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Roger Luccioni - One of the best experts on this subject based on the ideXlab platform.
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Accuracy of bedside Tissue Doppler Echocardiography for the prediction of in-hospital mortality in elderly patients with acute heart failure with preserved left ventricular systolic function. Comparison with B-type natriuretic peptide measurement
International journal of cardiology, 2007Co-Authors: Stephane Arques, Emmanuel Roux, Pierre Ambrosi, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, Roger LuccioniAbstract:According to recent studies, Tissue Doppler Echocardiography used as a non-invasive surrogate for left ventricular diastolic pressures regardless of rhythm is likely to offer additional information beyond the clinical judgment and the B-type natriuretic peptide (BNP) assay in the emergency diagnosis of acute heart failure with preserved left ventricular systolic function (HFPSF). The present study attempted to determine the usefulness of bedside Tissue Doppler Echocardiography as compared with BNP, both obtained at presentation before unloading therapy, for the prediction of in-hospital outcome in 75 consecutive elderly patients with acute HFPSF, of whom 16 died during their in-hospital stay. Unlike BNP (p=0.002), the spectral Tissue Doppler-derived E/Ea ratio was not able to provide prognostic information in such patients before tailored therapy (p=0.9).
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Accuracy of Tissue Doppler Echocardiography in the Diagnosis of New-Onset Congestive Heart Failure in Patients with Levels of B-Type Natriuretic Peptide in the Midrange and Normal Left Ventricular Ejection Fraction
Echocardiography (Mount Kisco N.Y.), 2006Co-Authors: Stephane Arques, Emmanuel Roux, Pierre Ambrosi, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, Roger LuccioniAbstract:Background: Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of Tissue Doppler Echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. Methods: 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100–400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler Echocardiography was performed within 3 hours after admission. Results: unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). Conclusion: by better reflecting LV filling pressures, bedside Tissue Doppler Echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction.
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Accuracy of Tissue Doppler Echocardiography in the emergency diagnosis of decompensated heart failure with preserved left ventricular systolic function: comparison with B-type natriuretic peptide measurement.
Echocardiography (Mount Kisco N.Y.), 2005Co-Authors: Stephane Arques, Emmanuel Roux, Pierre Ambrosi, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, Lionel Taieb, Roger LuccioniAbstract:BACKGROUND Tissue Doppler Echocardiography provides a reliable noninvasive estimation of left ventricular (LV) filling pressures irrespective of LV ejection fraction. However, the diagnostic accuracy of E/Ea ratio has not been adequately determined in patients with suspected heart failure (HF) with preserved LV systolic function in the acute care setting. OBJECTIVE To investigate the accuracy of E/Ea ratio in the emergency diagnosis of decompensated HF with preserved LV systolic function. METHODS Seventy patients with a LV ejection fraction >or=45%, 32 with decompensated HF (77 +/- 12 years of age), and 38 with noncardiac cause of acute dyspnea (74 +/- 12) were enrolled. B-type natriuretic peptide (BNP) was measured on admission; lateral, septal and average E/Ea ratios were calculated within 24 hours. RESULTS Using receiver-operating characteristic curves to evaluate diagnostic performance, BNP (AUC of 0.875, P < 0.0001) and E/Ea ratios (AUC of 0.90-0.92, P < 0.0001) provided similar accuracy for predicting decompensated HF. Optimal cutoffs were 146 pg/ml for BNP (sensitivity and specificity of 90.6% and 76.3%), 9.8 for lateral E/Ea (83.3% and 88.9%), 12.7 for septal E/Ea (76.7% and 91.4%), and 11.5 for average E/Ea ratio (80% and 94.3%). On multivariate logistic regression analysis, average E/Ea ratio yielded independent additional information to a model based on the clinical judgment and BNP level according to the standard cutoff of 100 pg/ml. CONCLUSIONS Tissue Doppler Echocardiography is accurate for predicting decompensated HF with preserved LV systolic function and may be used as a diagnostic complement to inconclusive BNP level in this setting.
J M Walker - One of the best experts on this subject based on the ideXlab platform.
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Tissue Doppler Echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload
European Heart Journal, 2003Co-Authors: M Vogel, Lisa J Anderson, S Holden, J E Deanfield, Dudley J Pennell, J M WalkerAbstract:Aims To compare an echocardiographic method for detecting abnormal cardiac function before development of overt cardiomyopathy with a recently validated technique of quantifying myocardial iron load. Methods and results We examined thalassaemia patients whose myocardial iron load had been evaluated with magnetic resonance imaging (MRI). By Tissue Doppler Echocardiography, myocardial velocities were sampled continuously from base to apex in the RV and LV free wall, and the septum in 52 patients aged 29.2 (14.2–43.1) years and 52 age-matched controls. Ninety-six percent of patients had normal LV ejection fraction by MRI. Thirty-eight (73%) had abnormal iron loading of the myocardium, and 33 of those had regional wall motion abnormalities detected in the septum (n=29), LV (n=2), RV (n=1), and septum plus LV (n=1). The incidence of wall motion abnormalities was significantly higher ( P <0.04) in patients with myocardial iron overload (87%) than in the 14 without (35%). Furthermore, myocardial iron overload was suggested by a low T2*(15.1±15.8 ms) in patients with wall motion abnormalities vs those with normal wall motion (T2*: 30±19 ms) ( P <0.007). Conclusions Wall motion abnormalities may represent an early sign of cardiac disease despite preserved global function. The regional abnormalities are related to iron overload and easily detectable with Tissue Doppler Echocardiography.
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Tissue Doppler Echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload.
European heart journal, 2003Co-Authors: M Vogel, Lisa J Anderson, S Holden, J E Deanfield, Dudley J Pennell, J M WalkerAbstract:Aims To compare an echocardiographic method for detecting abnormal cardiac function before development of overt cardiomyopathy with a recently validated technique of quantifying myocardial iron load. Methods and results We examined thalassaemia patients whose myocardial iron load had been evaluated with magnetic resonance imaging (MRI). By Tissue Doppler Echocardiography, myocardial velocities were sampled continuously from base to apex in the RV and LV free wall, and the septum in 52 patients aged 29.2 (14.2–43.1) years and 52 age-matched controls. Ninety-six percent of patients had normal LV ejection fraction by MRI. Thirty-eight (73%) had abnormal iron loading of the myocardium, and 33 of those had regional wall motion abnormalities detected in the septum (n=29), LV (n=2), RV (n=1), and septum plus LV (n=1). The incidence of wall motion abnormalities was significantly higher ( P
Stephane Arques - One of the best experts on this subject based on the ideXlab platform.
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Accuracy of bedside Tissue Doppler Echocardiography for the prediction of in-hospital mortality in elderly patients with acute heart failure with preserved left ventricular systolic function. Comparison with B-type natriuretic peptide measurement
International journal of cardiology, 2007Co-Authors: Stephane Arques, Emmanuel Roux, Pierre Ambrosi, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, Roger LuccioniAbstract:According to recent studies, Tissue Doppler Echocardiography used as a non-invasive surrogate for left ventricular diastolic pressures regardless of rhythm is likely to offer additional information beyond the clinical judgment and the B-type natriuretic peptide (BNP) assay in the emergency diagnosis of acute heart failure with preserved left ventricular systolic function (HFPSF). The present study attempted to determine the usefulness of bedside Tissue Doppler Echocardiography as compared with BNP, both obtained at presentation before unloading therapy, for the prediction of in-hospital outcome in 75 consecutive elderly patients with acute HFPSF, of whom 16 died during their in-hospital stay. Unlike BNP (p=0.002), the spectral Tissue Doppler-derived E/Ea ratio was not able to provide prognostic information in such patients before tailored therapy (p=0.9).
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Usefulness of Bedside Tissue Doppler Echocardiography and B‐Type Natriuretic Peptide (BNP) in Differentiating Congestive Heart Failure from Noncardiac Cause of Acute Dyspnea in Elderly Patients with a Normal Left Ventricular Ejection Fraction and Per
Echocardiography (Mount Kisco N.Y.), 2007Co-Authors: Stephane Arques, Emmanuel Roux, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, F.a.c.c. Roger Luccioni, Pierre AmbrosiAbstract:BACKGROUND The incremental role of bedside Tissue Doppler Echocardiography and B-type natriuretic peptide (BNP) over the clinical judgment has been recently reported in the emergency diagnosis of congestive heart failure with a normal left ventricular ejection fraction (HFNEF). However, how well does this diagnostic strategy be applicable in the setting of atrial fibrillation is unknown. OBJECTIVE To investigate the usefulness of bedside Tissue Doppler Echocardiography and BNP in the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation. METHODS Forty-one consecutive elderly patients with an ejection fraction > or =50% (mean age 84 years; 22 with HFNEF and 19 with noncardiac cause), hospitalized for acute dyspnea at rest, were prospectively enrolled; bedside septal E/Ea and BNP were obtained at admission. RESULTS By multivariable logistic regression analysis including the clinical judgment of heart failure, E/Ea and BNP, E/Ea (P = 0.014) and BNP (P = 0.018) provided independent diagnostic information. Optimal cutoffs were 13 for E/Ea (area under the ROC curve of 0.846, P < 0.0001; sensitivity 81.8%, specificity 89.5%) and 253 pg/ml for BNP (area under the ROC curve of 0.928, P < 0.0001; sensitivity 86.4%, specificity 89.5%). The concordance between the clinical judgment and BNP concentration at the cutoff of 253 pg/ml correctly classified 24 of 25 patients; E/Ea at the cutoff of 13 correctly classified 14 of the 16 patients with discrepancy. CONCLUSION Bedside Tissue Doppler Echocardiography and BNP provide useful additional diagnostic information over the clinical judgment for the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.
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Accuracy of Tissue Doppler Echocardiography in the Diagnosis of New-Onset Congestive Heart Failure in Patients with Levels of B-Type Natriuretic Peptide in the Midrange and Normal Left Ventricular Ejection Fraction
Echocardiography (Mount Kisco N.Y.), 2006Co-Authors: Stephane Arques, Emmanuel Roux, Pierre Ambrosi, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, Roger LuccioniAbstract:Background: Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of Tissue Doppler Echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. Methods: 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100–400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler Echocardiography was performed within 3 hours after admission. Results: unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). Conclusion: by better reflecting LV filling pressures, bedside Tissue Doppler Echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction.
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Accuracy of Tissue Doppler Echocardiography in the emergency diagnosis of decompensated heart failure with preserved left ventricular systolic function: comparison with B-type natriuretic peptide measurement.
Echocardiography (Mount Kisco N.Y.), 2005Co-Authors: Stephane Arques, Emmanuel Roux, Pierre Ambrosi, Pascal Sbragia, Richard Gelisse, Bertrand Pieri, Lionel Taieb, Roger LuccioniAbstract:BACKGROUND Tissue Doppler Echocardiography provides a reliable noninvasive estimation of left ventricular (LV) filling pressures irrespective of LV ejection fraction. However, the diagnostic accuracy of E/Ea ratio has not been adequately determined in patients with suspected heart failure (HF) with preserved LV systolic function in the acute care setting. OBJECTIVE To investigate the accuracy of E/Ea ratio in the emergency diagnosis of decompensated HF with preserved LV systolic function. METHODS Seventy patients with a LV ejection fraction >or=45%, 32 with decompensated HF (77 +/- 12 years of age), and 38 with noncardiac cause of acute dyspnea (74 +/- 12) were enrolled. B-type natriuretic peptide (BNP) was measured on admission; lateral, septal and average E/Ea ratios were calculated within 24 hours. RESULTS Using receiver-operating characteristic curves to evaluate diagnostic performance, BNP (AUC of 0.875, P < 0.0001) and E/Ea ratios (AUC of 0.90-0.92, P < 0.0001) provided similar accuracy for predicting decompensated HF. Optimal cutoffs were 146 pg/ml for BNP (sensitivity and specificity of 90.6% and 76.3%), 9.8 for lateral E/Ea (83.3% and 88.9%), 12.7 for septal E/Ea (76.7% and 91.4%), and 11.5 for average E/Ea ratio (80% and 94.3%). On multivariate logistic regression analysis, average E/Ea ratio yielded independent additional information to a model based on the clinical judgment and BNP level according to the standard cutoff of 100 pg/ml. CONCLUSIONS Tissue Doppler Echocardiography is accurate for predicting decompensated HF with preserved LV systolic function and may be used as a diagnostic complement to inconclusive BNP level in this setting.
M Vogel - One of the best experts on this subject based on the ideXlab platform.
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Tissue Doppler Echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload
European Heart Journal, 2003Co-Authors: M Vogel, Lisa J Anderson, S Holden, J E Deanfield, Dudley J Pennell, J M WalkerAbstract:Aims To compare an echocardiographic method for detecting abnormal cardiac function before development of overt cardiomyopathy with a recently validated technique of quantifying myocardial iron load. Methods and results We examined thalassaemia patients whose myocardial iron load had been evaluated with magnetic resonance imaging (MRI). By Tissue Doppler Echocardiography, myocardial velocities were sampled continuously from base to apex in the RV and LV free wall, and the septum in 52 patients aged 29.2 (14.2–43.1) years and 52 age-matched controls. Ninety-six percent of patients had normal LV ejection fraction by MRI. Thirty-eight (73%) had abnormal iron loading of the myocardium, and 33 of those had regional wall motion abnormalities detected in the septum (n=29), LV (n=2), RV (n=1), and septum plus LV (n=1). The incidence of wall motion abnormalities was significantly higher ( P <0.04) in patients with myocardial iron overload (87%) than in the 14 without (35%). Furthermore, myocardial iron overload was suggested by a low T2*(15.1±15.8 ms) in patients with wall motion abnormalities vs those with normal wall motion (T2*: 30±19 ms) ( P <0.007). Conclusions Wall motion abnormalities may represent an early sign of cardiac disease despite preserved global function. The regional abnormalities are related to iron overload and easily detectable with Tissue Doppler Echocardiography.
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Tissue Doppler Echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload.
European heart journal, 2003Co-Authors: M Vogel, Lisa J Anderson, S Holden, J E Deanfield, Dudley J Pennell, J M WalkerAbstract:Aims To compare an echocardiographic method for detecting abnormal cardiac function before development of overt cardiomyopathy with a recently validated technique of quantifying myocardial iron load. Methods and results We examined thalassaemia patients whose myocardial iron load had been evaluated with magnetic resonance imaging (MRI). By Tissue Doppler Echocardiography, myocardial velocities were sampled continuously from base to apex in the RV and LV free wall, and the septum in 52 patients aged 29.2 (14.2–43.1) years and 52 age-matched controls. Ninety-six percent of patients had normal LV ejection fraction by MRI. Thirty-eight (73%) had abnormal iron loading of the myocardium, and 33 of those had regional wall motion abnormalities detected in the septum (n=29), LV (n=2), RV (n=1), and septum plus LV (n=1). The incidence of wall motion abnormalities was significantly higher ( P
A. A. Ionescu - One of the best experts on this subject based on the ideXlab platform.
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Subclinical right ventricular dysfunction in cystic fibrosis. A study using Tissue Doppler Echocardiography.
American journal of respiratory and critical care medicine, 2001Co-Authors: Alan G. Fraser, A. A. Ionescu, Nicola Payne, Izaskun Obieta-fresnedo, Dennis J. ShaleAbstract:Patients with severe cystic fibrosis can develop cor pulmonale, but little is known about the function of the right ventricle (RV) early in the disease. We hypothesized that such patients might have subclinical RV dysfunction, detectable by Tissue Doppler Echocardiography, and related to the severity of lung disease. We studied 21 clinically stable patients (Group 1), five patients with severe lung disease (Group 2), and 23 age-matched healthy subjects. Patients had impaired RV systolic function. The mean (SD) systolic velocities of the RV free wall were 8.9 (1.7) cm/s in Group 1, 7.7 (1.0) in Group 2, and 10.8 (1.9) in healthy subjects (p < 0.001). The velocities of the tricuspid annulus were less in patients (p < 0.0001). Patients had a greater isovolumic relaxation time (p < 0.001), indicating RV diastolic dysfunction. RV wall thickness was greater in patients (0.4 [0.1] versus 0.3 [0.1] cm/m(2), p < 0.01). RV systolic function was related to C-reactive protein (r = - 0.66, p < 0.001) and FEV(1) (r = 0.62, p = 0.003) and diastolic function to interleukin-6 (r = 0.64, p < 0.005). Patients with cystic fibrosis have subclinical RV dysfunction, which correlates with the severity of lung disease. Tissue Doppler Echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression.
