Michael Coll Barroso

Elevated plasma levels of TNF-alpha and interleukin-6 in patients with diastolic dysfunction and glucose metabolism disorders.

BackgroundDiabetes mellitus (DM) has reached epidemic proportions and is an important risk factor for heart failure (HF). Left ventricular diastolic dysfunction (LVDD) is recognized as the earliest manifestation of DM-induced LV dysfunction, but its pathophysiology remains incompletely understood. We sought to evaluate the relationship between proinflammatory cytokine levels (TNF-alpha, IL-6) and tissue Doppler derived indices of LVDD in patients with stable coronary artery disease.MethodsWe enrolled 41 consecutive patients (mean age 65+/-10 years) submitted for coronary angiography. Echocardiographic assessment was performed in all patients. Pulsed tissue Doppler imaging was performed at the mitral annulus and was characterized by the diastolic early relaxation velocity Em. Conventional transmitral flow was measured with pw-doppler. Early (E) transmitral flow velocity was measured. LVDD was defined as E/Em ratio ≥ 15, E/Em 8-14 was classified as borderline. Plasma levels of TNF-alpha and IL-6 were determined in all patients. A standardized oral glucose tolerance test was performed in subjects without diabetes.ResultsPatients with E/Em ratio ≥ 15, classified as LVDD and those with E/Em ratio 8-14 (classified as borderline) had significantly higher IL-6 (P = 0,001), TNF-alpha (P < 0,001) and NT-pro- BNP (P = 0,001) plasma levels compared to those with normal diastolic function. TNF-alpha and IL-6 levels remains significantly elevated after adjustment for sex, age, left ventricular ejection function, body mass index, coronary heart disease, smoking, hypertension and diabetes mellitus with linear regression analysis. Furthermore, in subjects LVDD or borderline LV diastolic function, 75% had diabetes or IGT, respectively. When subjects without diabetes were excluded, both IL-6 (P = 0,006) and TNF-alpha (P = 0,002) remained significantly elevated in subjects with E/Em ratio ≥ 15.ConclusionThis study reveals that increased plasma levels of IL-6 and TNF-alpha were associated with LVDD. These findings suggest a link between low-grade inflammation and the presence of LVDD. An active proinflammatory process may be of importance in the pathogenesis of diastolic dysfunction.

Reduced global longitudinal strain in association to increased left ventricular mass in patients with aortic valve stenosis and normal ejection fraction: a hybrid study combining echocardiography and magnetic resonance imaging

BackgroundIncreased muscle mass index of the left ventricle (LVMi) is an independent predictor for the development of symptoms in patients with asymptomatic aortic stenosis (AS). While the onset of clinical symptoms and left ventricular systolic dysfunction determines a poor prognosis, the standard echocardiographic evaluation of LV dysfunction, only based on measurements of the LV ejection fraction (EF), may be insufficient for an early assessment of imminent heart failure. Contrary, 2-dimensional speckle tracking (2DS) seems to be superior in detecting subtle changes in myocardial function. The aim of the study was to assess these LV function deteriorations with global longitudinal strain (GLS) analysis and the relations to LVMi in patients with AS and normal EF.Methods50 patients with moderate to severe AS and 31 controls were enrolled. All patients underwent echocardiography, including 2DS imaging. LVMi measures were performed with magnetic resonance imaging in 38 patients with AS and indexed for body surface area.ResultsThe total group of patients with AST showed a GLS of -15,2 ± 3,6% while the control group reached -19,5 ± 2,7% (p < 0,001). By splitting the group with AS in normal, moderate and severe increased LVMi, the GLS was -17,0 ± 2,6%, -13,2 ± 3,8% and -12,4 ± 2,9%, respectively (p = 0,001), where LVMi and GLS showed a significant correlation (r = 0,6, p < 0,001).ConclusionsIn conclusion, increased LVMi is reflected in abnormalities of GLS and the proportion of GLS impairment depends on the extent of LV hypertrophy. Therefore, simultaneous measurement of LVMi and GLS might be useful to identify patients at high risk for transition into heart failure who would benefit from aortic valve replacement irrespectively of LV EF.

High sensitive troponin T and heart fatty acid binding protein: Novel biomarker in heart failure with normal ejection fraction?: A cross-sectional study

BackgroundHigh sensitive troponin T (hsTnT) and heart fatty acid binding protein (hFABP) are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF). We tested whether hsTnT and hFABP plasma levels are elevated in patients with heart failure with normal ejection fraction (HFnEF).MethodsWe analyzed hsTnT, hFABP and N-terminal brain natriuretic peptide in 130 patients comprising 49 HFnEF patients, 51 patients with asymptomatic left ventricular diastolic dysfunction (LVDD), and 30 controls with normal diastolic function. Patients were classified to have HFnEF when the diagnostic criteria as recommended by the European Society of Cardiology were met.ResultsLevels of hs TnT and hFABP were significantly higher in patients with asymptomatic LVDD and HFnEF (both p < 0.001) compared to controls. The hsTnT levels were 5.6 [0.0-9.8] pg/ml in LVDD vs. 8.5 [3.9-17.5] pg/ml in HFnEF vs. <0.03 [< 0.03-6.4] pg/ml in controls; hFABP levels were 3029 [2533-3761] pg/ml in LVDD vs. 3669 [2918-4839] pg/ml in HFnEF vs. 2361 [1860-3081] pg/ml in controls. Furthermore, hsTnT and hFABP levels were higher in subjects with HFnEF compared to LVDD (p = 0.015 and p = 0.022).ConclusionIn HFnEF patients, hsTnT and hFABP are elevated independent of coronary artery disease, suggesting that ongoing myocardial damage plays a critical role in the pathophysiology. A combination of biomarkers and echocardiographic parameters might improve diagnostic accuracy and risk stratification of patients with HFnEF.

Serum insulin-like growth factor-1 and its binding protein-7: potential novel biomarkers for heart failure with preserved ejection fraction

BackgroundInsulin-like growth factor binding protein-7 (IGFBP-7) modulates the biological activities of insulin-like growth factor-1 (IGF-1). Previous studies demonstrated the prognostic value of IGFBP-7 and IGF-1 among patients with systolic heart failure (HF). This study aimed to evaluate the IGF1/IGFBP-7 axis in HF patients with preserved ejection fraction (HFpEF).MethodsSerum IGF-1 and IGFBP-7 levels were measured in 300 eligible consecutive patients who underwent comprehensive cardiac assessment. Patients were categorized into 3 groups including controls with normal diastolic function (n = 55), asymptomatic left ventricular diastolic dysfunction (LVDD, n = 168) and HFpEF (n = 77).ResultsIGFBP-7 serum levels showed a significant graded increase from controls to LVDD to HFpEF (median 50.30 [43.1-55.3] vs. 54.40 [48.15-63.40] vs. 61.9 [51.6-69.7], respectively, P < 0.001), whereas IGF-1 levels showed a graded decline from controls to LVDD to HFpEF (120.0 [100.8-144.0] vs. 112.3 [88.8-137.1] vs. 99.5 [72.2-124.4], p < 0.001). The IGFBP-7/IGF-1 ratio increased from controls to LVDD to HFpEF (0.43 [0.33-0.56] vs. 0.48 [0.38-0.66] vs. 0.68 [0.55-0.88], p < 0.001). Patents with IGFB-7/IGF1 ratios above the median demonstrated significantly higher left atrial volume index, E/E’ ratio, and NT-proBNP levels (all P ≤ 0.02).ConclusionIn conclusion, this hypothesis-generating pilot study suggests the IGFBP-7/IGF-1 axis correlates with diastolic function and may serve as a novel biomarker in patients with HFpEF. A rise in IGFBP-7 or the IGFBP-7/IGF-1 ratio may reflect worsening diastolic function, adverse cardiac remodeling, and metabolic derangement.

Growth-differentiation factor-15: a novel biomarker in patients with diastolic dysfunction?

BACKGROUND Growth differentiation factor-15 (GDF-15), a stress-responsive transforming growth factor-ß-related cytokine, is elevated and independently related to an adverse prognosis in systolic heart failure. OBJECTIVE This study aimed to investigate plasma levels of GDF-15 in patients with preclinical diastolic dysfunction or heart failure with normal ejection fraction (HFnEF). METHODS We evaluated 119 patients with normal ejection fraction referred for an elective coronary angiography, 75 (63%) of whom had coronary artery disease. Subjects were classified as having either mild left ventricular diastolic dysfunction (LVDD grade I, n = 61), HFnEF (LVDD grade II or III, n = 38) or normal diastolic function (controls, n = 20). In a subgroup of 20 subjects, changes in cardiac output (CO) were measured by inert gas rebreathing (InnocorTM) in response to an orthostatic hemodynamic test. RESULTS Growth differentiation factor-15 levels in HFnEF [median 1.08, interquartile range (0.88-1.30) ng/ml] were significantly higher than in controls [0.60 (0.50-0.71) ng/ml, p = 0.003] and in patients with LVDD grade I [0.78 (0.62-1.04) ng/ml, p < 0.001]. In addition, GDF-15 was significantly elevated in patients with LVDD grade I compared to controls (p = 0.003). Furthermore, GDF-15 was correlated with echocardiographic markers of diastolic dysfunction and was correlated with the magnitude of CO response to the change in body position from standing to supine (r = -0.67, p = 0.005). CONCLUSION Growth differentiation factor-15 levels are elevated in subjects with HFnEF and can differentiate normal diastolic function from asymptomatic LVDD. In addition, GDF-15 is associated with a reduced cardiac output response in the orthostatic hemodynamic test.FUNDAMENTO: El factor de diferenciacion de crecimiento-15 o GDF-15, una citocina de respuesta al estres relacionada con el factor transformador de crecimiento beta (TGF-s), es elevado y esta independientemente relacionado con el pronostico adverso en la insuficiencia cardiaca sistolica. OBJETIVO: El objetivo del presente estudio es investigar los niveles plasmaticos de GDF-15 en pacientes con disfuncion diastolica preclinica o insuficiencia cardiaca con fraccion de eyeccion normal (ICFEN). METODOS: Evaluamos a 119 pacientes con fraccion de eyeccion (FE) normal, derivados a angiografia coronaria electiva, de los cuales 75 (63%), tenian enfermedad arterial coronaria (EAC). Los individuos fueron clasificados como teniendo una disfuncion diastolica ventricular izquierda leve (DDVI grado I, n = 61), ICFEN (DDVI grado II o III, n = 38), o funcion diastolica normal (controles, n = 20). En un subgrupo de 20 individuos, las alteraciones en el debito cardiaco (DC), se midieron a traves de una nueva inhalacion de gas inerte (Innocor®) en respuesta a un test hemodinamico ortostatico. RESULTADOS: Los niveles de GDF-15 en la ICFEN [mediana 1,08, variacion intercuartil (0,88-1,30) ng/ml], eran significantemente mas altos que en los controles [0,60 (0,50-0,71) ng/ml, p = 0,003] y en los pacientes con DDVI grado I [0,78 (0,62-1,04) ng/ml, p < 0,001]. Ademas, los niveles de GDF-15 estaban significantemente elevados en los pacientes con DDVI grado I, en comparacion con los controles (p = 0,003). Por anadidura, el GDF-15 estaba correlacionado con los marcadores ecocardiograficos de disfuncion diastolica y con la magnitud de la respuesta del DC a la alteracion en la posicion del cuerpo variando de la posicion erecta a la posicion supina (r = -0,67, p = 0,005). CONCLUSION: Los niveles de GDF-15 estan elevados en individuos con ICFEN y pueden diferenciar una funcion diastolica normal de DDVI. Ademas, los niveles de GDF-15 estan asociados con una reduccion en la respuesta del DC en el test hemodinamico ortostatico.

Fator de diferenciação de crescimento 15: um novo biomarcador em pacientes com disfunção diastólica?

BACKGROUND Growth differentiation factor-15 (GDF-15), a stress-responsive transforming growth factor-ß-related cytokine, is elevated and independently related to an adverse prognosis in systolic heart failure. OBJECTIVE This study aimed to investigate plasma levels of GDF-15 in patients with preclinical diastolic dysfunction or heart failure with normal ejection fraction (HFnEF). METHODS We evaluated 119 patients with normal ejection fraction referred for an elective coronary angiography, 75 (63%) of whom had coronary artery disease. Subjects were classified as having either mild left ventricular diastolic dysfunction (LVDD grade I, n = 61), HFnEF (LVDD grade II or III, n = 38) or normal diastolic function (controls, n = 20). In a subgroup of 20 subjects, changes in cardiac output (CO) were measured by inert gas rebreathing (InnocorTM) in response to an orthostatic hemodynamic test. RESULTS Growth differentiation factor-15 levels in HFnEF [median 1.08, interquartile range (0.88-1.30) ng/ml] were significantly higher than in controls [0.60 (0.50-0.71) ng/ml, p = 0.003] and in patients with LVDD grade I [0.78 (0.62-1.04) ng/ml, p < 0.001]. In addition, GDF-15 was significantly elevated in patients with LVDD grade I compared to controls (p = 0.003). Furthermore, GDF-15 was correlated with echocardiographic markers of diastolic dysfunction and was correlated with the magnitude of CO response to the change in body position from standing to supine (r = -0.67, p = 0.005). CONCLUSION Growth differentiation factor-15 levels are elevated in subjects with HFnEF and can differentiate normal diastolic function from asymptomatic LVDD. In addition, GDF-15 is associated with a reduced cardiac output response in the orthostatic hemodynamic test.FUNDAMENTO: El factor de diferenciacion de crecimiento-15 o GDF-15, una citocina de respuesta al estres relacionada con el factor transformador de crecimiento beta (TGF-s), es elevado y esta independientemente relacionado con el pronostico adverso en la insuficiencia cardiaca sistolica. OBJETIVO: El objetivo del presente estudio es investigar los niveles plasmaticos de GDF-15 en pacientes con disfuncion diastolica preclinica o insuficiencia cardiaca con fraccion de eyeccion normal (ICFEN). METODOS: Evaluamos a 119 pacientes con fraccion de eyeccion (FE) normal, derivados a angiografia coronaria electiva, de los cuales 75 (63%), tenian enfermedad arterial coronaria (EAC). Los individuos fueron clasificados como teniendo una disfuncion diastolica ventricular izquierda leve (DDVI grado I, n = 61), ICFEN (DDVI grado II o III, n = 38), o funcion diastolica normal (controles, n = 20). En un subgrupo de 20 individuos, las alteraciones en el debito cardiaco (DC), se midieron a traves de una nueva inhalacion de gas inerte (Innocor®) en respuesta a un test hemodinamico ortostatico. RESULTADOS: Los niveles de GDF-15 en la ICFEN [mediana 1,08, variacion intercuartil (0,88-1,30) ng/ml], eran significantemente mas altos que en los controles [0,60 (0,50-0,71) ng/ml, p = 0,003] y en los pacientes con DDVI grado I [0,78 (0,62-1,04) ng/ml, p < 0,001]. Ademas, los niveles de GDF-15 estaban significantemente elevados en los pacientes con DDVI grado I, en comparacion con los controles (p = 0,003). Por anadidura, el GDF-15 estaba correlacionado con los marcadores ecocardiograficos de disfuncion diastolica y con la magnitud de la respuesta del DC a la alteracion en la posicion del cuerpo variando de la posicion erecta a la posicion supina (r = -0,67, p = 0,005). CONCLUSION: Los niveles de GDF-15 estan elevados en individuos con ICFEN y pueden diferenciar una funcion diastolica normal de DDVI. Ademas, los niveles de GDF-15 estan asociados con una reduccion en la respuesta del DC en el test hemodinamico ortostatico.

Assessment of aortic valve area combining echocardiography and magnetic resonance imaging

FUNDAMENTO: La ecocardiografia transtoracica (ETT) es habitualmente utilizada para calcular el area de la valvula aortica (AVA) por la ecuacion de continuidad (EC). Mientras tanto, la medida exacta de las vias de salida del ventriculo izquierdo (VSVI) puede ser dificil y la aceleracion del flujo en el VSVI puede llevar a error de calculo del AVA. OBJETIVO: El objetivo del nuestro estudio fue comparar las mediciones del AVA por ETT estandar, resonancia magnetica cardiaca (RM) y un abordaje hibrido que combina las dos tecnicas. METODOS: AEI AVA fue calculada en 38 pacientes (edad 73 ± 9 anos) con la ETT estandar, planimetria cine-RM y un abordaje hibrido: Metodo hibrido 1: la medicion de la VSVI derivada por el ETT en el numerador CE fue substituida por la evaluacion de resonancia magnetica de la VSVI y el AVA fue calculada: (VSVIRM/*VSVI-VTIETT)/transaortico-VTIETT; Metodo 2: Substituimos el VS en el numerador por el VS derivado por la RM y calculamos el AVA = VSRM/transaortico-VTIETT. RESULTADOS: La media de AVA obtenida por la ETT fue 0,86 cm2 ± 0,23 cm2 y 0,83 cm2 ± 0,3 cm2 por la RM-planimetria, respectivamente. La diferencia media absoluta del AVA fue de 0,03 cm2 para la RM versus planimetria-resonancia magnetica. El AVA calculada con el metodo 1 y el metodo 2 fue de 1,23 cm2 ± 0,4 cm2 y 0,92cm2 ± 0,32 cm2, respectivamente. La diferencia media absoluta entre la ETT y los metodos 1 y 2 fue de 0,37 cm2 y 0,06 cm2, respectivamente (p < 0,001). CONCLUSION: La RM-planimetria del AVA y el metodo hibrido 2 son precisos y demostraron buena consistencia con las mediciones estandar obtenidas por la ETT. Por lo tanto, el metodo hibrido 2 es una alternativa razonable en la eventualidad de ventanas acusticas malas o en caso de aceleraciones de flujo VSVI que limiten la precision de la ETT, particularmente en pacientes con alto riesgo de un estudio hemodinamico invasivo.BACKGROUND Transthoracic echocardiography (TTE) is routinely used to calculate aortic valve area (AVA) by continuity equation (CE). However, accurate measurement of the left ventricular outflow tract (LVOT) can be difficult and flow acceleration in the LVOT may lead to miscalculation of the AVA. OBJECTIVE The aim of our study was to compare AVA measurements by standard TTE, cardiac magnetic resonance imaging (MRI) and a hybrid approach combining both techniques. METHODS AVA was calculated in 38 patients (age 73±9 years) with standard TTE, cine-MRI planimetry and a hybrid approach: Hybrid Method 1: TTE-derived LVOT measurement in the CE numerator was replaced by the MRI assessment of the LVOT and AVA was calculated: (LVOT(MRI)/*LVOT-VTI(TTE))/transaortic-VTI(TTE). Method 2: We replaced the SV in the numerator by the MRI-derived SV and calculated AVA = SV(MRI)/ transaortic-VTI(TTE). RESULTS Mean AVA derived by TTE was 0.86 cm(2)±0.23 cm(2) and 0.83 cm(2)±0.3 cm(2) by MRI- planimetry, respectively. The mean absolute difference in AVA was 0.03 cm(2) for TTE vs. MRI planimetry. AVA calculated with method 1 and method 2 was 1.23 cm(2)±0.4 cm(2) and 0.92 cm(2)±0.32 cm(2), respectively. The mean absolute difference between TTE and method 1 and method 2 was 0.37 cm(2) and 0.06 cm(2), respectively (p<0.001). CONCLUSION MRI-planimetry of AVA and hybrid method 2 are accurate and showed a good agreement with standard TTE measurements. Therefore, hybrid method 1 is a reasonable alternative if poor acoustic windows or LVOT flow accelerations limit the accuracy of TTE, particularly in patients at high risk for an invasive hemodynamic study.

Avaliação da área valvar aórtica combinando ecocardiografia e ressonância magnética

FUNDAMENTO: La ecocardiografia transtoracica (ETT) es habitualmente utilizada para calcular el area de la valvula aortica (AVA) por la ecuacion de continuidad (EC). Mientras tanto, la medida exacta de las vias de salida del ventriculo izquierdo (VSVI) puede ser dificil y la aceleracion del flujo en el VSVI puede llevar a error de calculo del AVA. OBJETIVO: El objetivo del nuestro estudio fue comparar las mediciones del AVA por ETT estandar, resonancia magnetica cardiaca (RM) y un abordaje hibrido que combina las dos tecnicas. METODOS: AEI AVA fue calculada en 38 pacientes (edad 73 ± 9 anos) con la ETT estandar, planimetria cine-RM y un abordaje hibrido: Metodo hibrido 1: la medicion de la VSVI derivada por el ETT en el numerador CE fue substituida por la evaluacion de resonancia magnetica de la VSVI y el AVA fue calculada: (VSVIRM/*VSVI-VTIETT)/transaortico-VTIETT; Metodo 2: Substituimos el VS en el numerador por el VS derivado por la RM y calculamos el AVA = VSRM/transaortico-VTIETT. RESULTADOS: La media de AVA obtenida por la ETT fue 0,86 cm2 ± 0,23 cm2 y 0,83 cm2 ± 0,3 cm2 por la RM-planimetria, respectivamente. La diferencia media absoluta del AVA fue de 0,03 cm2 para la RM versus planimetria-resonancia magnetica. El AVA calculada con el metodo 1 y el metodo 2 fue de 1,23 cm2 ± 0,4 cm2 y 0,92cm2 ± 0,32 cm2, respectivamente. La diferencia media absoluta entre la ETT y los metodos 1 y 2 fue de 0,37 cm2 y 0,06 cm2, respectivamente (p < 0,001). CONCLUSION: La RM-planimetria del AVA y el metodo hibrido 2 son precisos y demostraron buena consistencia con las mediciones estandar obtenidas por la ETT. Por lo tanto, el metodo hibrido 2 es una alternativa razonable en la eventualidad de ventanas acusticas malas o en caso de aceleraciones de flujo VSVI que limiten la precision de la ETT, particularmente en pacientes con alto riesgo de un estudio hemodinamico invasivo.BACKGROUND Transthoracic echocardiography (TTE) is routinely used to calculate aortic valve area (AVA) by continuity equation (CE). However, accurate measurement of the left ventricular outflow tract (LVOT) can be difficult and flow acceleration in the LVOT may lead to miscalculation of the AVA. OBJECTIVE The aim of our study was to compare AVA measurements by standard TTE, cardiac magnetic resonance imaging (MRI) and a hybrid approach combining both techniques. METHODS AVA was calculated in 38 patients (age 73±9 years) with standard TTE, cine-MRI planimetry and a hybrid approach: Hybrid Method 1: TTE-derived LVOT measurement in the CE numerator was replaced by the MRI assessment of the LVOT and AVA was calculated: (LVOT(MRI)/*LVOT-VTI(TTE))/transaortic-VTI(TTE). Method 2: We replaced the SV in the numerator by the MRI-derived SV and calculated AVA = SV(MRI)/ transaortic-VTI(TTE). RESULTS Mean AVA derived by TTE was 0.86 cm(2)±0.23 cm(2) and 0.83 cm(2)±0.3 cm(2) by MRI- planimetry, respectively. The mean absolute difference in AVA was 0.03 cm(2) for TTE vs. MRI planimetry. AVA calculated with method 1 and method 2 was 1.23 cm(2)±0.4 cm(2) and 0.92 cm(2)±0.32 cm(2), respectively. The mean absolute difference between TTE and method 1 and method 2 was 0.37 cm(2) and 0.06 cm(2), respectively (p<0.001). CONCLUSION MRI-planimetry of AVA and hybrid method 2 are accurate and showed a good agreement with standard TTE measurements. Therefore, hybrid method 1 is a reasonable alternative if poor acoustic windows or LVOT flow accelerations limit the accuracy of TTE, particularly in patients at high risk for an invasive hemodynamic study.

Endostatin a Potential Biomarker for Heart Failure with Preserved Ejection Fraction

Background Endostatin is a circulating endogenous angiogenesis inhibitor preventing neovascularization. Previous studies demonstrated the prognostic value of Endostatin among patients with heart failure with reduced ejection fraction (HFrEF). However, the role of Endostatin among patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. Objective This study aimed to investigate the association between serum Endostatin levels, natriuretic peptide levels and the severity of left ventricular diastolic dysfunction and the diagnosis of HFpEF. Methods Endostatin serum concentrations were measured in 301 patients comprising 77 HFpEF patients, 169 patients with asymptomatic left ventricular diastolic dysfunction (ALVDD), and 55 controls with normal cardiac function. Results Endostatin serum levels were significantly elevated in patients with HFpEF (median/interquartile range 179.0 [159-220]) and ALVDD (163.8 [145.4-191.3]) compared to controls (149.1 [130.6-176.9]), p < 0.001 and p = 0.004, respectively) and significant correlated with N-terminal pro B-type natriuretic peptide (NT-proBNP). Conclusions This hypothesis-generating pilot study gives first evidence that Endostatin correlates with the severity of diastolic dysfunction and may become a novel biomarker for HFpEF. We hypothesize a rise in Endostatin levels may reflect inhibition of adaptive angiogenesis and adverse cardiac remodeling.

Evaluación del área valvular aórtica combinando ecocardiografía y resonancia magnética

FUNDAMENTO: La ecocardiografia transtoracica (ETT) es habitualmente utilizada para calcular el area de la valvula aortica (AVA) por la ecuacion de continuidad (EC). Mientras tanto, la medida exacta de las vias de salida del ventriculo izquierdo (VSVI) puede ser dificil y la aceleracion del flujo en el VSVI puede llevar a error de calculo del AVA. OBJETIVO: El objetivo del nuestro estudio fue comparar las mediciones del AVA por ETT estandar, resonancia magnetica cardiaca (RM) y un abordaje hibrido que combina las dos tecnicas. METODOS: AEI AVA fue calculada en 38 pacientes (edad 73 ± 9 anos) con la ETT estandar, planimetria cine-RM y un abordaje hibrido: Metodo hibrido 1: la medicion de la VSVI derivada por el ETT en el numerador CE fue substituida por la evaluacion de resonancia magnetica de la VSVI y el AVA fue calculada: (VSVIRM/*VSVI-VTIETT)/transaortico-VTIETT; Metodo 2: Substituimos el VS en el numerador por el VS derivado por la RM y calculamos el AVA = VSRM/transaortico-VTIETT. RESULTADOS: La media de AVA obtenida por la ETT fue 0,86 cm2 ± 0,23 cm2 y 0,83 cm2 ± 0,3 cm2 por la RM-planimetria, respectivamente. La diferencia media absoluta del AVA fue de 0,03 cm2 para la RM versus planimetria-resonancia magnetica. El AVA calculada con el metodo 1 y el metodo 2 fue de 1,23 cm2 ± 0,4 cm2 y 0,92cm2 ± 0,32 cm2, respectivamente. La diferencia media absoluta entre la ETT y los metodos 1 y 2 fue de 0,37 cm2 y 0,06 cm2, respectivamente (p < 0,001). CONCLUSION: La RM-planimetria del AVA y el metodo hibrido 2 son precisos y demostraron buena consistencia con las mediciones estandar obtenidas por la ETT. Por lo tanto, el metodo hibrido 2 es una alternativa razonable en la eventualidad de ventanas acusticas malas o en caso de aceleraciones de flujo VSVI que limiten la precision de la ETT, particularmente en pacientes con alto riesgo de un estudio hemodinamico invasivo.BACKGROUND Transthoracic echocardiography (TTE) is routinely used to calculate aortic valve area (AVA) by continuity equation (CE). However, accurate measurement of the left ventricular outflow tract (LVOT) can be difficult and flow acceleration in the LVOT may lead to miscalculation of the AVA. OBJECTIVE The aim of our study was to compare AVA measurements by standard TTE, cardiac magnetic resonance imaging (MRI) and a hybrid approach combining both techniques. METHODS AVA was calculated in 38 patients (age 73±9 years) with standard TTE, cine-MRI planimetry and a hybrid approach: Hybrid Method 1: TTE-derived LVOT measurement in the CE numerator was replaced by the MRI assessment of the LVOT and AVA was calculated: (LVOT(MRI)/*LVOT-VTI(TTE))/transaortic-VTI(TTE). Method 2: We replaced the SV in the numerator by the MRI-derived SV and calculated AVA = SV(MRI)/ transaortic-VTI(TTE). RESULTS Mean AVA derived by TTE was 0.86 cm(2)±0.23 cm(2) and 0.83 cm(2)±0.3 cm(2) by MRI- planimetry, respectively. The mean absolute difference in AVA was 0.03 cm(2) for TTE vs. MRI planimetry. AVA calculated with method 1 and method 2 was 1.23 cm(2)±0.4 cm(2) and 0.92 cm(2)±0.32 cm(2), respectively. The mean absolute difference between TTE and method 1 and method 2 was 0.37 cm(2) and 0.06 cm(2), respectively (p<0.001). CONCLUSION MRI-planimetry of AVA and hybrid method 2 are accurate and showed a good agreement with standard TTE measurements. Therefore, hybrid method 1 is a reasonable alternative if poor acoustic windows or LVOT flow accelerations limit the accuracy of TTE, particularly in patients at high risk for an invasive hemodynamic study.