. Echocardiography in Athletes in Primary Prevention of Sudden Death. J Cardiovasc Echogr 2019; 29:139-148. [PMID: 32089993 PMCID: PMC7011488 DOI: 10.4103/jcecho.jcecho_26_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Echocardiography is a noninvasive imaging technique useful to provide clinical data regarding physiological adaptations of athlete's heart. Echocardiographic characteristics may be helpful for the clinicians to identify structural cardiac disease, responsible of sudden death during sport activities. The application of echocardiography in preparticipation screening might be essential: it shows high sensitivity and specificity for identification of structural cardiac disease and it is the first-line imagining technique for primary prevention of SCD in athletes. Moreover, new echocardiographic techniques distinguish extreme sport cardiac remodeling from beginning state of cardiomyopathy, as hypertrophic or dilated cardiomyopathy and arrhythmogenic right ventricle dysplasia. The aim of this paper is to review the scientific literature and the clinical knowledge about athlete's heart and main structural heart disease and to describe the rule of echocardiography in primary prevention of SCD in athletes.
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Affiliation(s)
- Juri Radmilovic
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Andrea D'Amato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Simona Sperlongano
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Alberto Forni
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Gianluca Pontone
- Department of Radiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
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7
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Tsioufis C. "Hearts that strain": Distinguishing athlete's heart from hypertensive disease in the echo lab and beyond. Hellenic J Cardiol 2018; 59:189-191. [PMID: 29964160 DOI: 10.1016/j.hjc.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 01/20/2023] Open
Abstract
Individuals with hypertension that engage in regular exercise comprise a special patient group that needs a careful approach to differentiate hypertensive cardiac damage from physiologic cardiac adaptations. Echocardiography is the diagnostic modality of choice in such cases. Hypertensive left ventricular hypertrophy is expected to resemble isometric exercise-associated hypertrophy in some but not all cases. On the other side, the hearts of regularly exercising individuals are expected to be normal or present with a variable mix of increased end-diastolic volume and increased wall thickness. It is therefore important to clearly document the type, frequency and duration of exercise performed. Diastolic dysfunction even without hypertrophy is often the first and only presentation in hypertension. On the contrary, diastolic function in athletes may be enhanced in order to maintain a stroke volume in high heart rates. Novel imaging techniques such as global longitudinal strain are helpful to identify subclinical systolic dysfunction that is inconsistent with athletic cardiac changes.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
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8
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Tower-Rader A, Betancor J, Lever HM, Desai MY. A Comprehensive Review of Stress Testing in Hypertrophic Cardiomyopathy: Assessment of Functional Capacity, Identification of Prognostic Indicators, and Detection of Coronary Artery Disease. J Am Soc Echocardiogr 2017; 30:829-844. [DOI: 10.1016/j.echo.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Indexed: 01/17/2023]
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9
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Abstract
Athletic heart syndrome refers to the physiological and morphological changes that occur in a human heart after repetitive strenuous physical exercise. Examples of exercise-induced changes in the heart include increases in heart cavity dimensions, augmentation of cardiac output, and increases in heart muscle mass. These cardiac adaptations vary based on the type of exercise performed and are often referred to as sport-specific cardiac remodeling. The hemodynamic effects of endurance and strength training exercise lead to these adaptations. Any abnormalities in chamber dilatation and left ventricular function usually normalize with cessation of exercise. Athletic heart syndrome is rare and should be differentiated from pathologic conditions such as hypertrophic cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia when assessing a patient for athletic heart syndrome. This paper describes specific adaptations that occur in athletic heart syndrome and tools to distinguish between healthy alterations versus underlying pathology.
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Affiliation(s)
- Asaad A Khan
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lucy Safi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Malissa Wood
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Choudhury L, Rigolin VH, Bonow RO. Integrated Imaging in Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 119:328-339. [PMID: 27816114 DOI: 10.1016/j.amjcard.2016.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/27/2022]
Abstract
Hypertrophic cardiomyopathy (HC) has a very heterogeneous clinical spectrum and lends itself to multimodality imaging for evaluation and management. This review addresses clinical applications of cardiac imaging in patients with HC. Integrating various techniques of echocardiography and cardiac magnetic resonance (CMR) is discussed in the clinical context such as diagnosis, evaluation, management, risk stratification, and family screening of patients with HC. The utility of periprocedural imaging techniques is highlighted for guiding surgical and transcatheter septal reduction procedures. More limited roles of invasive or computed tomography coronary angiography are discussed for patients with HC with chest pain and risk factors for coronary artery disease. Nuclear techniques although available for decades play a more limited role in contemporary routine management but may assist in risk assessment. Newer CMR and echo imaging techniques are discussed in their emerging roles for further characterization of patients with HC and family members with prospects of preclinical diagnosis. The strengths of the different imaging modalities are presented as well as a flow diagram summarizing integrated imaging in this disease. In conclusion, integrated imaging using the various imaging techniques predominantly echocardiography and CMR based on the clinical picture plays an essential role in the management of patients with HC.
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11
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Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy. Heart Vessels 2016; 32:591-599. [PMID: 27757525 DOI: 10.1007/s00380-016-0906-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 10/14/2016] [Indexed: 01/19/2023]
Abstract
We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular (LV) myocardial contraction pattern in patients with hypertrophic cardiomyopathy (HCM), and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension (HT). From global strain and strain-rate curves in the longitudinal and circumferential directions, the time from mitral valve closure to the peak strains (T-LS and T-CS, respectively) and the peak systolic strain rates (T-LSSR and T-CSSR, respectively) were measured in 34 patients with HCM, 30 patients with HT, and 25 control subjects. The systolic strain-rate waveform was classified into 3 patterns ("V", "W", and "√" pattern). In the HCM group, T-LS was prolonged, but T-LSSR was shortened; consequently, T-LSSR/T-LS ratio was distinctly lower than in the HT and control groups. The "√" pattern of longitudinal strain-rate waveform was more frequently seen in the HCM group (74 %) than in the control (4 %) and HT (20 %) groups. Similar but less distinct results were obtained in the circumferential direction. To differentiate HCM from HT, the sensitivity and specificity of the T-LSSR/T-LS ratio <0.34 and the "√"-shaped longitudinal strain-rate waveform were 85 and 63 %, and 74 and 80 %, respectively. In conclusion, in patients with HCM, a reduced T-LSSR/T-LS ratio and a characteristic "√"-shaped waveform of LV systolic strain rate was seen, especially in the longitudinal direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT.
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12
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Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 16:353. [PMID: 25681828 DOI: 10.1093/ehjci/jeu323] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
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MESH Headings
- Adult
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Cardiac Imaging Techniques/methods
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
- Cardiomegaly/diagnosis
- Cardiomegaly, Exercise-Induced
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Hypertrophic/diagnosis
- Consensus
- Contrast Media
- Death, Sudden, Cardiac/prevention & control
- Echocardiography, Stress/methods
- Electrocardiography
- European Union
- Gadolinium
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Magnetic Resonance Imaging, Cine
- Predictive Value of Tests
- Sensitivity and Specificity
- Societies, Medical
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed/methods
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13
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Abstract
Professional and amateur athletic training can cause tremendous overload of the cardiovascular system and thus become a trigger of serious and often fatal cardiac events in athletes with a previously undetected underlying cardiovascular disease. Therefore, every athlete should undergo a specialized diagnostic and qualification screening before a training program is prescribed or continued. However, it is still an unresolved issue which of the accessible diagnostic tools should be routinely applied in order to increase the safety of extreme physical training and reduce the risk of sudden cardiac death. Pre-participation athlete evaluation including a standard electrocardiogram (ECG), physical examination, and familial history of cardiovascular diseases is important, but does not always guarantee high diagnostic accuracy. Hence, the aim of this review article is to discuss the controversy over the usefulness of ECG for the detection of cardiovascular diseases in athletes as well as the views on athlete screening methods in Europe and the USA. Differential diagnostic options and screening schemes are also described in particular groups of athletes in reference to their age, cardiovascular risk factors, as well as intensity and type of sport discipline.
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Affiliation(s)
- R Skalik
- Department of Physiology, Medical University of Wroclaw, T. Chalubinskiego ST 10, 50-368, Wroclaw, Poland,
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14
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Sampaio F, Pimenta J. Left ventricular function assessment in cirrhosis: Current methods and future directions. World J Gastroenterol 2016; 22:112-125. [PMID: 26755864 PMCID: PMC4698479 DOI: 10.3748/wjg.v22.i1.112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/29/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future.
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15
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Hersi A, Giannoccaro JP, Howarth A, Exner D, Weeks S, Eitel I, Herman RC, Duff H, Ritchie D, Mcrae M, Sheldon R. Statin Induced Regression of Cardiomyopathy Trial: A Randomized, Placebo-controlled Double-blind Trial. Heart Views 2016; 17:129-135. [PMID: 28400935 PMCID: PMC5363087 DOI: 10.4103/1995-705x.201784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM), characterized by a thickened, fibrotic myocardium, remains the most common cause of sudden cardiac death in young adults. Based on animal and clinical data, we hypothesized that atorvastatin would induce left ventricular (LV) mass regression. Methods: Statin Induced Regression of Cardiomyopathy Trial (SIRCAT) was a randomized, placebo-controlled study. The primary endpoint was change in LV mass measured by cardiac magnetic resonance imaging 12 months after treatment with once-daily atorvastatin 80 mg or placebo. A key secondary endpoint was diastolic dysfunction measured echocardiographically by transmitral flow velocities. SIRCAT is registered with www.clinicaltrials.gov (NCT00317967). Results: Of 222 screened patients, 22 were randomized evenly to atorvastatin and placebo. The mean age was 47 ± 10 years, and 15 (68%) were male. All subjects completed the protocol. At baseline, LV masses were 197 ± 76 g and 205 ± 82 g in the placebo and atorvastatin groups, respectively. After 12 months treatment, the LV masses in the placebo and atorvastatin groups were 196 ± 80 versus 206 ± 92 g (P = 0.80), respectively. Echocardiographic indices were not different in the two groups at baseline. After 12 months, diastolic dysfunction as assessed using transmitral flow velocities E/E', A/A', and peak systolic mitral velocity showed no benefit from atorvastatin. Conclusions: In patients with HCM, atorvastatin did not cause LV mass regression or improvements in LV diastolic function.
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Affiliation(s)
- Ahmad Hersi
- Department of Cardiac Sciences, King Saud University Medical City, College of Medicine, Riyadh, Kingdom of Saudi Arabia
| | - J Peter Giannoccaro
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Howarth
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Derek Exner
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Weeks
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Ingo Eitel
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - R Cameron Herman
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Henry Duff
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Debbie Ritchie
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Maureen Mcrae
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Robert Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institue of Alberta, University of Calgary, Calgary, Alberta, Canada
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D'Andrea A, Bossone E, Radmilovic J, Caso P, Calabrò R, Russo MG, Galderisi M. The role of new echocardiographic techniques in athlete's heart. F1000Res 2015; 4:289. [PMID: 26664708 PMCID: PMC4654447 DOI: 10.12688/f1000research.6745.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 01/15/2023] Open
Abstract
'Athlete's heart' is a common term for the various adaptive changes induced by intensive exercise. Exercise causes alterations of the heart in hemodynamic response to the increased systemic and pulmonary demand during exercise. The understanding of these adaptations is of high importance, since they may overlap with those caused by pathological conditions. Cardiac imaging assessment of the athlete's heart should begin with a complete echocardiographic examination. In recent years classical echocardiographic surveys have been joined by new developments: tissue Doppler imaging, strain rate echocardiography, and real-time 3-dimensional echocardiography. This review paper focuses on the importance of these new echocardiographic techniques in delineating the morphological characteristics and functional properties of the athlete's heart.
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Affiliation(s)
- Antonello D'Andrea
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | | | - Juri Radmilovic
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | - Pio Caso
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | - Raffaele Calabrò
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, 80138, Italy
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17
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Sampaio F, Lamata P, Bettencourt N, Alt SC, Ferreira N, Kowallick JT, Pimenta J, Kutty S, Fraga J, Steinmetz M, Bettencourt P, Gama V, Schuster A. Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy. J Cardiovasc Magn Reson 2015; 17:61. [PMID: 26187817 PMCID: PMC4506630 DOI: 10.1186/s12968-015-0157-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/22/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver cirrhosis has been shown to affect cardiac performance. However cardiac dysfunction may only be revealed under stress conditions. The value of non-invasive stress tests in diagnosing cirrhotic cardiomyopathy is unclear. We sought to investigate the response to pharmacological stimulation with dobutamine in patients with cirrhosis using cardiovascular magnetic resonance. METHODS Thirty-six patients and eight controls were scanned using a 1.5 T scanner (Siemens Symphony TIM; Siemens, Erlangen, Germany). Conventional volumetric and feature tracking analysis using dedicated software (CMR42; Circle Cardiovascular Imaging Inc, Calgary, Canada and Diogenes MRI; Tomtec; Germany, respectively) were performed at rest and during low to intermediate dose dobutamine stress. RESULTS Whilst volumetry based parameters were similar between patients and controls at rest, patients had a smaller increase in cardiac output during stress (p = 0.015). Ejection fraction increase was impaired in patients during 10 μg/kg/min dobutamine as compared to controls (6.9 % vs. 16.5 %, p = 0.007), but not with 20 μg/kg/min (12.1 % vs. 17.6 %, p = 0.12). This was paralleled by an impaired improvement in circumferential strain with low dose (median increase of 14.4 % vs. 30.9 %, p = 0.03), but not with intermediate dose dobutamine (median increase of 29.4 % vs. 33.9 %, p = 0.54). There was an impaired longitudinal strain increase in patients as compared to controls during low (median increase of 6.6 % vs 28.6 %, p < 0.001) and intermediate dose dobutamine (median increase of 2.6%vs, 12.6 % p = 0.016). Radial strain response to dobutamine was similar in patients and controls (p > 0.05). CONCLUSION Cirrhotic cardiomyopathy is characterized by an impaired cardiac pharmacological response that can be detected with magnetic resonance myocardial stress testing. Deformation analysis parameters may be more sensitive in identifying abnormalities in inotropic response to stress than conventional methods.
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MESH Headings
- Aged
- Cardiomyopathies/diagnosis
- Cardiomyopathies/etiology
- Cardiomyopathies/physiopathology
- Cardiotonic Agents/administration & dosage
- Case-Control Studies
- Dobutamine/administration & dosage
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Liver Cirrhosis/complications
- Liver Cirrhosis/diagnosis
- Magnetic Resonance Imaging, Cine/methods
- Male
- Middle Aged
- Myocardial Contraction
- Observer Variation
- Predictive Value of Tests
- Reproducibility of Results
- Software
- Stroke Volume
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Francisco Sampaio
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal.
- University of Porto Medical School, Porto, Portugal.
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, Kings College London, St. Thomas' Hospital, London, UK.
| | - Nuno Bettencourt
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal.
- University of Porto Medical School, Porto, Portugal.
| | - Sophie Charlotte Alt
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University, Göttingen, Germany.
| | - Nuno Ferreira
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal.
| | - Johannes Tammo Kowallick
- Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), Göttingen, Germany.
| | - Joana Pimenta
- University of Porto Medical School, Porto, Portugal.
| | - Shelby Kutty
- University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA.
| | - José Fraga
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Espinho, Portugal.
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), Göttingen, Germany.
| | | | - Vasco Gama
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal.
| | - Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, Kings College London, St. Thomas' Hospital, London, UK.
- DZHK (German Centre for Cardiovascular Research), Göttingen, Germany.
- Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.
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18
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Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, Bettencourt P, Fraga J, Gama V. Systolic and diastolic dysfunction in cirrhosis: a tissue-Doppler and speckle tracking echocardiography study. Liver Int 2013; 33:1158-65. [PMID: 23617332 DOI: 10.1111/liv.12187] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/18/2013] [Accepted: 04/01/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Cardiac dysfunction has been described in patients with cirrhosis. Conventional echocardiographic methods are frequently unable to detect abnormalities at rest and have limitations. We aimed to evaluate cardiac function in cirrhosis patients assessing: (i) left ventricular systolic function using speckle-tracking imaging; (ii) diastolic function using a tissue-Doppler based algorithm and comparing it with previously proposed definition of diastolic dysfunction (DD). METHODS We included 109 hospitalized and ambulatory patients with cirrhosis and 18 healthy controls. Detailed echocardiographic evaluation was performed including tissue-Doppler and speckle-tracking analysis. RESULTS Peak systolic longitudinal strain (PLS) was lower in patients [-19.99% (-21.88 to -18.71) vs -22.02% (-23.10 to -21.18), P = 0.003]. Ejection fraction was similar in patients and controls [64% (59-67) vs 61% (60-65), P = 0.42)]. Based on mitral-flow pattern, DD was present in 44 patients (40.4%). Patients without DD had higher cardiac output compared with those with DD [6.4 L/min (5.4-7.2) vs 5.6 L/min (4.6-6.8), P = 0.02]. Using a tissue-Doppler based definition, the prevalence of DD was 16.5%. No differences in haemodynamic variables were found in patients with and without this definition of DD. The agreement between the two definitions of DD was weak (kappa = 0.24, P = 0.003). Echocardiographic abnormalities in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies. CONCLUSIONS Patients with cirrhosis have systolic and diastolic cardiac dysfunction at rest. Newer echocardiographic techniques may identify patients with functional impairment more accurately than conventional methods, which are more influenced by flow conditions.
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Affiliation(s)
- Francisco Sampaio
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Espinho, Portugal.
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19
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Seo HS, Cho YH, Choi JH, Suh J, Lee NH, Lim OK. The Association of Left Ventricular Hypertrophy with Intraventricular Dyssynchrony at Rest and during Exercise in Hypertensive Patients. J Cardiovasc Ultrasound 2012; 20:174-80. [PMID: 23346286 PMCID: PMC3542510 DOI: 10.4250/jcu.2012.20.4.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 11/24/2022] Open
Abstract
Background Impaired exercise tolerance with dyspnea is common in hypertensive patients and this may be due to the exaggeration of nonuniform ventricular activation during exercise. So we want to evaluate the effect of left ventricular hypertrophy (LVH) on systolic intraventricular dyssynchrony during exercise. Methods A total of 85 patients with hypertension who having exertional dyspnea and 30 control individuals were enrolled. Exercise stress echocardiography was performed using a symptom limited, multistage supine bicycle test. To evaluate the dyssynchrony of left ventricular (LV), we calculated the standard deviation (SD) of the averaged time-to-peak systolic velocity (TPs-SD, ms) of 12 middle and basal LV segments obtained from the three standard apical views at rest and peak exercise. Results There was no significant difference in systolic blood pressure (BP) and heart rate between the two groups. TPs-SD was significantly higher in patients with LVH at rest (31.5 ± 12.1 vs. 22.0 ± 12.6 ms, p = 0.002) with exaggeration of the degree at peak exercise (39.0 ± 11.9 vs. 24.6 ± 13.3 ms, p < 0.001). Multiple regression analysis showed LV mass index was independently associated with LV dyssynchrony at peak exercise (β = 0.515, p = 0.001) when controlled for age, sex, and systolic BP at peak exercise. Conclusion Intraventricular systolic dyssynchrony during exercise is significantly associated with the degree of LVH in hypertensive patients.
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Affiliation(s)
- Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea
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20
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Abstract
Early investigations in the late 1890s and early 1900s documented cardiac enlargement in athletes with above-normal exercise capacity and no evidence of cardiovascular disease. Such findings have been reported for more than a century and continue to intrigue scientists and clinicians. It is well recognized that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. This process, termed exercise-induced cardiac remodeling (EICR), is characterized by structural cardiac changes including left ventricular hypertrophy with sport-specific geometry (eccentric vs concentric). Associated alterations in both systolic and diastolic functions are emerging as recognized components of EICR. The increasing popularity of recreational exercise and competitive athletics has led to a growing number of individuals exhibiting these findings in routine clinical practice. This review will provide an overview of EICR in athletes.
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21
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22
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Usefulness of two-dimensional and speckle tracking echocardiography in "Gray Zone" left ventricular hypertrophy to differentiate professional football player's heart from hypertrophic cardiomyopathy. Am J Cardiol 2011; 108:1322-6. [PMID: 21855830 DOI: 10.1016/j.amjcard.2011.06.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 12/21/2022]
Abstract
Distinguishing the pathologic hypertrophy of hypertrophic cardiomyopathy (HC) from the physiologic hypertrophy of professional football players (PFP) can be challenging when septal wall thickness falls within a "gray zone" between 12 and 16 mm. It was hypothesized that 2-dimensional and speckle-tracking strain (ε) echocardiography could differentiate the hearts of PFPs from those of patients with HC with similar wall thicknesses. Sixty-six subjects, including 28 professional American football players and 21 patients with HC, with septal wall thicknesses of 12 to 16 mm, along with 17 normal controls, were studied using 2-dimensional echocardiography. Echocardiographic parameters, including modified relative wall thickness (RWT; septal wall thickness + posterior wall thickness/left ventricular end-diastolic diameter) and early diastolic annular tissue velocity (e'), were measured. Two-dimensional ε was analyzed by speckle tracking to measure endocardial and epicardial longitudinal ε and circumferential ε and radial cardiac ε. Septal wall thickness was higher in patients with HC than in PFPs (14.7 ± 1.1 vs 12.9 ± 0.9 mm, respectively, p <0.001), while posterior wall thickness showed no difference. RWT was larger in patients with HC than in PFPs (0.68 ± 0.10 vs 0.48 ± 0.06, p <0.001). Longitudinal endocardial ε and radial cardiac ε were significantly higher in PFPs than in patients with HC, while circumferential endocardial ε was no different. RWT was the parameter that most accurately differentiated PFPs from patients with HC. An RWT cut point of 0.6 differentiated PFPs from patients with HC, with an area under the curve of 0.97. In conclusion, a 2-dimensional echocardiographic measure of RWT (septal wall + posterior wall thickness/left ventricular end-diastolic dimension) accurately differentiated PFPs' hearts from those of patients with HC when septal wall thickness was in the gray zone of 12 to 16 mm. Two-dimensional strain analysis identifies variations in myocardial deformation between PFPs and patients with HC with gray-zone hypertrophy.
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23
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Carro A, Carro F, del Valle ME. [The "athlete's heart": structure, function and differential diagnosis]. Med Clin (Barc) 2011; 137:509-12. [PMID: 21185574 DOI: 10.1016/j.medcli.2010.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/05/2010] [Accepted: 10/14/2010] [Indexed: 11/29/2022]
Abstract
Long-term, intense sport activity induces morphologic and functional adaptations on cardiovascular system. The magnitude of these changes is determined by various factors, creating a specific condition: the "Athlete's Heart" (AH). It is important to distinguish this entity from other cardiomyopathies, taking into account that the differential diagnosis can be challenging. There has been an increase in the number of people practicing sports, which goes in parallel with the increase in the prevalence of AH. However, the proportion of asymptomatic subjects affected by cardiovascular diseases taking part on competitive sports, is also growing. We revise the main characteristics of AH, as well as the key points to distinguish AH from pathologic conditions. A delicate characterization as AH or cardiomyopathy would help to settle appropriate measures to lower the risk of sports-related sudden cardiac death.
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Affiliation(s)
- Amelia Carro
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain.
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24
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Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:167-205. [PMID: 21385887 DOI: 10.1093/ejechocard/jer021] [Citation(s) in RCA: 703] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment. Several such techniques have emerged over the past decades to address the issue of reader's experience and inter-measurement variability in interpretation. Some were widely embraced by echocardiographers around the world and became part of the clinical routine, whereas others remained limited to research and exploration of new clinical applications. Two such techniques have dominated the research arena of echocardiography: (1) Doppler-based tissue velocity measurements, frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements. Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated back- scatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses, briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.
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25
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Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011; 24:277-313. [PMID: 21338865 DOI: 10.1016/j.echo.2011.01.015] [Citation(s) in RCA: 893] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment.Several such technique shave emerged over the past decades to address the issue of reader's experience and inter measurement variability in interpretation.Some were widely embraced by echocardiographers around the world and became part of the clinical routine,whereas others remained limited to research and exploration of new clinical applications.Two such techniques have dominated the research arena of echocardiography: (1) Doppler based tissue velocity measurements,frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements.Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated backscatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses,briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.
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26
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Affiliation(s)
- Aaron L. Baggish
- From the Division of Cardiology, Massachusetts General Hospital, Boston
| | - Malissa J. Wood
- From the Division of Cardiology, Massachusetts General Hospital, Boston
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27
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Santos JLF, Salemi VMC, Picard MH, Mady C, Coelho OR. Subclinical regional left ventricular dysfunction in obese patients with and without hypertension or hypertrophy. Obesity (Silver Spring) 2011; 19:1296-303. [PMID: 20966911 DOI: 10.1038/oby.2010.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the impact of obesity on the abnormalities of systolic and diastolic regional left ventricular (LV) function in patients with or without hypertension or hypertrophy, and without heart failure. We studied 120 individuals divided into 6 groups of 20 patients (42 ± 6 years, 60 females) using standard and pulsed-wave tissue Doppler imaging (TDI) echocardiography, and heterogeneity index (HI): nonobese (I: no hypertension, no hypertrophy, control group; II: hypertension, no hypertrophy; III: hypertension and hypertrophy) and obese (IV: no hypertension, no hypertrophy; V: hypertension, no hypertrophy; VI: hypertension and hypertrophy). The criterion for obesity was BMI ≥30 kg/m2, for hypertension was blood pressure ≥ 140/90 mm Hg, for hypertrophy in nonobese was LV mass/body surface area (BSA) >134 g/m(2) (men) and >110 mg/m2 (women), and in obese was LV mass/height(2.7) >50 (men) and >40 (women). Obese groups had normal LV ejection fraction compared with nonobese groups, but decreased longitudinal and radial systolic myocardial peak velocities (S'), and early diastolic myocardial peak velocity (E'). Also, a great variability of E' and late diastolic myocardial peak velocity (A') from the longitudinal basal region was observed in obese groups (E'basal nonobese: 11 ± 7 vs. obese 19 ± 11, P < 0.001, A'basal nonobese: 7 ± 4 vs. obese 11 ± 7, P < 0.001). Our findings were more evident when comparing groups IV with V and VI, with the latter having concentric hypertrophy and obvious segmental systolic and diastolic dysfunctions. Subclinical myocardial alterations and increased variability of the velocities were observed in obese groups, especially with hypertension and hypertrophy, reflecting impaired regional LV relaxation, segmental atrial, and systolic dysfunctions.
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Affiliation(s)
- José L F Santos
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas UNICAMP, São Paulo, Brazil
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28
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Wilson MG, Chatard JC, Carre F, Hamilton B, Whyte GP, Sharma S, Chalabi H. Prevalence of electrocardiographic abnormalities in West-Asian and African male athletes. Br J Sports Med 2011; 46:341-7. [PMID: 21596717 PMCID: PMC3329226 DOI: 10.1136/bjsm.2010.082743] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate the electrocardiographic (ECG) characteristics of West-Asian, black and Caucasian male athletes competing in Qatar using the 2010 recommendations for 12-lead ECG interpretation by the European Society of Cardiology (ESC). Design Cardiovascular screening with resting 12-lead ECG analysis of 1220 national level athletes (800 West-Asian, 300 black and 120 Caucasian) and 135 West-Asian controls was performed. Results Ten per cent of athletes presented with ‘uncommon’ ECG findings. Black African descent was an independent predictor of ‘uncommon’ ECG changes when compared with West-Asian and Caucasian athletes (p<0.001). Black athletes also demonstrated a significantly greater prevalence of lateral T-wave inversions than both West-Asian and Caucasian athletes (6.1% vs 1.6% and 0%, p<0.05). The rate of ‘uncommon’ ECG changes between West-Asian and Caucasian athletes was comparable (7.9% vs 5.8%, p>0.05). Seven athletes (0.6%) were identified with a disease associated with sudden death; this prevalence was two times higher in black athletes than in West-Asian athletes (1% vs 0.5%), and no cases were reported in Caucasian athletes and West-Asian controls. Eighteen West-Asian and black athletes were identified with repolarisation abnormalities suggestive of a cardiomyopathy, but ultimately, none were diagnosed with a cardiac disease. Conclusion West-Asian and Caucasian athletes demonstrate comparable rates of ECG findings. Black African ethnicity is positively associated with increased frequencies of ‘uncommon’ ECG traits. Future work should examine the genetic mechanisms behind ECG and myocardial adaptations in athletes of diverse ethnicity, aiding in the clinical differentiation between physiological remodelling and potential cardiomyopathy or ion channel disorders.
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Affiliation(s)
- M G Wilson
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar.
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29
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D'Andrea A, Cocchia R, Riegler L, Scarafile R, Salerno G, Gravino R, Golia E, Pezzullo E, Citro R, Limongelli G, Pacileo G, Cuomo S, Caso P, Russo MG, Bossone E, Calabrò R. Left Ventricular Myocardial Velocities and Deformation Indexes in Top-Level Athletes. J Am Soc Echocardiogr 2010; 23:1281-1288. [DOI: 10.1016/j.echo.2010.09.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Indexed: 01/25/2023]
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Chejtman D, Baratta S, Fernández H, Ferroni F, Bilbao J, Kotliar C, Marani A, Turri D, Hita A. Clinical Value of the Tissue DopplerSWave to Characterize Left Ventricular Hypertrophy as Defined by Echocardiography. Echocardiography 2010; 27:370-7. [DOI: 10.1111/j.1540-8175.2009.01044.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Williams LK, Frenneaux MP, Steeds RP. Echocardiography in hypertrophic cardiomyopathy diagnosis, prognosis, and role in management. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 10:iii9-14. [PMID: 19889657 DOI: 10.1093/ejechocard/jep157] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is diagnosed on the basis of left ventricular (LV) hypertrophy for which there is insufficient explanation (e.g. mild hypertension or mild aortic stenosis with marked hypertrophy). Echocardiography is an invaluable tool in the diagnosis and follow-up of patients with HCM. Echocardiographic assessment requires a comprehensive assessment in several imaging planes with careful attention to correct beam alignment in order to minimize errors in the measurement of LV wall thickness and appropriate identification of hypertrophy with an unusual distribution.
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Affiliation(s)
- L K Williams
- Department of Cardiology, University Hospital Birmingham, NHS Trust, Edgbaston, Birmingham B15 2TT, UK.
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Kuchynka P, Palecek T, Vilikus Z, Havranek S, Taborska K, Louch WE, Linhart A. Cardiac Structural and Functional Changes in Competitive Amateur Cyclists. Echocardiography 2010; 27:11-6. [DOI: 10.1111/j.1540-8175.2009.00965.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schwarzwald CC, Schober KE, Bonagura JD. Methods and reliability of tissue Doppler imaging for assessment of left ventricular radial wall motion in horses. J Vet Intern Med 2009; 23:643-52. [PMID: 19645848 DOI: 10.1111/j.1939-1676.2009.0287.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Noninvasive assessment of left ventricular (LV) function is incompletely studied in horses. OBJECTIVES The goals of this study were to investigate the feasibility, techniques, and reliability of tissue Doppler imaging (TDI) for characterization of LV radial wall motion in healthy horses. ANIMALS Three Standardbreds, 3 Thoroughbreds; age 8-14 years; body weight 517-606 kg. METHODS Repeated echocardiographic examinations were performed by 2 observers in unsedated horses using TDI. Test reliability was determined by estimating measurement variability, within-day interobserver variability, and between-day interobserver and intraobserver variability of all echocardiographic variables. Variability was expressed as coefficient of variation (CV) and the absolute value below which the difference between 2 measurements will lie with 95% probability. RESULTS Assessment of LV radial wall motion by TDI was feasible in all horses. Measurement variabilities were very low (CV < 5%) to low (CV 5-15%) for most variables. Within-day interobserver variability as well as between-day interobserver and intraobserver variabilities were low to moderate (CV 16-25%) for most variables. All pulsed-wave TDI variables of systolic LV function showed very low to low variability, whereas some of the variables of LV diastolic and LA function showed moderate to high (CV > 25%) variability. Pulsed-wave TDI variables appeared more reliable than color TDI variables. CONCLUSIONS AND CLINICAL IMPORTANCE Measurement of TDI indices of LV function is feasible and reliable in adult Standardbred and Thoroughbred horses. The clinical relevance of LV function assessment by TDI remains to be determined.
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Affiliation(s)
- C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Systolic and early diastolic left ventricular velocities assessed by tissue Doppler imaging in 100 top-level handball players. ACTA ACUST UNITED AC 2009; 17:342-8. [PMID: 20560167 DOI: 10.1097/hjr.0b013e32833333de] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghio S, Revera M, Mori F, Klersy C, Raisaro A, Raineri C, Serio A, Pasotti M, Visconti LO. Regional abnormalities of myocardial deformation in patients with hypertrophic cardiomyopathy: correlations with delayed enhancement in cardiac magnetic resonance. Eur J Heart Fail 2009; 11:952-7. [PMID: 19789398 DOI: 10.1093/eurjhf/hfp122] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stefano Ghio
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Miriam Revera
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Francesca Mori
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Service; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Arturo Raisaro
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Claudia Raineri
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
| | - Alessandra Serio
- Centre for Inherited Cardiovascular Diseases; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Michele Pasotti
- Centre for Inherited Cardiovascular Diseases; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology; Fondazione IRCCS Policlinico S. Matteo; Piazza Golgi 1 Pavia 27100 Italy
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La Gerche A, Taylor AJ, Prior DL. Athlete's heart: the potential for multimodality imaging to address the critical remaining questions. JACC Cardiovasc Imaging 2009; 2:350-63. [PMID: 19356581 DOI: 10.1016/j.jcmg.2008.12.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 12/16/2008] [Indexed: 12/26/2022]
Abstract
Moderate exercise is a powerful therapy in the treatment and prevention of cardiac disease, but intense habitual exercise leads to cardiac adaptations for which the prognostic benefits are less clear. The athlete's heart syndrome refers to the morphological and electrical remodeling which occurs to varying extents dependent upon the sporting discipline. Its accurate differentiation from pathological entities is critical. This review describes the role multi-modality imaging serves in determining the limitations and consequences of intense exercise. Tissue characterization and imaging studies during exercise are emphasized as important future directions of inquiry with the potential to address remaining controversies.
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Affiliation(s)
- Andre La Gerche
- St Vincent's Hospital and University of Melbourne, Melbourne, Australia
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Christophe C, Chodek-Hingray A, Pruna A, Bruntz JF, Chometon F, Groben L, Huttin O, Aliot E, Juilliere Y, Selton-Suty C. [Correlation between atrial function and functional capacity in highly trained subjects]. Ann Cardiol Angeiol (Paris) 2009; 58:144-150. [PMID: 19467642 DOI: 10.1016/j.ancard.2009.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 02/20/2009] [Indexed: 05/27/2023]
Abstract
AIM The aim of the study is to show the relationship existing between tissular Doppler imaging (TDI) parameters and functional capacity in highly trained subjects. METHODS AND PATIENTS We therefore studied 46 patients including 22 untrained and 24 trained subjects. Each subject had pulsed TDI recording of systolic (S) and diastolic (E and A) longitudinal myocardial velocities in the basal portion of the RV free wall (RV), the septum (sep) and the LV free wall (LV) from apical 4C view. Athletes underwent the same day a cardiopulmonary test during which we measured peak V(O)2 (ml/kg/min) and anaerobic threshold (AT, ml/kg/min) and calculated VE/V(CO)2 slope. We studied differences between echocardiographic parameters in the two groups using Student test. Coefficients of correlations were calculated using the Spearman method. RESULTS Differences between two groups concerned Tei index of right (RV) and left ventricle (LV), telediastolic diameter of LV, and A waves on each wall. In athletes RV, sep and LV S waves did not correlate with V(O)2, AT or VE/V(CO)2 RV, sep and LV A waves correlated significantly and negatively with V(O)2, RV and sep A waves negatively with AT, and sep and LV A waves positively with VE/V(CO)2. CONCLUSION In athletes, atrial function shows a negative relationship with cardiopulmonary exercise parameters: the lower the proportion of LV filling due to atrial contraction, the better the level of functional capacity. This is probably due to myocardial structure, which allows more efficient early filling in hypertrophic athlete's heart.
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Affiliation(s)
- C Christophe
- Département Cardiologie et Maladies Cardiovasculaires, CHU Nancy-Brabois, Vandoeuvre, France.
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Echocardiography in hypertrophic cardiomyopathy: the role of conventional and emerging technologies. JACC Cardiovasc Imaging 2008; 1:787-800. [PMID: 19356516 DOI: 10.1016/j.jcmg.2008.09.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 08/27/2008] [Accepted: 09/05/2008] [Indexed: 02/07/2023]
Abstract
Hypertrophic cardiomyopathy is a relatively common inherited cardiomyopathy that is occasionally challenging to differentiate from hypertensive heart disease and athlete hearts on the basis of morphologic or functional abnormalities alone. Echocardiography has traditionally played a preeminent role in the diagnosis, formulation of management strategies, and the prognostication of this complex disease. In this review, we briefly profile the utility and pitfalls of established echocardiographic modalities and discuss the evolving role of novel echocardiographic imaging modalities such as tissue Doppler, Doppler-based strain, 2-dimensional strain (speckle tracking imaging), and 3-dimensional imaging in the assessment of hypertrophic cardiomyopathy.
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Basavarajaiah S, Boraita A, Whyte G, Wilson M, Carby L, Shah A, Sharma S. Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51:2256-62. [PMID: 18534273 DOI: 10.1016/j.jacc.2007.12.061] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/12/2007] [Accepted: 12/17/2007] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate ethnic differences in left ventricular (LV) remodeling between highly-trained athletes of African/Afro-Caribbean (black) and Caucasian (white) athletes. BACKGROUND The upper limits of left ventricular hypertrophy (LVH) are established in white athletes and aid the differentiation of physiologic LVH from hypertrophic cardiomyopathy (HCM). However, there are few data regarding LV remodeling in black athletes, in whom deaths from HCM are more prevalent. METHODS Between 2003 and 2007, 300 nationally ranked black male athletes (mean age 20.5 years) underwent 12-lead electrocardiogram and 2-dimensional echocardiography. The results were compared with 150 black and white sedentary individuals and 300 highly-trained white male athletes matched for age, size, and sport. RESULTS Black athletes exhibited greater LV wall thickness and cavity size compared with sedentary black and white individuals. Black athletes had greater LV wall thickness compared with white athletes (11.3 +/- 1.6 mm vs. 10 +/- 1.5 mm; p < 0.001). In absolute terms, 54 black athletes (18%) had LV wall thickness >12 mm compared with 12 white athletes (4%), and 3% of black athletes exhibited LV wall thickness >/=15 mm compared with none of the white athletes. Black athletes with LVH displayed an enlarged LV cavity and normal diastolic function. CONCLUSIONS Black athletes develop a greater magnitude of LVH compared with white athletes; therefore, extrapolation of conclusions derived from white athletes has the potential of generating false-positive diagnoses of HCM in black athletes.
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Tissue Doppler-derived diastolic myocardial velocities are abnormal in pediatric cardiac transplant recipients in the absence of endomyocardial rejection. Pediatr Cardiol 2008; 29:749-54. [PMID: 18176771 DOI: 10.1007/s00246-007-9188-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 11/26/2007] [Accepted: 12/03/2007] [Indexed: 09/29/2022]
Abstract
The aim of this study was to evaluate diastolic function in pediatric cardiac transplant recipients free of acute rejection using tissue Doppler. E' and A' velocities at the mitral, septal, and tricuspid annuli in 31 pediatric heart transplant recipients free of acute rejection were compared with 28 controls and with previously published pediatric normative data. E' velocities were lower in the transplant group at the mitral (0.13 +/- 0.04 vs. 0.2 +/- 0.04 m/s, p < 0.0001), septal (0.1 +/- 0.03 vs. 0.14 +/- 0.03 m/s, p = 0.001), and tricuspid annuli (0.1 +/- 0.04 vs. 0.17 +/- 0.04 m/s, p < 0.0001). A' velocities were also lower in the transplant group at the septal (0.04 +/- 0.01 vs. 0.06 +/- 0.01 m/s, p = 0.001) and tricuspid annuli (0.06 +/- 0.02 vs. 0.1 +/- 0.03 m/s, p < 0.00001). E' and A' were abnormally low at the mitral annulus in 31% and 13%, septal annulus in 50% and 21%, and tricuspid annulus in 63% and 36% of the subjects, respectively. Abnormalities in tissue Doppler-derived diastolic myocardial velocities are common in pediatric cardiac transplant recipients free of acute rejection.
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Baggish AL, Wang F, Weiner RB, Elinoff JM, Tournoux F, Boland A, Picard MH, Hutter AM, Wood MJ. Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes. J Appl Physiol (1985) 2008; 104:1121-8. [DOI: 10.1152/japplphysiol.01170.2007] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This prospective, longitudinal study examined the effects of participation in team-based exercise training on cardiac structure and function. Competitive endurance athletes (EA, n = 40) and strength athletes (SA, n = 24) were studied with echocardiography at baseline and after 90 days of team training. Left ventricular (LV) mass increased by 11% in EA (116 ± 18 vs. 130 ± 19 g/m2; P < 0.001) and by 12% in SA (115 ± 14 vs. 132 ± 11 g/m2; P < 0.001; P value for the compared Δ = NS). EA experienced LV dilation (end-diastolic volume: 66.6 ± 10.0 vs. 74.7 ± 9.8 ml/m2, Δ = 8.0 ± 4.2 ml/m2; P < 0.001), enhanced diastolic function (lateral E ′: 10.9 ± 0.8 vs. 12.4 ± 0.9 cm/s, P < 0.001), and biatrial enlargement, while SA experience LV hypertrophy (posterior wall: 4.5 ± 0.5 vs. 5.2 ± 0.5 mm/m2, P < 0.001) and diminished diastolic function (E′ basal lateral LV: 11.6 ± 1.3 vs. 10.2 ± 1.4 cm/s, P < 0.001). Further, EA experienced right ventricular (RV) dilation (end-diastolic area: 1,460 ± 220 vs. 1,650 ± 200 mm/m2, P < 0.001) coupled with enhanced systolic and diastolic function (E′ basal RV: 10.3 ± 1.5 vs. 11.4 ± 1.7 cm/s, P < 0.001), while SA had no change in RV parameters. We conclude that participation in 90 days of competitive athletics produces significant training-specific changes in cardiac structure and function. EA develop biventricular dilation with enhanced diastolic function, while SA develop isolated, concentric left ventricular hypertrophy with diminished diastolic relaxation.
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Kim YJ, Choi BW, Hur J, Lee HJ, Seo JS, Kim TH, Choe KO, Ha JW. Delayed enhancement in hypertrophic cardiomyopathy: Comparison with myocardial tagging MRI. J Magn Reson Imaging 2008; 27:1054-60. [DOI: 10.1002/jmri.21366] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Richand V, Lafitte S, Reant P, Serri K, Lafitte M, Brette S, Kerouani A, Chalabi H, Dos Santos P, Douard H, Roudaut R. An ultrasound speckle tracking (two-dimensional strain) analysis of myocardial deformation in professional soccer players compared with healthy subjects and hypertrophic cardiomyopathy. Am J Cardiol 2007; 100:128-32. [PMID: 17599454 DOI: 10.1016/j.amjcard.2007.02.063] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 02/06/2007] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
Deformation analysis using 2-dimensional strain echocardiography can detect early systolic function abnormalities in patients with left ventricular hypertrophy. This study was designed to characterize global and regional myocardial deformation using 2-dimensional strain in professional soccer players (PSPs) compared with control subjects and patients with hypertrophic cardiomyopathy (HC). Twenty nine PSPs, 26 patients with HC, and 17 controls were investigated at rest using transthoracic echocardiography with 2-dimensional strain analysis. Radial and transverse strains were significantly higher in PSPs compared with controls, whereas longitudinal strain was lower. Compared with patients with HC, athletes had higher values for transverse, radial, and circumferential strains. In pathologic hypertrophic segments, longitudinal strain was lower in patients with HC than in PSPs. In conclusion, 2-dimensional strain can identify specific patterns of myocardial deformation in PSPs, controls, and patients with HC. It has the potential to become a routinely used method for the differentiation of athlete's heart and HC.
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Affiliation(s)
- Viviane Richand
- CHU de Bordeaux, Université Victor Segalen Bordeaux 2, Bordeaux-Pessac, France
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Krieg A, Scharhag J, Kindermann W, Urhausen A. Cardiac tissue Doppler imaging in sports medicine. Sports Med 2007; 37:15-30. [PMID: 17190533 DOI: 10.2165/00007256-200737010-00002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The differentiation of training-induced cardiac adaptations from pathological conditions is a key issue in sports cardiology. As morphological features do not allow for a clear delineation of early stages of relevant pathologies, the echocardiographic evaluation of left ventricular function is the technique of first choice in this regard. Tissue Doppler imaging (TDI) is a relatively recent method for the assessment of cardiac function that provides direct, local measurements of myocardial velocities throughout the cardiac cycle. Although it has shown a superior sensitivity in the detection of ventricular dysfunction in clinical and experimental studies, its application in sports medicine is still rare. Besides technical factors, this may be due to a lack in consensus on the characteristics of ventricular function in relevant conditions. For more than two decades there has been an ongoing debate on the existence of a supernormal left ventricular function in athlete's heart. While results from traditional echocardiography are conflicting, TDI studies established an improved diastolic function in endurance-trained athletes with athlete's heart compared with controls.The influence of anabolic steroids on cardiac function also has been investigated by standard echocardiographic techniques with inconsistent results. The only TDI study dealing with this topic demonstrated a significantly impaired diastolic function in bodybuilders with long-term abuse of anabolic steroids compared with strength-trained athletes without abuse of anabolic steroids and controls, respectively.Hypertrophic cardiomyopathy is the most frequent cause of sudden death in young athletes. However, in its early stages, it is difficult to distinguish from athlete's heart. By means of TDI, ventricular dysfunction in hypertrophic cardiomyopathy can be disclosed even before the development of left ventricular hypertrophy. Also, a differentiation of left ventricular hypertrophy due to hypertrophic cardiomyopathy or systemic hypertension is possible by TDI. Besides the evaluation of different forms of left ventricular hypertrophy, the diagnosis of myocarditis is also of particular importance in athletes. Today, it still requires myocardial biopsy. The analysis of focal disturbances in myocardial velocities might be a promising non-invasive method; however, systematic validation studies are lacking. An important future issue for the implementation of TDI into routine examination will be the standardisation of procedures and the establishment of significant reference values for the above-mentioned conditions. Innovative TDI parameters also merit further investigation.
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Affiliation(s)
- Anne Krieg
- Institute of Sports and Preventive Medicine, University of Saarland, Saarbruecken, Germany.
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Chang SM, Lin CC, Hsiao SH, Lee CY, Yang SH, Lin SK, Huang WC. Pulmonary Hypertension and Left Heart Function: Insights from Tissue Doppler Imaging and Myocardial Performance Index. Echocardiography 2007; 24:366-73. [PMID: 17381645 DOI: 10.1111/j.1540-8175.2007.00405.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND As a consequence of a leftward shift of the interventricular septum and of pericardial restraint, related to the degree RV dilatation, left heart function would be influenced after pulmonary hypertension and right heart failure. METHODS AND RESULTS We enrolled 70 patients with pulmonary artery systolic pressure (PASP) more than 30 mmHg: 40 patients with PASP between 30 and 60 mmHg (Group 2), 30 patients with PASP more than 60 mmHg (Group 3). Another 70 patients with normal heart performance and PASP less than 30 mmHg served as the control group (Group 1). Myocardial performance index (MPI), isovolumic contraction time (IVCT), and isovolumic relaxation time (IVRT) were obtained by tissue Doppler imaging (TDI). PASP correlated negatively to peak systolic velocity of lateral tricuspid annulus (RV-Sm) and RVEF. The MPI of RV and LV in patients with severe pulmonary hypertension (Group 3) became higher as the result of the prolongation of IVRT. The higher E/Em (peak early-diastolic mitral-inflow velocity divided by early-diastolic velocity of mitral annulus) in pulmonary hypertension indicated diastolic dysfunction of LV. The decline of left ventricular ejection fraction, and also right ventricular ejection fraction, suggested LV systolic dysfunction after pulmonary hypertension. The LV-MPI truly reflected LV systolic and diastolic dysfunction in patients with pulmonary hypertension. In multiple linear regression analysis, LV-MPI was independently associated only with RV-MPI (Beta 0.47, P < 0.0001). CONCLUSION The result infers that the systolic and diastolic function of LV declined, following pulmonary hypertension.
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MESH Headings
- Adult
- Aged
- Analysis of Variance
- Blood Flow Velocity
- Case-Control Studies
- Echocardiography, Doppler, Pulsed
- Heart Rate
- Heart Septum/diagnostic imaging
- Heart Septum/physiopathology
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Linear Models
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/physiopathology
- Myocardial Contraction
- Observer Variation
- Pulmonary Wedge Pressure
- Research Design
- Severity of Illness Index
- Stroke Volume
- Tricuspid Valve/diagnostic imaging
- Tricuspid Valve/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/epidemiology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Shu-Mei Chang
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, R.O.C
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New Aspects of Septal Function by Using 1-Dimensional Strain and Strain Rate Imaging. J Am Soc Echocardiogr 2006; 19:1345-9. [DOI: 10.1016/j.echo.2006.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Indexed: 12/14/2022]
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Hsiao SH, Lin SK, Wang WC, Yang SH, Gin PL, Liu CP. Severe tricuspid regurgitation shows significant impact in the relationship among peak systolic tricuspid annular velocity, tricuspid annular plane systolic excursion, and right ventricular ejection fraction. J Am Soc Echocardiogr 2006; 19:902-10. [PMID: 16825000 DOI: 10.1016/j.echo.2006.01.014] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Peak systolic mitral annular velocities correlate with left ventricular ejection fraction (EF) regardless of mitral regurgitation severity. Peak systolic tricuspid annular velocity (RV-Sm) and tricuspid annular plane systolic excursion (TAPSE) are used to assess right ventricular (RV) EF (RVEF). We investigated whether tricuspid regurgitation (TR) affects the relationship among RV-Sm, TAPSE, and RVEF. METHODS Patients (n = 625) underwent echocardiography and Doppler tissue studies. Left ventricular EF and RVEF were estimated by Simpson's rule. Because of confounding, we excluded patients with diseases that influence mitral annular motion or left ventricular function. We finally enrolled 225 patients: 125 with mild TR, 50 with moderate TR, and 50 with severe TR. Forty study patients (20 with mild TR, 10 with moderate TR, and 10 with severe TR) received radionuclide ventriculography. RESULTS The RVEF estimated by Simpson's method correlated strongly to that estimated by the radionuclide method (r = 0.793, r2 = 0.629, P < .0001). With mild or moderate TR, RV-Sm correlated well to RVEF (mild TR group: r = 0.765, r2 = 0.59, P < .0001; moderate TR group: r = 0.756, r2 = 0.57, P < .0001). RV-Sm had no significant correlation to RVEF in patients with severe TR (r = 0.212, r2 = 0.05, P = .167). Over a range of TR severities, the relationship between TAPSE and RVEF showed a similar trend to that between RV-Sm and RVEF. CONCLUSION Severe TR has a significant impact on the relationship between RV-Sm and RVEF and between TAPSE and RVEF. TAPSE and RV-Sm in patients with severe TR show poor correlation to RVEF. When applying Doppler tissue method or TAPSE to assess RV function, severe TR is a significantly confounding factor.
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Affiliation(s)
- Shih-Hung Hsiao
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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D'Andrea A, D'Andrea L, Caso P, Scherillo M, Zeppilli P, Calabrò R. The usefulness of Doppler myocardial imaging in the study of the athlete's heart and in the differential diagnosis between physiological and pathological ventricular hypertrophy. Echocardiography 2006; 23:149-57. [PMID: 16445736 DOI: 10.1111/j.1540-8175.2006.00186.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Athlete's heart is a cardiac adaptation to long-term, intensive training, which includes changes as increased ventricular cavity diameters, wall thickness and mass, produced with a degree consistent with sports activities and exercise programs. The Doppler myocardial imaging (DMI) permits characterization of the velocities of each ventricular myocardial segment by placing the sample volume at the center of the cardiac muscle. Even if the standard two-dimensional (2D) echocardiography represents an irreplaceable method in the evaluation of cardiac adaptations to physical exercise, the data currently available suggests the usefulness of DMI in the assessment of the myocardial systolic and diastolic functions of the athlete's heart. In particular, an athlete's left ventricular hypertrophy is characterized by a "supernormal" DMI pattern, with increased myocardial early-diastolic velocity. Therefore, DMI analysis in the trained subject has demonstrated interesting prospective for: (1) the differential diagnosis from pathological, both, left and right ventricular hypertrophy; (2) the prediction of cardiac performance during physical effort; (3) the evaluation of the biventricular interaction; (4) the analysis of the myocardial adaptations to various training protocols; and (5) the early identification of specific genotypes associated with cardiomyopathies. On this ground, a combined use of standard 2D echo and DMI may be taken into account for a valid noninvasive and easy-repeatable evaluation of both physiological and pathological ventricular hypertrophies.
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Hsiao SH, Lee CY, Chang SM, Lin SK, Liu CP. Right Heart Function in Scleroderma: Insights from Myocardial Doppler Tissue Imaging. J Am Soc Echocardiogr 2006; 19:507-14. [PMID: 16644433 DOI: 10.1016/j.echo.2005.12.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Indexed: 12/31/2022]
Abstract
To use Doppler tissue imaging to evaluate heart function and to predict rehospitalization rate in progressive systemic sclerosis, we studied 40 patients (limited in 24 patients, diffuse in 16 patients) with chest roentgenography, pulmonary function test, routine echocardiography, and myocardial Doppler tissue. Another 45 volunteers without any sign of heart failure served as the control group. Significant difference of echocardiographic parameters was found in peak transmitral early diastolic velocity, right ventricular (RV) ejection fraction (EF) (RVEF), pulmonary artery systolic pressure, and Doppler tissue parameters of the RV and septum (peak transmitral early diastolic velocity, P = .012; RVEF, P < .0001; pulmonary artery systolic pressure, P < .0001). The parameters derived by pulsed wave Doppler tissue decreased in RV, including peak systolic myocardial velocity (Sm), early diastolic velocity, late diastolic velocity, and myocardial performance index. RVEF and left ventricular EF were estimated by Simpson's method. RV-Sm could be used to identify RV failure. Receiver operating characteristic area under the curve for RV-Sm was 0.935. RV-Sm less than 11 cm/s indicted RVEF less than 40% with sensitivity of 87% and specificity of 86%. Contrary to expectation, pulmonary artery systolic pressure was not so well correlated with RV function. The frequency of admission was reverse correlated with decrement of RV-Sm in patients with RV-Sm less than 12 cm/s. We conclude that in progressive systemic sclerosis, RV systolic dysfunction is common and appears to be a result of pulmonary hypertension, disturbance of myocardial microcirculation, and myocardial fibrosis. Pulmonary hypertension was not well correlated with RV dysfunction; it suggested pulmonary hypertension was not the only cause of RV failure. Primary right heart involvement was the other possible cause. By myocardial Doppler tissue imaging, we can predict the frequency of hospitalization; it suggests simultaneous involvement of heart, skin, lung, and other organs. RV-Sm more than 12 cm/s predicted a decreased likelihood of readmission to the hospital.
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Affiliation(s)
- Shih-Hung Hsiao
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Fowler SJ, Narula J, Gurudevan SV. Review of Noninvasive Imaging for Hypertrophic Cardiac Syndromes and Restrictive Physiology. Heart Fail Clin 2006; 2:215-30. [PMID: 17386891 DOI: 10.1016/j.hfc.2006.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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