Echocardiographic parameters associated with in‐hospital adverse outcomes in patients with Takotsubo syndrome

2021 ◽  
Author(s):  
Lauren A. Farina ◽  
Anjan Tibrewala ◽  
Jay M. Voit ◽  
Sasan R. Raissi ◽  
Liqi Chen ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Takotsubo Syndrome ◽  
Echocardiographic Parameters

Signal transduction pathways initiated by catecholamines in takotsubo syndrome: focus on nitrosative stress and energetic impairment

ESC CardioMed ◽  
2018 ◽  
pp. 1283-1286
Author(s):  
John D. Horowitz ◽  
Thanh Ha Nguyen ◽  
Sven Y. Surikow ◽  
Gao Jing Ong ◽  
Cher-Rin Chong ◽  
...  
Keyword(s):  
Signal Transduction ◽  
Longitudinal Strain ◽  
Nitrosative Stress ◽  
Global Longitudinal Strain ◽  
Myocardial Inflammation ◽  
Resonance Spectroscopy ◽  
Takotsubo Syndrome ◽  
Echocardiographic Parameters ◽  
Increased Sensitivity

Takotsubo syndrome reflects an ‘aberrant’ response to acute catecholamine stimulation, largely but not entirely as a manifestation of increased sensitivity to β‎2-adrenoceptor stimulation and signal transduction via Gi proteins, especially in ageing female hearts. It is now apparent that prolonged impairment of quality of life and slow recovery of echocardiographic parameters such as global longitudinal strain after episodes of takotsubo syndrome reflect ongoing myocardial inflammation and associated oedema, together with impairment of cardiac energetics on phosphorus magnetic resonance spectroscopy.

scholarly journals Can echocardiographic parameters predict mortality in COVID-19?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Babu ◽  
N Eden ◽  
Z Meng ◽  
D Lamb ◽  
R Bhatia ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Clinical Indication ◽  
Electronic Patient Records ◽  
Ventricular Ejection Fraction ◽  
Hospitalised Patients ◽  
Echocardiographic Parameters ◽  
The Mean

Abstract Introduction The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), otherwise known as the coronavirus (COVID-19) pandemic presents one of the greatest medical challenges of our generation. Whilst commonly causing a viral pneumonitis, myocardial damage has also been suggested by elevated serum troponin values greater than the 99th centile in up to 30% of individuals who require hospitalisation and correlates with increased mortality. Purpose We aim to identify whether transthoracic echocardiography (TTE) parameters can elucidate the phenomenon of abnormal troponin levels. Furthermore, we seek to characterise the most frequent demographic, biochemical, echocardiographic features and co-morbidities associated with adverse outcomes in this cohort. Methods A retrospective analysis was conducted utilising electronic patient records of consecutive hospitalised patients with a positive COVID-19 swab between 1st March and 31st October 2020 who underwent a TTE at our institution. Pertinent variables were collected including: the clinical indication, demographics including cardiovascular (CV) risk factors, peak troponin values and fundamental echocardiographic parameters. Results During this 8-month period, a total of 90 patients underwent a TTE. The mean age of the cohort was 63 years of age and 56% were male. More than half (56.6%) were admitted to the intensive care unit (ICU). A salient 41.1% (n=37) of our cohort succumbed to this devastating virus. Notably, 38.9% (n=35) were of black and minority ethnic origin (BAME). A striking 64.9% (n=24) of patients who died had hypertension. The mean troponin levels were 168.7 ng/L and 176.6 ng/L (0–34 ng/L) in the survivors and non-survivors group respectively. With regards to TTE, the left ventricular parameters were similar between both groups with a mean left ventricular ejection fraction (LVEF) of 60.6% in the non-survivors. Conversely, both right ventricular (RV) dysfunction (37.8%) and raised pulmonary artery systolic pressures (PASP) (51.4%) were markedly more frequent in the patients who perished due to COVID-19 infection. Conclusion Remarkably, in this extremely ill group of patients who died, 91.9% of patients had a preserved LVEF. There were no overt differences between troponin levels in the survivors and non-survivors. However, hypertension, RV dysfunction and raised PASP were distinctly more prominent in the non-survivors. Thus, providing insight that a normally functioning left ventricle does not preclude to poor outcomes. Overall, this single-centre retrospective study demonstrates that the echocardiographic phenotype associated with mortality is consistent with a severe respiratory illness rather than direct myocardial injury from COVID-19. A multi-modality imaging approach may facilitate the identification of adverse tissue characterisation changes associated with this novel virus as well as guiding further risk stratification and patient management on a case-by-case basis. FUNDunding Acknowledgement Type of funding sources: None.

Long-term follow-up of subvalvular aortic stenosis in children: a single-centre experience

2021 ◽  
pp. 1-8
Author(s):  
Mehmet G. Ramoğlu ◽  
Selen Karagözlü ◽  
Tayfun Uçar ◽  
Zeynep Eyileten ◽  
Adnan Uysalel ◽  
...  
Keyword(s):  
Aortic Insufficiency ◽  
Adverse Outcomes ◽  
Subaortic Stenosis ◽  
Male Predominance ◽  
Single Centre Experience ◽  
Long Term Follow Up ◽  
Echocardiographic Parameters ◽  
Subvalvular Aortic Stenosis

Abstract Objective: The aim of this study is to evaluate clinical and surgical outcomes of children with subaortic stenosis, to determine the risk factors for surgery and reoperation and to compare isolated subaortic stenosis and those concomitant with CHDs. Methods: The study involved 80 children with subaortic stenosis. The patients were first classified as isolated and CHD group, and the isolated group was further classified as membranous/fibromuscular group. The initial, pre-operative, post-operative and the most recent echocardiographic data, demographic properties and follow-up results of the groups were analysed and compared. The correlation of echocardiographic parameters with surgery and reoperation was evaluated. Results: There was a significant male predominance in all groups. The frequency of the membranous type was higher than the fibromuscular type in the whole and the CHD group. The median time to the first operation was 4.6 years. Thirty-five (43.7%) patients underwent surgery, 5 of 35 (14%) patients required reoperation. The rate of surgery was similar between groups, but reoperation was significantly higher in the isolated group. The gradient was the most important factor for surgery and reoperation in both groups. In the isolated group besides gradient, mitral-aortic separation was the only echocardiographic parameter correlated with surgery and reoperation. Conclusion: Reoperation is higher in isolated subaortic stenosis but similar in membranous and fibromuscular types. Early surgery may be beneficial in preventing aortic insufficiency but does not affect the rate of reoperation. Higher initial gradients are associated with adverse outcomes, recurrence and reoperation.

scholarly journals Postdischarge outcome after Takotsubo syndrome compared with patients post-ACS and those without prior CVD: ANZACS-QI 19

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000918 ◽  
Author(s):  
Jen-Li Looi ◽  
Mildred Lee ◽  
Mark W I Webster ◽  
Andrew C Y To ◽  
Andrew J Kerr
Keyword(s):  
Hospital Mortality ◽  
Adverse Outcomes ◽  
Takotsubo Syndrome ◽  
Term Survival ◽  
Coronary Syndrome ◽  
Long Term Prognosis ◽  
And Gender ◽  
Almost All

ObjectiveTakotsubo syndrome (TS) mimics acute coronary syndrome (ACS) but has a distinct pathophysiology. While in-hospital adverse outcomes appear similar to those presenting with an ACS, data on longer term postdischarge risk are conflicting. This study sought to assess the long-term prognosis of patients discharged alive after TS.MethodsThe clinical profile and in-hospital and long-term outcomes were prospectively assessed in consecutive patients with TS. Survival in patients with TS was compared with two representative age-matched and gender-matched comparison cohorts: a hospitalised ACS cohort and a community cohort without known cardiovascular disease (CVD).ResultsTwo hundred and-twenty-five patients with TS (216 women, mean age 63.7±11.8 years) were included. In-hospital mortality was 1.8% and 1.9% for patients with TS and ACS, respectively. Of the 219 patients with TS with postdischarge follow-up, at a mean follow-up of 4.8±3.2 years, there were 19 (8.3%) deaths, 18 of which were from non-cardiac causes. When compared with the cohort without prior CVD, postdischarge patients with TS were at increased mortality risk (HR 2.00, 95% CI 1.26 to 3.17, p=0.003), but mortality in postdischarge patients with ACS was over threefold higher (HR 3.43, 95% CI 2.97 to 3.96, p<0.0001).ConclusionsIn-hospital mortality for patients diagnosed with TS and ACS was similar. However, while postdischarge survivors of TS had a long-term survival which was poorer than for a community-based cohort without known CVD, their survival was better than for postdischarge survivors of an ACS event. Late deaths in patients with TS were almost all from non-cardiac causes.

scholarly journals The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting

2021 ◽  
Vol 8 ◽  
Author(s):  
Blanka Morvai-Illés ◽  
Nóra Polestyuk-Németh ◽  
István Adorján Szabó ◽  
Magdolna Monoki ◽  
Luna Gargani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Adverse Outcomes ◽  
Ambulatory Setting ◽  
Preserved Ejection Fraction ◽  
Newly Diagnosed ◽  
Echocardiographic Parameters ◽  
B Lines

Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed.Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting.Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death.Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at &gt;15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p &lt; 0.001).Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.

scholarly journals The prognostic value of B-lines in heart failure with preserved ejection fraction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
N Nemeth ◽  
B Morvai-Illes ◽  
I Szabo ◽  
L Gargani ◽  
A Varga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Diuretic Therapy ◽  
Adverse Outcomes ◽  
Preserved Ejection Fraction ◽  
Funding Sources ◽  
Echocardiographic Parameters ◽  
B Lines

Abstract Funding Acknowledgements Type of funding sources: None. Background  Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Despite its common occurrence, HFpEF remained a challenge in every aspect. The evaluation of B-lines with lung ultrasound (LUS) is a promising diagnostic and prognostic tool in this population. Objectives The aim of our study was to assess the diagnostic and prognostic performance of B-lines compared with traditional clinical, echocardiographic parameters and natriuretic peptide levels in patients with clinical suspicion of HFpEF. Methods 78 consecutive patients (70.45 ± 6.75 years, 72% female) with suspected HFpEF were prospectively enrolled. Exclusion criteria were: ejection fraction ≤55%, more than mild mitral and/or aortic valve disease, cardiomyopathy, pulmonary disease, pulmonary arterial hypertension, renal failure and anemia. All patients underwent comprehensive echocardiography, lung ultrasound exam and NT-proBNP measurement during their first appointment. Our endpoint was a composite of acute heart failure (HF),  hospitalization for the worsening HF symptoms and intensification of diuretic therapy. Also, traditional major cardiac adverse events such as death, myocardial infarction, stroke and revascularization were collected. Results We detected 11 events during 12 ± 6 months follow up. The number of B-lines showed a good correlation with NT-proBNP levels (p &lt; 0,001, r = 0.693). B-lines were found to have similar performance to NT-proBNP in predicting events (AUC = 0.778 vs. 0.770, respectively). Those who had more than 30 B-lines on LUS had significantly worse event-free survival p = 0.004. Having more than 30 B-lines at baseline was associated with 7 times greater hazard of adverse outcomes. Conclusions LUS is a simple, feasible tool to detect pulmonary congestion in patients with HFpEF. In our prospective cohort study, LUS was found to be a useful tool for prognostic stratification. Abstract Figure. Prognostic value of B-lines

scholarly journals Takotsubo Syndrome: Uncovering Myths and Misconceptions

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
Victoria L. Cammann ◽  
Michael Würdinger ◽  
Jelena R. Ghadri ◽  
Christian Templin
Keyword(s):  
Clinical Characteristics ◽  
Recurrent Events ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Takotsubo Syndrome ◽  
The Past ◽  
Substantial Risk ◽  
Morphological Variants ◽  
Medical Disciplines ◽  
Acute Event

Abstract Purpose of Review Takotsubo syndrome (TTS) was described in Japan 3 decades ago to affect predominately postmenopausal women after emotional stress. This history is the basis of commonly held beliefs which may contribute to the underdiagnosis and misperception of TTS. Recent Findings TTS affects not only women, but can be present in both sexes, and can appear in children as well as in the elderly. TTS is characterized by unique clinical characteristics with morphological variants, and incurs a substantial risk for recurrent events and adverse outcomes. Physical triggers are more common than emotional triggers and are major disease determinants. TTS seems not to be completely transient as patients report ongoing chest pain, dyspnea, or fatigue even after months of the acute event. Summary Knowledge of the clinical features and outcomes of TTS patients has evolved substantially over the past decades. The heterogeneous appearance of TTS needs to be recognized in all medical disciplines to maximize therapy and improve outcomes.

scholarly journals Pre-operative right ventricular echocardiographic parameters associated with short-term outcomes and long-term mortality after CABG

2018 ◽  
pp. 155-166 ◽  
Author(s):  
Mohammed Andaleeb Chowdhury ◽  
Jered M Cook ◽  
George V Moukarbel ◽  
Sana Ashtiani ◽  
Thomas A Schwann ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Performance Index ◽  
Left Atrial ◽  
Adverse Outcomes ◽  
Myocardial Performance ◽  
Short Term ◽  
Echocardiographic Parameters ◽  
Long Term Mortality

Background This analysis aims to assess the prognostic value of pre-operative right ventricular echocardiographic parameters in predicting short-term adverse outcomes and long-term mortality after coronary artery bypass graft (CABG). Methods Study design: Observational retrospective cohort. Pre-operative echocardiographic data, perioperative adverse outcomes (POAO) and long-term mortality were retrospectively analyzed in 491 patients who underwent isolated CABG at a single academic center between 2006 and 2014. Results Average age of enrolled subjects was 66 ± 11.5 years with majority being male (69%). 227/491 patients had 30 days POAO (46%); most common being post-operative atrial fibrillation (27.3%) followed by prolonged ventilation duration (12.7%). On multivariate analysis, left atrial volume index ≥42 mL/m2 (LAVI) (OR (95% CI): 1.98 (1.03–3.82), P = 0.04), mitral E/A >2 (1.97 (1.02–3.78), P = 0.04), right atrial size >18 cm2 (1.86 (1.14–3.05), P = 0.01), tricuspid annular plane systolic excursion (TAPSE) <16 mm (1.8 (1.03–3.17), P = 0.04), right ventricular systolic pressure (RVSP) ≥36 mmHg (pulmonary hypertension) (1.6 (1.03–2.38), P = 0.04) and right ventricle myocardial performance index (RVMPI) >0.55 (1.58 (1.01–2.46), P = 0.04) were found to be associated with increased 30-day POAO. On 3.5-year follow-up, cumulative survival was decreased in patients with myocardial performance index (MPI) ≥0.55 (log rank: 4.5, P = 0.034) and in patients with mitral valve E/e′ ≥14 (log rank: 4.9, P = 0.026). Conclusion Pre-operative right ventricle dysfunction (RVD) is associated with increased perioperative complications. Furthermore, pre-operative RVD and increased left atrial pressures are associated with long-term mortality post CABG.

Abstract 11521: Prognostic Value of Left Atrial Function in Normal Exercise Stress Echocardiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rayji S Tsutsui ◽  
Kenya Kusunose ◽  
Zoran B Popovic ◽  
James D Thomas
Keyword(s):  
Prognostic Value ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Statistical Significance ◽  
Adverse Outcomes ◽  
Exercise Stress ◽  
Exercise Stress Echocardiography ◽  
Echocardiographic Parameters ◽  
The Mean ◽  
Artery Disease

Background: The association between poor left atrial (LA) function and adverse outcomes in subjects following an acute myocardial infarction is recognized. On the other hand, prognostic value of LA function in low risk subjects is not well characterized. The purpose of this study was to assess the prognostic value of LA function in subjects who have exercise stress echocardiography negative for ischemia. Methods: Subjects who underwent exercise stress echocardiography for exclusion of coronary artery disease (CAD) between January to April 2010 were included. Subjects were excluded if they were in atrial fibrillation/flutter at the time of exercise, left ventricular ejection fraction (LVEF) < 45%, moderate or severe valvular disease, echocardiographic evidence of exercise-induced myocardial ischemia, or had known CAD. Maximum metabolic equivalents (METs), LA total strain (analyzed offline with Siemens Syngo VVI), LV E/e’, LA volume index (LAVI) were measured for all subjects. Diagnosis of major adverse cardiac events (MACE: myocardial infarction, coronary revascularization, cardiovascular mortality) and coronary artery disease (CAD: angina, unstable angina) were recorded. Results: Of 672 subjects identified, 486 subjects remained after exclusion. The mean follow up time was 51.6 ± 1.2 months, and the mean LVEF was 56 ± 5%. Following the index stress test, 25 (5%) subjects had MACE and 35 (7%) subjects had CAD. With MACE, maximum METs was a strong prognostic factor, with worse outcome when METs < 9 (median = 9). None of the echocardiographic parameters reached statistical significance. For CAD, none of the variables reached statistical significance including METs. Conclusions: In subjects who have negative exercise stress test for ischemia, reduced METs was strongly associated with adverse outcomes. In this low risk population, none of the tested LA echocardiographic parameters appeared to be associated with adverse outcomes.

scholarly journals Longitudinal strain by speckle tracking and echocardiographic parameters as predictors of adverse cardiovascular outcomes in chronic Chagas cardiomyopathy

2022 ◽  
Author(s):  
Luis Eduardo Echeverría ◽  
Lyda Z. Rojas ◽  
Oscar L. Rueda-Ochoa ◽  
Sergio Alejandro Gómez-Ochoa ◽  
Miguel A. Mayer ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Assist ◽  
Chagas Cardiomyopathy ◽  
Echocardiographic Parameters ◽  
Incremental Prognostic Value

AbstractTo analyze the prognostic value of left ventricular global longitudinal strain (LV-GLS) and other echocardiographic parameters to predict adverse outcomes in chronic Chagas cardiomyopathy (CCM). Prospective cohort study conducted in 177 consecutive patients with different CCM stages. Transthoracic echocardiography measurements were obtained following the American Society of Echocardiography recommendations. By speckle-tracking echocardiography, LV-GLS was obtained from the apical three-chamber, apical two-chamber, and apical four-chamber views. The primary composite outcome (CO) was all-cause mortality, cardiac transplantation, and a left ventricular assist device implantation. After a median follow-up of 42.3 months (Q1 = 38.6; Q3 = 52.1), the CO incidence was 22.6% (95% CI 16.7–29.5%, n = 40). The median LV-GLS value was − 13.6% (Q1 =  − 18.6%; Q3 =  − 8.5%). LVEF, LV-GLS, and E/e′ ratio with cut-off points of 40%, − 9, and 8.1, respectively, were the best independent CO predictors. We combined these three echocardiographic markers and evaluated the risk of CO according to the number of altered parameters, finding a significant increase in the risk across the groups. While in the group of patients in which all these three parameters were normal, only 3.2% had the CO; those with all three abnormal parameters had an incidence of 60%. We observed a potential incremental prognostic value of LV-GLS in the multivariate model of LVEF and E/e′ ratio, as the AUC increased slightly from 0.76 to 0.79, nevertheless, this difference was not statistically significant (p = 0.066). LV-GLS is an important predictor of adverse cardiovascular events in CCM, providing a potential incremental prognostic value to LVEF and E/e′ ratio when analyzed using optimal cut-off points, highlighting the potential utility of multimodal echocardiographic tools for predicting adverse outcomes in CCM.

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