scholarly journals Morphofunctional cardiac changes in pregnant women: associations with biomarkers

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000850 ◽  
Author(s):  
Takeshi Umazume ◽  
Takahiro Yamada ◽  
Satoshi Yamada ◽  
Satoshi Ishikawa ◽  
Itsuko Furuta ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Vena Cava ◽  
Left Ventricular ◽  
Volume Index ◽  
Blood Levels ◽  
Lv Mass ◽  
Creatine Kinase Mb ◽  
In Pregnancy

ObjectiveThis longitudinal study was performed to determine changes in echocardiography parameters in association with various biomarker levels in pregnancy/postpartum.MethodsFifty-one healthy pregnant women underwent echocardiography with simultaneous determination of blood levels of five biomarkers at each of the first, second and third trimesters of pregnancy, immediately postpartum within 1 week after childbirth and approximately 1 month postpartum. Data on 255 echocardiography scans (five times per woman) and biomarkers were analysed.ResultsLeft ventricular end-diastolic dimension, left atrial (LA) volume index and left ventricular (LV) mass index increased with advancing gestation and reached the maximum immediately postpartum concomitant with the highest brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI) and creatine kinase MB levels. The inferior vena cava diameter was significantly reduced in the third trimester compared with that in the first trimester and the peak occurred immediately after childbirth. In 255 paired measurements, hs-TnI level was significantly positively correlated with LA volume index and LV mass index; BNP and NT-proBNP were significantly positively correlated with LA volume index and estimated glomerular filtration rate (eGFR) was significantly positively correlated with the average of early diastolic septal and lateral mitral annular velocity (e′).ConclusionsMaximal cardiac changes in morphology occurred postpartum within 1 week after childbirth, not during pregnancy. BNP/NT-proBNP, hs-TnI and eGFR reflected cardiac changes in pregnancy.

scholarly journals Cardiac-specific troponins in uncomplicated pregnancy and pre-eclampsia: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247946
Author(s):  
Samuel Dockree ◽  
Jennifer Brook ◽  
Brian Shine ◽  
Tim James ◽  
Lauren Green ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Troponin I ◽  
Troponin T ◽  
High Sensitivity ◽  
Reference Intervals ◽  
Careful Consideration ◽  
Blood Levels ◽  
Specific Reference ◽  
Uncomplicated Pregnancy ◽  
In Pregnancy

Background The risk of myocardial infarction (MI) increases during pregnancy, particularly in women with pre-eclampsia. MI is diagnosed by measuring high blood levels of cardiac-specific troponin (cTn), although this may be elevated in women with pre-eclampsia without MI, which increases diagnostic uncertainty. It is unclear how much cTn is elevated in uncomplicated and complicated pregnancy, which may affect whether the existing reference intervals can be used in pregnant women. Previous reviews have not investigated high-sensitivity troponin in pregnancy, compared to older, less sensitive methods. Methods Electronic searches using the terms “troponin I” or “troponin T”, and “pregnancy”, “pregnancy complications” or “obstetrics”. cTn levels were extracted from studies of women with uncomplicated pregnancies or pre-eclampsia. Results The search identified ten studies with 1581 women. Eight studies used contemporary methods that may be too insensitive to use reliably in this clinical setting. Two studies used high-sensitivity assays, with one reporting an elevation in troponin I (TnI) in pre-eclampsia compared to uncomplicated pregnancy, and the other only examining women with pre-eclampsia. Seven studies compared cTn between women with pre-eclampsia or uncomplicated pregnancy using any assay. Seven studies showed elevated TnI in pre-eclampsia compared to uncomplicated pregnancy or non-pregnant women. One study measured troponin T (TnT) in pregnancy but did not examine pre-eclampsia. Conclusion TnI appears to be elevated in pre-eclampsia, irrespective of methodology, which may reflect the role of cardiac stress in this condition. TnI may be similar in healthy pregnant and non-pregnant women, but we found no literature reporting pregnancy-specific reference intervals using high-sensitivity tests. This limits broader application of cTn in pregnancy. There is a need to define reference intervals for cTn in pregnant women, which should involve serial sampling throughout pregnancy, with careful consideration for gestational age and body mass index, which cause dynamic changes in normal maternal physiology.

scholarly journals Association of peripartum troponin I levels with left ventricular relaxation in women with hypertensive disorders of pregnancy

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000829
Author(s):  
Takeshi Umazume ◽  
Satoshi Yamada ◽  
Takahiro Yamada ◽  
Satoshi Ishikawa ◽  
Itsuko Furuta ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Troponin I ◽  
Vena Cava ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Hypertensive Disorders Of Pregnancy ◽  
Third Trimester ◽  
Receiver Operating Characteristic Curves ◽  
The Third ◽  
Hypertensive Disorders

ObjectiveWomen with hypertensive disorders of pregnancy (HDP) show elevated risk of heart failure despite decreased circulating plasma volume compared with those with normotensive control pregnancies (NCP). This study was performed to better characterise the heart in women with HDP and determine whether high-sensitivity troponin I (hs-TnI) around childbirth predicts reduced left ventricular (LV) relaxation at 1 month postpartum.MethodsEchocardiography was performed longitudinally during the first, second and third trimesters and immediately postpartum within 1 week and 1 month postpartum in 24 women with HDP, with simultaneous determination of blood variables in comparison with 51 women with NCP.ResultsCompared with NCP, HDP showed greater antepartum left atrial (LA) volume, LV mass and inferior vena cava (IVC) diameter, higher peripartum brain natriuretic peptide/N-terminal pro–B-type natriuretic peptide and hs-TnI with the highest value immediately postpartum, and lower early diastolic mitral annular velocity (e') during pregnancy/postpartum. In analyses of data on HDP and NCP, hs-TnI at the third trimester as well as that immediately postpartum was negatively correlated with later e' at 1 month postpartum. The areas under the receiver operating characteristic curves were 0.82 and 0.81 for hs-TnI at the third trimester and immediately postpartum, respectively, in the prediction of reduced LV relaxation at 1 month postpartum.ConclusionReduced LV diastolic function and decreased splanchnic blood reservoir may contribute to the increased third trimester IVC diameter and LA volume in women with HDP. The rise in hs-TnI around childbirth was associated with poor LV relaxation ability at 1 month postpartum.

Abstract P234: Hypertensive Disorders Of Pregnancy And Increased Levels Of Cardiac Troponin I After Delivery

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Takao Kato ◽  
Eri Muta ◽  
Moriaki Inoko
Keyword(s):  
Pregnant Women ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Normal Population ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hypertensive Disorders Of Pregnancy ◽  
Ventricular Ejection Fraction ◽  
Hypertensive Disorders

Background: Cardiovascular functions and hemodynamics dramatically change during pregnancy such as cardiac output, expanded blood volume, reduced systematic vascular resistance, and heart chamber enlargement. Hypertensive disorders of pregnancy (HDP) may affect the cardiac load during pregnancy; however, the data about plasma concentration of cardiac troponin in pregnant women with HDP is very limited. Methods: We prospectively collected data of 751 pregnant women between 2012 and 2013 in Japanese general hospital. We analyzed laboratory data and echocardiographic findings after delivery. The elevated cTnI was defined as >0.015 ng/mL because the normal population have serum cTnI of less than 0.015 ng/mL in this assay. Results: The HDP were observed in 32 patients; the elevated cTnI was observed 40 patients. The age of patients with HDP (33.7 ±4.3 years) was not different from that of those without HDP (33.3 ± 5.0 years). The brain natriuretic peptides levels were not different between those with and without HDP. The proportion of elevated cTnI was higher in those with HDP (21.8%) than those without (3.6%, P<0.0001). After adjusting for confounders, the risk of elevated cTnI in those with HDP relative to those without HDP remained significant (odds ratio 4.52, 95% confidence interval 1.45-14.5). There were no women with reduced left ventricular ejection fraction. Conclusions: HDP was associated with elevated cTni, suggesting myocardial microinjury might occur more frequently in those with HDP.

Effect of endurance training on cardiac morphology in Alaskan sled dogs

1998 ◽  
Vol 85 (4) ◽  
pp. 1368-1375 ◽  
Author(s):  
R. L. Stepien ◽  
K. W. Hinchcliff ◽  
P. D. Constable ◽  
J. Olson
Keyword(s):  
Endurance Training ◽  
Morphological Changes ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Weight ◽  
Wall Thickening ◽  
Cardiac Morphology ◽  
End Diastolic Volume ◽  
Sled Dogs ◽  
Lv Mass

The cardiac morphology of 77 conscious Alaskan sled dogs before and after 5 mo of endurance training (20 km/day team pulling a sled and musher) was studied using two-dimensional and M-mode echocardiography. Subgroups included dogs with at least one season of previous training (“veterans”) and dogs undergoing their first season of training (“rookies”). Training resulted in a significant ( P< 0.05) decrease in resting heart rate (−15%) and significant increases in interventricular septal thickness (systole, 15%; diastole, 13%), left ventricular (LV) internal dimension in diastole (LVIDd, 4%), LV free wall thickness in systole (9%) and diastole (LVWd, 9%), and left atrial diameter (5%) in all dogs, but the increase in LVWd was greater in rookies (16%) than in veterans (7%). Training increased end-diastolic volume index (8%), LV mass index (24%), and heart weight index (24%) and decreased the LVIDd-to-LVWd ratio (−6%) but did not alter cardiac index. We conclude that increased LV mass attributable to LV dilation and hypertrophy is associated with endurance training in Alaskan sled dogs. Disproportionate LV wall thickening accompanying LV dilation suggests that cardiac morphological changes are due to volume and pressure loading. These training-induced changes are similar to those documented in human athletes undergoing combined isometric and isotonic training and differ from studies of dogs trained on treadmills.

scholarly journals Assessment of Left Atrial Function after ST-Segment Elevation Acute Myocardial Infarction: An Application of Real Time Three-Dimensional Echocardiography

2021 ◽  
Author(s):  
yuxia Miao ◽  
min Xu ◽  
yuetao Wang ◽  
xiao Xie ◽  
fei Liu ◽  
...  
Keyword(s):  
Real Time ◽  
Acute Phase ◽  
Troponin I ◽  
Contractile Function ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Functional Change ◽  
Multiple Time ◽  
St Segment Elevation ◽  
Creatine Kinase Mb

Objective: The purpose of this study is to evaluate the changes of LA size and function by real-time 3D echocardiography (RT-3DE), and provide a better understanding about their effects on treatment and prognosis. Methods: Ten Bama miniature pigs were used for modeling STEMI. Images were obtained by RT-3DE at multiple time points. From the LA volume-time relation curve, the LA volume (LAV) and functions (storage, channel, and active emptying) at different phases were calculated. Blood samples were obtained for measurements of NT-proBNP, creatine kinase-MB(CK-MB) and cardiac Troponin-I(cTn-I). Results: (1) LAVmax, LAVmin and LAVpre-a were all increased with time. (2) The LA expansion index was the most sensitive index of LA functional change. It increased (p< .05 vs. baseline) at the 1st day after STEMI (acute phase), and was correlated with diastolic function E/E’ (p< .05), as shown by univariate correlation analysis. (3) On the 28th day after STEMI, the active emptying percentage of total emptying (AE) showed a continuously increasing trend (p< .05), and was correlated with VTILVOT (time-velocity integral of left ventricular outflow tract) (p< .05). Conclusions: During the acute phase after STEMI, LA volume changed in order to increase LV preload. After STIMI, the storage function of LA was the first to change, while active contractile function was significantly enhanced during subacute phase. With the accurate measurement of LA function with RT-3DE, our study will help improving the therapeutic target setting and pharmacologic interventions, which may enhance the clinical outcomes of STEMI patients.

Abstract 13055: Impact of New Pacing Requirement on Echocardiographic Outcomes After Transcatheter Aortic Valve Replacement With Sapien-3 Valve

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yasser Sammour ◽  
Rama D Gajulapalli ◽  
Hassan Mehmood Lak ◽  
Sanchit Chawla ◽  
Arnav Kumar ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Cleveland Clinic ◽  
Vena Cava ◽  
Left Ventricular ◽  
The Other ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sapien 3 ◽  
The Impact

Introduction: New permanent pacemaker (PPM) requirement has been linked with left ventricular dysfunction after TAVR. Objective: We sought to study the impact of new PPM on echocardiographic outcomes after TAVR with SAPIEN-3 (S3) valve. Methods: We included consecutive patients who underwent TAVR with S3 valve at the Cleveland Clinic between April 2015 and December 2018. Patients with prior PPM were excluded. Echocardiograms were reviewed to determine left ventricular ejection fraction (LVEF), left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi), left ventricular dimension during diastole (LVDd), posterior wall thickness during diastole (PWTd), interventricular septum during diastole (IVSd), right ventricular systolic pressure (RVSP), inferior vena cava (IVC) diameter and tricuspid regurgitation (TR) grade. Results: Among 886 patients, the rate of 30-day PPM was 10.2%. Baseline LVEF was similar between new PPM and no PPM (55.4 ± 12.7% vs. 57.2 ± 11.2%; p = 0.188). There were no differences in the other studied echocardiographic parameters at baseline. Among patients with new PPM, LVEF was lower at both 30 days (54.4 ± 11.3% vs. 58.4 ± 10.1%; p = 0.001) and 1 year (54.2 ± 12% vs. 59.1 ± 11.3%; p = 0.009) compared to no PPM with Δ LVEF -0.9% vs. +1.4%; p = 0.023. There were no differences in LVEDVi (52 ± 20.8 vs. 48.3 ± 17.6; p = 0.186) at 1 year. LVESVi was higher with new PPM (24.8 ± 16.1 vs. 20.2 ± 10.9; p = 0.038). However, Δ LVESVi was similar between the 2 groups (-1.6 vs. -2.6; p = 0.517). There were no differences in RVSP (38.9 ± 14.1 vs. 40 ± 14; p = 0.58). LVIDd, PWTd, IVSd and IVC diameter also did not show variations whether patients were paced or not. Moderate to severe TR rates were similar as well (17.7% vs. 21.5%; p = 0.407). Conclusion: Among S3 TAVR recipients, new pacing requirement had a detrimental impact on LVEF at both 30 days and 1 year. However, it did not seem to affect the other studied echocardiographic outcomes after TAVR.

Abstract 13441: D-dimmer is a Predictor of Cancer Therapeutics-related Cardiac Dysfunction in Patients Treated With Cardiotoxic Chemotherapy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Masayoshi Oikawa ◽  
Daiki Yaegashi ◽  
Tetsuro Yokokawa ◽  
Tomofumi Misaka ◽  
Takamasa Sato ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Troponin I ◽  
Uterine Cancer ◽  
Cancer Therapeutics ◽  
Left Ventricular ◽  
Time Dependent ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
D Dimer

Background: D-dimer is a sensitive biomarker for cancer-associated thrombosis, but little is known about its significance on cancer therapeutics-related cardiac dysfunction (CTRCD). Methods and Results: Consequtive 202 patients planned for cardiotoxic chemotherapy (anthracyclines, monoclonal antibodies, tyrosine kinase inhibitors, and proteasome inhibitors) were enrolled and followed up for 12 months. Cancer types were as follows: breast cancer (n=112), lymphoma (n=37), ovarian or uterine cancer (n=18), leukemia (n=13), multiple myeloma (n=6), bone cancer (n=4), and others (n=12). All patients underwent echocardiography and blood test at baseline, 3-month, 6-month, and 12-month. The patients were divided into 2 groups based on the value of D-dimer (>1.5 μg/ml or ≦1.5 μg/ml) at baseline before chemotherapy: High D-dimer group (n=52) and Low D-dimer group (n=150). At baseline, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index, and B-type natriuretic peptide levels were similar between two groups. Time-dependent decrease in LVEF was observed after chemotherapy in high D-dimer group (baseline, 66±5%; 3-month, 63±7%; 6-month, 62±7%; 12-month 62±6%; P=0.005, figure), but not in low D-dimer group. Time-dependent increase in troponin I was similarly observed after chemotherapy in both groups. The occurrence of CTRCD was higher in high D-dimer group than in low D-dimer group (11.5% vs. 4.0%, P=0.048). When we set the cut-off value of baseline D-dimer at 1.65 μg/ml from ROC analysis, sensitivity, specificity, and area under the curve to predict CTRCD were 50%, 77%, and 0.679, respectively. Multivariable logistic analysis revealed that baseline D-dimer was an independent factor to predict the decrease in LVEF more than 10% after cardiotoxic chemotherapy (odds ratio 1.210, 95% confidence interval [1.020-1.440], P=0.025). Conclusion: Baseline D-dimer is a pivotal parameter to predict CTRCD.

Do Pediatric Sickle Cell Disease Patients Develop Diastolic Dysfunction?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3195-3195
Author(s):  
Mark V. Zilberman ◽  
Wei Du ◽  
Wanda J. Whitten-Surney ◽  
Sharada A. Sarnaik
Keyword(s):  
Mitral Valve ◽  
Sickle Cell Disease ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Volume Index ◽  
Cell Disease ◽  
Mitral Inflow ◽  
Lv Mass ◽  
Z Scores ◽  
Mass Volume

Abstract Sickle cell disease (SCD) is a known cause of chronic volume overload. Although systolic dysfunction is rare, as many as 80% of adult patients with SCD have an echocardiographic mitral valve inflow pattern suggestive of abnormal left ventricular (LV) diastolic function (DF). DF has not been studied in pediatric SCD patients. Therefore, the objective of this study was to evaluate DF in pediatric SCD patients using echocardiographic velocities of mitral inflow and tissue Doppler (TDI) indices. Echocardiograms were performed in 79 SCD patients (ages 2 – 18 years), and 84 controls matched for age and race. LV and left atrial (LA) volumes, LV mass, early (E) and late (A) mitral inflow velocities, and TDI velocities at the septal and lateral aspects of the mitral valve were obtained. LV dilatation was defined as LV end-diastolic dimension more then 2 standard deviations above the median (z-value &gt;2). LV hypertrophy was defined as LV mass/volume index&gt;1.15 g/ml. For SCD patients, average hemoglobin (Hb) levels for the year prior to the study were recorded. Data were analyzed using t-test and Spearman correlation analysis. Of 79 SCD subjects, 32 (43%) had LV dilatation, 11(14.9%) had LV hypertrophy and 3 had both. LV z-scores were inversely related to Hb (r −0.62, p&lt;0.0001) but unrelated to age. The early mitral inflow velocities E were negatively correlated with Hb levels(r − 0.34, p&lt;0.04) and were positively correlated with LV z-scores (r 0.41, p&lt;0.04) reflecting pre-load dependency of mitral inflow indices. DTI diastolic velocities were unrelated to Hg or LV size reflecting pre-load independent nature of these indices. DTI systolic velocities S’ correlated positively with LV mass/volume index (r 0.28, p&lt;0.02). SCD patients had significantly larger LV and LA volumes than controls (p&lt;0.01). The early E and late A mitral inflow velocities were higher in the SCD group than the control, although the differences were not statistically significant. DTI indices did not differ between SCD patients and the control. Conclusion: Despite high incidence of left ventricular dilatation, pediatric SCD patients don’t demonstrate diastolic dysfunction when evaluated using pre-load independent echocardiographic tissue Doppler indices.

Role of Troponins I and T and N-Terminal Prohormone of Brain Natriuretic Peptide in Monitoring Cardiac Safety of Patients With Early-Stage Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer Receiving Trastuzumab: A Herceptin Adjuvant Study Cardiac Marker Substudy

2017 ◽  
Vol 35 (8) ◽  
pp. 878-884 ◽  
Author(s):  
Dimitrios Zardavas ◽  
Thomas M. Suter ◽  
Dirk J. Van Veldhuisen ◽  
Jutta Steinseifer ◽  
Johannes Noe ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Elevated Troponin ◽  
Cardiac Marker ◽  
Ventricular Ejection Fraction ◽  
End Point

Purpose Women receiving trastuzumab with chemotherapy are at risk for trastuzumab-related cardiac dysfunction (TRCD). We explored the prognostic value of cardiac markers (troponins I and T, N-terminal prohormone of brain natriuretic peptide [NT-proBNP]) to predict baseline susceptibility to develop TRCD. We examined whether development of cardiac end points or significant left ventricular ejection fraction (LVEF) drop was associated with markers’ increases. Patients and Methods Cardiac marker assessments were coupled with LVEF measurements at different time points for 533 patients from the Herceptin Adjuvant (HERA) study who agreed to participate in this study. Patients with missing marker assessments were excluded, resulting in 452 evaluable patients. A primary cardiac end point was defined as symptomatic congestive heart failure of New York Heart Association class III or IV, confirmed by a cardiologist, and a significant LVEF drop, or death of definite or probable cardiac causes. A secondary cardiac end point was defined as a confirmed significant asymptomatic or mildly symptomatic LVEF drop. Results Elevated baseline troponin I (> 40 ng/L) and T (> 14 ng/L), occurring in 56 of 412 (13.6%) and 101 of 407 (24.8%) patients, respectively, were associated with an increased significant LVEF drop risk (univariate analysis: hazard ratio, 4.52; P < .001 and hazard ratio, 3.57; P < .001, respectively). Few patients had their first elevated troponin value recorded during the study (six patients for troponin I and 25 patients for troponin T). Two patients developed a primary and 31 patients a secondary cardiac end point (recovery rate of 74%, 23 of 31). For NT-proBNP, higher increases from baseline were seen in patients with significant LVEF drop. Conclusion Elevated troponin I or T before trastuzumab is associated with increased risk for TRCD. A similar conclusion for NT-proBNP could not be drawn because of the lack of a well-established elevation threshold; however, higher increases from baseline were seen in patients with TRCD compared with patients without.

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