scholarly journals Acute Cardiac Complications and Subclinical Myocardial Injuries Associated with Pheochromocytoma and Paraganglioma

2020 ◽  
Author(s):  
Yunlang Dai ◽  
Jing Zhou ◽  
He Xuan ◽  
Yunxiang Miu ◽  
Junting Hu
Keyword(s):  
Longitudinal Strain ◽  
Wide Spectrum ◽  
Comprehensive Analysis ◽  
Cardiac Complications ◽  
Preserved Ejection Fraction ◽  
Invasive Behavior ◽  
Catecholamine Excess ◽  
Cardiac Manifestations ◽  
Myocardial Injuries ◽  
Primary Pattern

Abstract Background: Catecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations, including acute cardiac complications (ACCs) and subclinical myocardial injuries (SMIs). Hence, we aimed to conduct a comprehensive analysis of ACCs and SMIs in a large cohort of PPGLs.Methods: We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2013 and July 2020 (n = 189). The prevalence and presentation of ACCs and SMIs were investigated, and comparisons were conducted between cases with and without ACCs. Results: Fourteen patients (7.4%) fulfilled the criteria for ACCs, consisting of nine cases (4.8%) with Takotsubo-like cardiomyopathy, three cases (1.6%) with heart failure with preserved ejection fraction, and the remaining one (0.5%) with catecholamine-induced cardiomyopathy. Compared to those without ACCs (n = 175), patients with ACCs had higher prevalence of epinephrine-producing PPGLs (81.8% vs 33.9%. P = 0.006), and were more likely to show invasive behavior (61.5% vs 27.3%, P = 0.022) and hemorrhage/necrosis (53.9% vs 17.4%, P = 0.005) at histology. Among patients suffered Takotsubo-like cardiomyopathy, an apical sparing pattern (5/7, 71.4%) dominated in the impaired patterns of longitudinal strain (LS). In the end, a fairly high percent (21/77, 27.2%) of patients (excluding 14 cases with ACCs) who underwent screening troponin, natriuretic peptide, and echocardiography had SMIs.Conclusions: One in every fourteen PPGLs patients presented with ACCs; and, in the cases with Takotsubo-like cardiomyopathy, an apical sparing pattern was the primary pattern in LS. Furthermore, nearly one-third of patients without symptoms had SMIs. The diagnosis of PPGLs should be considered in patients with acute reversible cardiomyopathy, especially with an apical sparing pattern in LS.

scholarly journals Acute cardiac complications and subclinical myocardial injuries associated with pheochromocytoma and paraganglioma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Zhou ◽  
He Xuan ◽  
Yunxiang Miao ◽  
Junting Hu ◽  
Yunlang Dai
Keyword(s):  
Longitudinal Strain ◽  
Wide Spectrum ◽  
Comprehensive Analysis ◽  
Cardiac Complications ◽  
Preserved Ejection Fraction ◽  
Cardiac Symptoms ◽  
Invasive Behavior ◽  
Catecholamine Excess ◽  
Cardiac Manifestations ◽  
Myocardial Injuries

Abstract Background Catecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations, including acute cardiac complications (ACCs) and subclinical myocardial injuries (SMIs). In this study, we aimed to conduct a comprehensive analysis of ACCs and SMIs in a large cohort of patients with PPGLs. Methods We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2013 and July 2020 (n = 189). The prevalence of ACCs and SMIs and characteristics of patients identified with ACCs and SMIs were investigated. Moreover, comparisons were performed between patients with and without ACCs. Results Fourteen patients (7.4%) fulfilled the criteria for ACCs, including nine (4.8%) who presented with Takotsubo-like cardiomyopathy, four (2.1%) with heart failure with preserved ejection fraction, and finally one (0.5%) with catecholamine-induced cardiomyopathy. Compared to those without ACCs (n = 175), patients with ACCs had a higher prevalence of epinephrine-producing PPGLs (81.8% vs 33.9%, P = 0.006) and were more likely to show invasive behavior (61.5% vs 27.3%, P = 0.022) or hemorrhage/necrosis (53.9% vs 17.4%, P = 0.005) on histology. The apical sparing pattern (5/7, 71.4%) was the dominant impairment pattern of longitudinal strain (LS) for patients displaying Takotsubo-like cardiomyopathy. In patients without cardiac symptoms, a fairly high proportion (21/77, 27.3%) of patients who underwent screening for troponin and/or natriuretic peptide and/or echocardiography had SMIs. Conclusions One in every fourteen PPGL patients presented with ACCs, and in the patients with Takotsubo-like cardiomyopathy, the apical sparing pattern was the primary impairment pattern of LS. Additionally, nearly one-third of patients without symptoms had SMIs. The diagnosis of PPGLs should be considered in patients with acute reversible cardiomyopathy, especially in those exhibiting an apical sparing pattern of LS.

scholarly journals Early Diastolic Longitudinal Strain Rate at MRI and Outcomes in Heart Failure with Preserved Ejection Fraction

Radiology ◽  
2022 ◽  
Vol 302 (1) ◽  
pp. E5-E5
Author(s):  
Jian He ◽  
Wenjing Yang ◽  
Weichun Wu ◽  
Shuang Li ◽  
Gang Yin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Longitudinal Strain ◽  
Preserved Ejection Fraction ◽  
Longitudinal Strain Rate

3225Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of all cause mortality in patients with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Romano ◽  
R Judd ◽  
R Kim ◽  
J Heitner ◽  
D Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Feature Tracking ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Regression Modeling ◽  
Preserved Ejection Fraction

Abstract Introduction Ejection fraction is the principal measure used clinically to assess cardiac mechanics and provides significant prognostic information. However, echocardiographic strain imaging has shown significant abnormalities of myocardial deformation can be present despite preserved ejection fraction, which maybe associated with adverse prognosis. Cardiac-Magnetic-Resonance (CMR) feature-tracking techniques now allow assessment of strain from routine cine-images, without specialized pulse sequences. Whether abnormalities of strain measured using CMR feature-tracking have prognostic value in patients with preserved ejection fraction is unknown. Purpose To evaluate the prognostic value of CMR feature-tracking derived global longitudinal strain (GLS) in a large multicenter population of patients with preserved ejection fraction. Methods Consecutive patients with preserved ejection fraction (EF ≥50%) and a clinical indication for CMR at four US medical centers were included in this study. Feature-tracking GLS was calculated from 3 long-axis-cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between GLS and death. The incremental prognostic value of GLS was assessed in nested models. Results Of the 1274 patients in this study, 115 died during a median follow-up of 6.2 years. By Kaplan-Meier analysis, patients with GLS ≥ median (−20%) had significantly reduced event free survival compared to those with GLS < median (log-rank p<0.001) (Figure, top panel). The continuous relationship between GLS and the hazard of death is shown in the cubic spline (Figure, lower panel). By Cox multivariable regression modeling, each 1% worsening in GLS was associated with a 23.6% increased risk-of-death after adjustment for clinical and imaging risk factors (HR=1.236 per %; p<0.001). Addition of GLS in this model resulted in significant-improvement in the global-chi-square (67 to 168; p<0.0001) and Harrel's C-statistic (0.716 to 0.825; p<0.0001). Conclusions CMR feature-tracking derived GLS is a powerful independent predictor of mortality in patients with preserved ejection fraction, incremental to common clinical and imaging risk factors.

Cardiac complications in trauma

2017 ◽  
Author(s):  
Lydia Lam ◽  
Leslie Kobayashi ◽  
Demetrios Demetriades
Keyword(s):  
Cardiogenic Shock ◽  
Hospital Care ◽  
Wide Spectrum ◽  
Cardiac Injury ◽  
Air Embolism ◽  
Cardiac Complications ◽  
Cardiac Trauma ◽  
Blunt Cardiac Trauma ◽  
Electrocardiographic Changes ◽  
Post Traumatic

Post-traumatic cardiac complications may occur after penetrating or blunt injuries to the heart or may follow severe extracardiac injuries. The majority of victims with penetrating injuries to the heart die at the scene and do not reach hospital care. For those patients who reach hospital care, an immediate operation, sometimes in the emergency room, cardiac injury repair, and cardiopulmonary resuscitation provide the only possibility of survival. Many patients develop perioperative cardiac complications such as acute cardiac failure, cardiac arrhythmias, coronary air embolism, and myocardial infarction. Some survivors develop post-operative functional abnormalities or anatomical defects, which may not manifest during the early post-operative period. It is essential that all survivors undergo detailed early and late cardiac evaluations. Blunt cardiac trauma encompasses a wide spectrum of injuries that includes asymptomatic myocardial contusion, arrhythmias, or cardiogenic shock to full-thickness cardiac rupture and death. Clinical examination, electrocardiograms, troponin measurements, and echocardiography are the cornerstone of diagnosis and monitoring of these patients. Lastly, some serious extracardiac traumatic conditions, such as traumatic pneumonectomy and severe traumatic brain injury, may result in cardiac complications. This may include tachyarrhythmias, cardiogenic shock, electrocardiographic changes, troponin elevations, heart failure, and cardiac arrest.

scholarly journals Anticoagulation in patients with cardiac manifestations of Chagas disease and cardioembolic ischemic stroke

2018 ◽  
Vol 76 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Jean M.C. Monteiro ◽  
Daniel L. San-Martin ◽  
Beatriz C.G. Silva ◽  
Pedro A.P. de Jesus ◽  
Jamary Oliveira Filho
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Chagas Disease ◽  
Retrospective Cohort ◽  
Cardiac Complications ◽  
Minor Bleeding ◽  
Warfarin Group ◽  
Cardiac Manifestations ◽  
Cis Methods

ABSTRACT Objectives To describe anticoagulation characteristics in patients with cardiac complications from Chagas disease and compare participants with and without cardioembolic ischemic stroke (CIS). Methods A retrospective cohort of patients with Chagas disease, using anticoagulation, conducted from January 2011 to December 2014. Results Forty-two patients with Chagas disease who were using anticoagulation were studied (age 62.9±12.4 years), 59.5% female and 47.6% with previous CIS, 78.6% with non-valvular atrial fibrillation and 69.7% with dilated cardiomyopathy. Warfarin was used in 78.6% of patients and dabigatran (at different times) in 38%. In the warfarin group, those with CIS had more medical appointments per person-years of follow-up (11.7 vs 7.9), a higher proportion of international normalized ratios within the therapeutic range (57% vs 42% medical appointments, p = 0.025) and an eight times higher frequency of minor bleeding (0.64 vs 0.07 medical appointments). Conclusion Patients with Chagas disease and previous CIS had better control of INR with a higher frequency of minor bleeding.

scholarly journals Increased myocardial stiffness more than impaired relaxation function limits cardiac performance during exercise in heart failure with preserved ejection fraction: a virtual patient study

2020 ◽  
Vol 1 (1) ◽  
pp. 40-50
Author(s):  
Tim van Loon ◽  
Christian Knackstedt ◽  
Richard Cornelussen ◽  
Koen D Reesink ◽  
Hans-Peter Brunner La Rocca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Relaxation Function ◽  
Wide Spectrum ◽  
Virtual Patient ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Patient Specific ◽  
Preserved Ejection Fraction ◽  
Passive Stiffness

Abstract Aims The relative impact of left ventricular (LV) diastolic dysfunction (LVDD) and impaired left atrial (LA) function on cardiovascular haemodynamics in heart failure with preserved ejection fraction (HFpEF) is largely unknown. We performed virtual patient simulations to elucidate the relative effects of these factors on haemodynamics at rest and during exercise. Methods and results The CircAdapt cardiovascular system model was used to simulate cardiac haemodynamics in wide ranges of impaired LV relaxation function, increased LV passive stiffness, and impaired LA function. Simulations showed that LV ejection fraction (LVEF) was preserved (&gt;50%), despite these changes in LV and LA function. Impairment of LV relaxation function decreased E/A ratio and mildly increased LV filling pressure at rest. Increased LV passive stiffness resulted in increased E/A ratio, LA dilation and markedly elevated LV filling pressure. Impairment of LA function increased E/A ratio and LV filling pressure, explaining inconsistent grading of LVDD using echocardiographic indices. Exercise simulations showed that increased LV passive stiffness exerts a stronger exercise-limiting effect than impaired LV relaxation function does, especially with impaired LA function. Conclusion The CircAdapt model enabled realistic simulation of virtual HFpEF patients, covering a wide spectrum of LVDD and related limitations of cardiac exercise performance, all with preserved resting LVEF. Simulations suggest that increased LV passive stiffness, more than impaired relaxation function, reduces exercise tolerance, especially when LA function is impaired. In future studies, the CircAdapt model can serve as a valuable platform for patient-specific simulations to identify the disease substrate(s) underlying the individual HFpEF patient’s cardiovascular phenotype.

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