The international journal of cardiovascular imaging
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Int J Cardiovasc Imaging · Oct 2014
Prognostic significance of dilated inferior vena cava in advanced decompensated heart failure.
Dilated inferior vena cava (IVC) is prevalent among patients with heart failure (HF), but whether its presence predicts worsening renal function (WRF) or adverse outcomes is unclear. This cohort study analyzed patients with left ventricular ejection fraction <40 % and repeated hospitalizations (≥2 times) for HF between August 2009 and August 2011. The study endpoints were death and HF re-hospitalization. ⋯ In Cox regression model, the risk of combined end-points was increased in patients with aging, elevated blood urine nitrogen, IVC >21 mm, and WRF. When adjusted for confounding factors, IVC >21 mm [hazard ratio (HR) 3.73, 95 % confidence interval (CI) 1.66-8.34] and WRF (HR 2.68, 95 % CI 1.07-6.75) were significant predictors for adverse outcomes. In patients with advanced decompensated HF, dilated IVC (>21 mm) predicted the development of WRF and could be a predictor for adverse outcomes.
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Int J Cardiovasc Imaging · Oct 2014
Evaluation of global circumferential strain as prognostic marker after administration of β-blockers for dilated cardiomyopathy.
The use of β-blockers has improved the prognosis of dilated cardiomyopathy (DCM) and the appearance of left ventricular (LV) reverse remodeling is generally thought to result in a more favorable prognosis. While there are many prognostic predictors, not all of them are applicable to individual patients. Global circumferential strain (GCS) was identified as a powerful prognostic marker, which appears to be a better parameter than LV global function for patients with depressed left ventricular (LV) ejection fraction. ⋯ An important finding of multivariate logistic regression analysis was that GCS was the best independent predictor of LV reverse remodeling (OR 7.692; 95 % CI 2.292-25.82; p = 0.001). It should be noted that only 1.3 ± 0.4 min per patient was needed to analyze GCS. In conclusions, GCS could result in further improvements in predicting LV reverse remodeling after β-blocker administration, and have clinical implications for better management in daily clinical practice.
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Int J Cardiovasc Imaging · Oct 2014
Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension.
We tested the hypothesis that the addition of right atrial (RA) remodeling to right ventricular (RV) function enhances the capability of the latter to predict long-term outcome for pulmonary hypertension (PH) patients. We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). ⋯ Kaplan-Meier analysis revealed that patients with RV-free ≤19.4 % had worse long-term outcomes than those with RV-free >19.4 % (log-rank p = 0.01), as did patients with RA area >18 cm(2) compared with those with RA area ≤18 cm(2) (log-rank p < 0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 = 3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 = 9.24; p < 0.05), and RV-free (χ2 = 17.11; p = 0.005), and further improved by addition of RA area (χ2 = 21.36, p < 0.05). In conclusion, the combined assessment of RV function and RA area results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.
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Int J Cardiovasc Imaging · Oct 2014
Comparative StudyReproducibility of area at risk assessment in acute myocardial infarction by T1- and T2-mapping sequences in cardiac magnetic resonance imaging in comparison to Tc99m-sestamibi SPECT.
Area at risk (AAR) is an important parameter for the assessment of the salvage area after revascularization in acute myocardial infarction (AMI). By combining AAR assessment by T2-weighted imaging and scar quantification by late gadolinium enhancement imaging cardiovascular magnetic resonance (CMR) offers a promising alternative to the "classical" modality of Tc99m-sestamibi single photon emission tomography (SPECT). Current T2 weighted sequences for edema imaging in CMR are limited by low contrast to noise ratios and motion artifacts. ⋯ AAR assessed by SPECT measured 41.6 ± 20.7 %LV. Correlation analysis revealed best correlation with SPECT for T2-MAP at a T2-threshold of 60 ms (ms) (slope = 0.99, Pearson's r = 0.94), and for MOLLI at T1-threshold of 1,075 ms (slope 0.86, r = 0.91, Pearson's r = 0.45). For the assessment of AAR in AMI, the novel T2-mapping technique correlates best with SPECT size, T1-mapping with MOLLI and standard T2-weighted imaging showed similar good correlations.