Comparison Between Echocardiography and Cardiac Computed Tomography in the Evaluation of Diastolic Dysfunction and Prediction of Heart Failure

Lessick, Jonathan; Mutlak, Diab; Efraim, Roi; Naami, Robert; Mutlak, Michael; Sheik-Muhamad, Rabia; Abadi, Sobhi; Aronson, Doron

doi:10.1016/j.amjcard.2022.07.017

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…Several factors make CTCA more attractive than other cardiac imaging modalities in rural and remote areas, including the speed of image acquisition, its high volume capacity, the relatively low level of ionising radiation, and the ability to identify non‐obstructive CAD. CTCA can also provide information about high risk plaque, peri‐coronary inflammation, cardiac chamber size, and diastolic function 6,7,22 …”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost‐effective alternative care model: a retrospective cross‐sectional study

Alexander

Lan

Dallo³

et al. 2023

Medical Journal of Australia

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ObjectivesTo examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD.DesignRetrospective cohort study.Setting, participantsAdults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year.Main outcome measuresSeverity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment).ResultsThe mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non‐ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50–69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed‐days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved.ConclusionMany rural and remote Western Australians transferred for ICA in Perth have non‐obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost‐effective strategy for risk stratification of people with suspected CAD.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost‐effective alternative care model: a retrospective cross‐sectional study

Alexander

Lan

Dallo³

et al. 2023

Medical Journal of Australia

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Section: Methodsmentioning

confidence: 99%

“…A full echocardiographic diastolic assessment was performed according to the ASE recommendations, 8 as previously described. 21 Two experienced cardiologists reviewed all transthoracic echocardiogram reports for assessment of diastolic function and classified them as normal, grade I to III LVDD, or indeterminate, based on the American Society of Echocardiography recommendations. 8 Patients with indeterminate diastolic function were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…19,20 LA expansion index, representing the relative LA volume changes during the reservoir phase, was calculated as follows: LA expansion indexI=(LAV max −LAV min )/LAV min . 15,16,18,[21][22][23] Based on these calculations, LV filling was divided into 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume, defined as the volume of blood that passes through the LA that cannot be accounted for by early or booster-pump function: LV SV−(LA max volume-LA min volume). 2 These components of the LA function were expressed in terms of LV filling as a percent contribution to LV SV.…”

Section: Asmentioning

confidence: 99%

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Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

Aronson,

Sliman,

Abadi

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction. METHODS: We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac computed tomography scanning (n=489). From LA and LV time-volume curves, we calculated 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110). RESULTS: The early passive filling progressively decreased with worsening diastolic function ( P <0.001). The atrial booster contribution to stroke volume modestly increases with impaired relaxation ( P =0.021) and declines with more advanced diastolic function ( P <0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively ( P <0.001), accounting for 75% of stroke volume (interquartile range, 63–81%) with a restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to stroke volume increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71; P <0.0001), indicating that the increase in mitral E wave in diastolic dysfunction represents the increased conduit flow. CONCLUSIONS: An increase in conduit volume contribution to stroke volume represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.

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“…13 Left atrial emptying fraction, defined as ((left atrial maximum volume − left atrial minimum volume)/left atrial maximum volume) × 100%, was assessed as a novel surrogate for diastolic function. 15 CCT was performed using a Toshiba 320-row multidetector computed tomography scanner (Toshiba Acquillion One ViSION Edition) and preferred to magnetic resonance imaging, as most patients had inserted devices. 13 Details of CCT are described in Supplemental Digital Content 4 (see http://links.lww.com/JCVP/B72) of this paper and in previous publication.…”

Section: Methodsmentioning

confidence: 99%

First-in-man trial of β3-adrenoceptor agonist treatment in chronic heart failure – impact on diastolic function.

Zohori Bahrami,

Hasselbalch,

Søholm

et al. 2024

Journal of Cardiovascular Pharmacology

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Diastolic dysfunction (DD) in heart failure (HF) is associated with increased myocardial cytosolic calcium, and calcium-efflux via the sodium-calcium-exchanger depends on the sodium gradient. Beta-3-adrenoceptor (β3-AR) agonists lower cytosolic sodium and have reversed organ congestion. Accordingly, β3-AR agonists might improve diastolic function, which we aimed to assess. In a first-in-man, randomized, double-blinded trial, we assigned 70 patients with HF with reduced ejection fraction (HFrEF), NYHA II-III, and LVEF<40% to receive the β3-AR agonist mirabegron (300 mg/day) or placebo for six months, in addition to recommended HF therapy. We performed echocardiography and cardiac computed tomography (CCT) and measured N-terminal pro-brain natriuretic peptide (NT-proBNP) at baseline and follow-up. DD was graded per multiple renowned algorithms. Baseline and follow-up data were available in 57 patients (59±11 years, 88% male, 49% ischemic heart disease). No clinically significant changes in diastolic measurements were found within or between groups by echocardiography (E/e' placebo: 13±7 to 13±5, p=0.21 vs mirabegron: 12±6 to 13±8, p=0.74, between group follow-up difference 0.2 [95% CI −3 to 4], p=0.89), or CCT (left atrial volume index: between group follow-up difference 9 ml/m2 [95% CI −3 to 19], p=0.15). DD gradings did not change within or between groups following two algorithms (p=0.72, p=0.75). NT-proBNP remained unchanged in both groups (p=0.74, p=0.64). In patients with HFrEF, no changes were identified in diastolic measurements, gradings or biomarker after β3-AR stimulation compared to placebo. The findings add to previous literature questioning the role of impaired Na+-Ca2+ mediated calcium-export as a major culprit in DD. NCT01876433.

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Comparison Between Echocardiography and Cardiac Computed Tomography in the Evaluation of Diastolic Dysfunction and Prediction of Heart Failure

Cited by 8 publications

References 23 publications

Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost‐effective alternative care model: a retrospective cross‐sectional study

Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost‐effective alternative care model: a retrospective cross‐sectional study

Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

First-in-man trial of β3-adrenoceptor agonist treatment in chronic heart failure – impact on diastolic function.

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