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Best Practice & Research. Clinical... Jun 2019Diastolic dysfunction (DD) is a common condition that is increasingly encountered in patients undergoing both cardiac and noncardiac surgery as the age profile of our... (Review)
Review
Diastolic dysfunction (DD) is a common condition that is increasingly encountered in patients undergoing both cardiac and noncardiac surgery as the age profile of our patient population increases and the noninvasive diagnosis of DD becomes more accessible. There is a growing body of evidence demonstrating the significance of DD and adverse perioperative outcomes, and thus, it is becoming imperative for anesthesiologists to have an understanding of the pathophysiology, diagnosis, and management of patients with DD. Current guidelines are based on transthoracic echocardiogram (TTE) measurements in patients who are spontaneously breathing and in a euvolemic state and, consequently, not applicable to the perioperative period. In this review article, we discuss the grading of DD as well as introduce a practical approach to the diagnosis and management of patients with DD during the perioperative period.
Topics: Anesthesiologists; Echocardiography, Transesophageal; Humans; Intraoperative Complications; Monitoring, Intraoperative; Ventricular Dysfunction
PubMed: 31582101
DOI: 10.1016/j.bpa.2019.07.014 -
Therapeutic Advances in Cardiovascular... Apr 2010The frequent occurrence of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage raises a number of issues about the clinical and... (Review)
Review
The frequent occurrence of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage raises a number of issues about the clinical and pathophysiological similarities with the transient left ventricular apical ballooning syndrome (TLVABS) or tako-tsubo cardiomyopathy (TTC). Given the latest clinical and pathophysiological evidence about neurogenic cardiomyopathies, the diagnosis of TTC should not be ruled out in patients experiencing acute brain injury and cerebrovascular events. Each type of reversible left ventricular dysfunction mediated by the central nervous system and initiated by acute brain injury, both physical, such as intracranial bleeding or head traumas, and psychological, such as sudden emotional stress, could be encompassed in a single definition with larger inclusion criteria, such as 'acute ballooning cardiomyopathy' (ABC), that is likely to be more representative of the real needs in the clinical setting.
Topics: Brain Injuries; Diagnosis, Differential; Humans; Stress, Psychological; Subarachnoid Hemorrhage; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left
PubMed: 20124311
DOI: 10.1177/1753944709356013 -
American Journal of Physiology. Heart... Mar 2019Right ventricular (RV) dysfunction can lead to complications after acute inferior myocardial infarction (MI). However, it is unclear how RV failure after MI contributes...
Right ventricular (RV) dysfunction can lead to complications after acute inferior myocardial infarction (MI). However, it is unclear how RV failure after MI contributes to left-sided dysfunction. The aim of the present study was to investigate the consequences of right coronary artery (RCA) ligation in mice. RCA ligation was performed in C57BL/6JRj mice ( n = 38). The cardiac phenotypes were characterized using high-resolution echocardiography performed up to 4 wk post-RCA ligation. Infarct size was measured using 2,3,5-triphenyltetrazolium chloride staining 24 h post-RCA ligation, and the extent of the fibrotic area was determined 4 wk after MI. RV dysfunction was confirmed 24 h post-RCA ligation by a decrease in the tricuspid annular plane systolic excursion ( P < 0.001) and RV longitudinal strain analysis ( P < 0.001). Infarct size measured ex vivo represented 45.1 ± 9.1% of the RV free wall. RCA permanent ligation increased the RV-to-left ventricular (LV) area ratio ( P < 0.01). Septum hypertrophy ( P < 0.01) was associated with diastolic septal flattening. During the 4-wk post-RCA ligation, LV ejection fraction was preserved, yet it was associated with impaired LV diastolic parameters ( E/ E', global strain rate during early diastole). Histological staining after 4 wk confirmed the remodeling process with a thin and fibrotic RV. This study validates that RCA ligation in mice is feasible and induces RV heart failure associated with the development of LV diastolic dysfunction. Our model offers a new opportunity to study mechanisms and treatments of RV/LV dysfunction after MI. NEW & NOTEWORTHY Right ventricular (RV) dysfunction frequently causes complications after acute inferior myocardial infarction. How RV failure contributes to left-sided dysfunction is elusive because of the lack of models to study molecular mechanisms. Here, we created a new model of myocardial infarction by permanently tying the right coronary artery in mice. This model offers a new opportunity to unravel mechanisms underlying RV/left ventricular dysfunction and evaluate drug therapy.
Topics: Animals; Coronary Vessels; Disease Models, Animal; Ligation; Mice; Mice, Inbred C57BL; Ventricular Dysfunction
PubMed: 30575433
DOI: 10.1152/ajpheart.00573.2018 -
Cardiology Journal 2023The comprehensive assessment of right ventricular (RV) performance is of paramount importance because it is has been recognized as a strong prognostic factor in a...
BACKGROUND
The comprehensive assessment of right ventricular (RV) performance is of paramount importance because it is has been recognized as a strong prognostic factor in a variety of clinical settings. The aim herein was to evaluate the usefulness of RV longitudinal strain imaging by speckle-tracking echocardiography (STE) in daily clinical practice, especially in the context of RV systolic function and its changes after acute coronary syndrome (ACS).
METHODS
This prospective study enrolled 63 patients with ischemic injury (left ventricular ejection fraction [LVEF] ≤ 45%). Additionally, a subgroup was created: patients with ACS treated with successful percutaneous coronary intervention. The clinical and echocardiographic parameters, including STE, were analyzed.
RESULTS
Significant correlations for both RV free-wall (RVFWSL) and four-chamber (RV4CSL) longitudinal strain evaluated by STE with New York Heart Association class, LVEF, E/E' ratio, as well as conventional parameters of RV function were found. RVFWSL was able to detect subtle RV functional abnormalities, unreachable for traditional indices. RV recovery after ACS was not related to higher LVEF but better contractility of the interventricular septum (IVS) assessed by STE.
CONCLUSIONS
Right ventricular strain proved to be a useful two-dimensional echocardiographic method to detect impaired RV performance, which showed a significant relationship with clinical and other echocardiographic indices. The IVS played a vital role in RV recovery among ACS survivors.
Topics: Humans; Heart Ventricles; Stroke Volume; Ventricular Function, Left; Prospective Studies; Echocardiography; Ventricular Dysfunction, Left; Ventricular Function, Right; Ventricular Dysfunction, Right
PubMed: 35470416
DOI: 10.5603/CJ.a2022.0024 -
Heart Failure Reviews Sep 2001The number of patients with severe ventricular dysfunction from coronary artery disease is constantly increasing. Although the medical management of these patients with... (Review)
Review
The number of patients with severe ventricular dysfunction from coronary artery disease is constantly increasing. Although the medical management of these patients with angiotensin-converting enzyme inhibitors and beta-blockers has favorable impact on the morbidity and mortality the overall prognosis is still poor. Historically many of these patients have been referred for transplantation. In the past few years there has been an increasing amount of information about the utility of surgical revascularization in patients with low ejection fraction. Careful patient selection and optimal perioperative management is of critical importance for good outcome. Coronary artery bypass grafting (CABG) can be performed relatively safely despite the advanced level of left ventricular dysfunction. Quality of life is improved by CABG with elimination of angina and enhanced functional capacity. Improvement in the ejection fraction and increased survival after the operation has been objectively demonstrated. However patients with advanced right ventricular dysfunction, pulmonary hypertension, redo bypass and ungraftable coronaries should be considered for heart transplantation. In this review we describe our experience and focus on pertinent issues in patient selection, perioperative management and long term outcome after coronary artery bypass grafting.
Topics: Aged; Coronary Artery Bypass; Coronary Disease; Female; Humans; Male; Patient Selection; Perioperative Care; Time Factors; Treatment Outcome; Ventricular Dysfunction
PubMed: 11391034
DOI: 10.1023/a:1011416929501 -
Current Opinion in Cardiology Jan 2010Although anecdotal evidence has long suggested links between emotion and ventricular arrhythmia, more recent studies have prospectively demonstrated the arrhythmogenic... (Review)
Review
PURPOSE OF REVIEW
Although anecdotal evidence has long suggested links between emotion and ventricular arrhythmia, more recent studies have prospectively demonstrated the arrhythmogenic effects of anger, as well as mechanisms underlying these effects.
RECENT FINDINGS
Epidemiological studies reveal that psychological stress increases sudden death, as well as arrhythmias, in patients with implantable cardioverter-defibrillators, in populations during emotionally devastating disasters such as earthquake or war. Diary-based studies confirm that anger and other negative emotions can trigger potentially lethal ventricular arrhythmias. Anger alters electrophysiological properties of the myocardium, including T-wave alternans, a measure of heterogeneity of repolarization, suggesting one mechanistic link between emotion and arrhythmia. Pilot studies of behavioral interventions have shown promise in decreasing arrhythmias in patients with implantable cardioverter-defibrillators.
SUMMARY
Anger and other strong emotions can trigger polymorphic, potentially life-threatening ventricular arrhythmias in vulnerable patients. Through autonomic changes including increased sympathetic activity and vagal withdrawal, anger leads to increases in heterogeneity of repolarization as measured by T-wave alternans, known to be associated with arrhythmogenesis, as well as increasing inducibility of arrhythmia. Further delineation of mechanisms linking anger and arrhythmia, and of approaches to decrease the detrimental effects of anger and other negative emotions on arrhythmogenesis, are important areas of future investigation.
Topics: Aged; Anger; Animals; Arrhythmias, Cardiac; Humans; Male; Stress, Psychological; Sympathetic Nervous System; Ventricular Dysfunction
PubMed: 19864944
DOI: 10.1097/HCO.0b013e32833358e8 -
British Journal of Anaesthesia Jan 2010Septic shock, the most severe complication of sepsis, accounts for approximately 10% of all admissions to intensive care. Our understanding of its complex... (Review)
Review
Septic shock, the most severe complication of sepsis, accounts for approximately 10% of all admissions to intensive care. Our understanding of its complex pathophysiology remains incomplete but clearly involves stimulation of the immune system with subsequent inflammation and microvascular dysfunction. Cardiovascular dysfunction is pronounced and characterized by elements of hypovolaemic, cytotoxic, and distributive shock. In addition, significant myocardial depression is commonly observed. This septic cardiomyopathy is characterized by biventricular impairment of intrinsic myocardial contractility, with a subsequent reduction in left ventricular (LV) ejection fraction and LV stroke work index. This review details the myocardial dysfunction observed in adult septic shock, and discusses the underlying pathophysiology. The utility of using the regulatory protein troponin for the detection of myocardial dysfunction is also considered. Finally, options for the management of sepsis-induced LV hypokinesia are discussed, including the use of levosimendan.
Topics: Biomarkers; Humans; Prognosis; Shock, Septic; Troponin; Ventricular Dysfunction
PubMed: 19939836
DOI: 10.1093/bja/aep339 -
Italian Heart Journal. Supplement :... Dec 2000Exercise training is a recommended treatment for chronic heart failure. So far, randomized clinical trials showed that exercise training can improve peak oxygen... (Review)
Review
Exercise training is a recommended treatment for chronic heart failure. So far, randomized clinical trials showed that exercise training can improve peak oxygen consumption and reduce neurohormonal and adrenergic activation, nevertheless, the effect on left ventricular remodeling is still controversial. The present study reviewed the randomized clinical trials that investigated the effects of exercise training on left ventricular remodeling. After a first study that showed a worsening of left ventricular function, the following studies showed a neutral effect, and finally, the ELVD-CHF study showed both a reduction in left ventricular dilation and an improvement of ejection fraction. These different results could be explained by the pharmacological treatment before exercise training: in the first study patients did not assume ACE-inhibitors, in the following studies most patients assumed ACE-inhibitors and, finally, in ELVD-CHF, patients assumed ACE-inhibitors and about one fifth of them were on beta-blockers too. In conclusion, exercise training may improve peak oxygen consumption and reduce neurohormonal and adrenergic activation in patients with chronic heart failure. Further studies are necessary to assess if exercise training, associated with ACE-inhibitors and beta-blockers, can reverse or prevent left ventricular remodeling.
Topics: Exercise Therapy; Humans; Ventricular Dysfunction, Left; Ventricular Remodeling
PubMed: 11221583
DOI: No ID Found -
Journal of Cardiothoracic and Vascular... Apr 2024
Topics: Humans; Extracorporeal Membrane Oxygenation; Ventricular Dysfunction, Right; Shock, Cardiogenic; Ventricular Dysfunction, Left; Heart-Assist Devices; Heart Failure; Treatment Outcome
PubMed: 38105124
DOI: 10.1053/j.jvca.2023.10.040 -
Current Heart Failure Reports Dec 2013Congestive heart failure is a major health care concern affecting almost six million Americans and an estimated 23 million people worldwide, and its prevalence is... (Review)
Review
Congestive heart failure is a major health care concern affecting almost six million Americans and an estimated 23 million people worldwide, and its prevalence is increasing with time. Long-standing tachycardia is a well-recognized cause of heart failure and left ventricular dysfunction and has led to the nomenclature, tachycardia-induced cardiomyopathy. Tachycardia-induced cardiomyopathy is generally a reversible cardiomyopathy with effective treatment of the causative arrhythmia, either with medications, surgery, or catheter ablation. Tachycardia-induced cardiomyopathy remains poorly understood and is likely under-diagnosed. A better understanding of tachycardia-induced cardiomyopathy and improved recognition of its presence in clinical practice is vital to the health of patients with this disorder. The goal of this review is to discuss the pathogenesis and clinical manifestations of tachycardia-induced cardiomyopathy, as well as approaches to its diagnosis and treatment.
Topics: Animals; Death, Sudden, Cardiac; Disease Models, Animal; Heart Failure; Humans; Prognosis; Recurrence; Tachycardia; Ventricular Dysfunction
PubMed: 23963583
DOI: 10.1007/s11897-013-0150-z