Browsing by keyword "echocardiography"

Now showing items 1-6 of 6

    • Alcohol Consumption, Left Atrial Diameter, and Atrial Fibrillation
      McManus, David D.; Yin, Xiaoyan; Gladstone, Rachel; Vittinghoff, Eric; Vasan, Ramachandran S.; Larson, Martin G.; Benjamin, Emelia J.; Marcus, Gregory M. (2016-09-14)
      BACKGROUND: Alcohol consumption has been associated with atrial fibrillation (AF) in several epidemiologic studies, but the underlying mechanisms remain unknown. We sought to test the hypothesis that an atrial myopathy, manifested by echocardiographic left atrial enlargement, explains the association between chronic alcohol use and AF. METHODS AND RESULTS: We evaluated the relationship between cumulative alcohol consumption and risk of incident AF in 5220 Offspring and Original Framingham Heart Study participants (mean age 56.3 years, 54% women) with echocardiographic left atrial size measurements. The incidence of AF was 8.4 per 1000 person-years, with 1088 incident AF cases occurring over a median 6.0 years (25th-75th percentiles 4.0-8.7 years) of follow-up. After multivariable adjustment for potential confounders, every additional 10 g of alcohol per day (just under 1 drink per day) was associated with a 0.16 mm (95% CI, 0.10-0.21 mm) larger left atrial dimension. Also in multivariable adjusted analysis, every 10 g per day of alcohol consumed was associated with a 5% higher risk of developing new-onset AF (hazard ratio, 1.05; 95% CI, 1.01-1.09). An estimated 24% (95% CI, 8-75) of the association between alcohol and AF risk was explained by left atrial enlargement. CONCLUSIONS: Our study of a large, community-based sample identified alcohol consumption as a predictor of left atrial enlargement and subsequent incident AF. Left atrial enlargement may be an intermediate phenotype along the causal pathway linking long-term alcohol consumption to AF.

    • Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study
      Sardana, Mayank; Lessard, Darleen M.; Barton, Bruce A.; Mitchell, Gary F.; Vaze, Aditya; McManus, David D. (2018-03-30)
      BACKGROUND: Left atrial (LA) size, a marker of atrial structural remodeling, is associated with increased risk for atrial fibrillation (AF) and cardiovascular disease (CVD). LA function may also relate to AF and CVD, irrespective of LA structure. We tested the hypothesis that LA function index (LAFI), an echocardiographic index of LA structure and function, may better characterize adverse LA remodeling and predict incident AF and CVD than existing measures. METHODS AND RESULTS: In 1786 Framingham Offspring Study eighth examination participants (mean age, 66+/-9 years; 53% women), we related LA diameter and LAFI (derived from the LA emptying fraction, left ventricular outflow tract velocity time integral, and indexed maximal LA volume) to incidence of AF and CVD on follow-up. Over a median follow-up of 8.3 years (range, 7.5-9.1 years), 145 participants developed AF and 139 developed CVD. Mean LAFI was 34.5+/-12.7. In adjusted Cox regression models, lower LAFI was associated with higher risk of incident AF (hazard ratio=3.83, 95% confidence interval=2.23-6.59, lowest [Q1] compared with highest [Q4] LAFI quartile) and over 2-fold higher risk of incident CVD (hazard ratio=2.20, 95% confidence interval=1.32-3.68, Q1 versus Q4). Addition of LAFI, indexed maximum LA volume, or LA diameter to prediction models for AF or CVD did not significantly improve model discrimination for either outcome. CONCLUSIONS: In our prospective investigation of a moderate-sized community-based sample, LAFI, a composite measure of LA size and function, was associated with incident AF and CVD. Addition of LAFI to the risk prediction models for AF or CVD, however, did not significantly improve their performance.

    • Association of smoking and right ventricular function in middle age: CARDIA study
      Moreira, Henrique T.; Armstrong, Anderson C.; Nwabuo, Chike C.; Vasconcellos, Henrique D.; Schmidt, Andre; Sharma, Ravi K.; Ambale-Venkatesh, Bharath; Ostovaneh, Mohammad R.; Kiefe, Catarina I.; Lewis, Cora E.; et al. (2020-03-08)
      Objective: To evaluate the association of cigarette smoking and right ventricular (RV) systolic and diastolic functions in a population-based cohort of individuals at middle age. Methods: This cross-sectional study included participants who answered the smoking questionnaire and underwent echocardiography at the Coronary Artery Risk Development in Young Adulthood year 25 examination. RV systolic function was assessed by echocardiographic-derived tricuspid annular plane systolic excursion (TAPSE) and by right ventricular peak systolic velocity (RVS'), while RV diastolic function was evaluated by early right ventricular tissue velocity (RVE'). Multivariable linear regression models assessed the relationship of smoking with RV function, adjusting for age, sex, race, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes mellitus, alcohol consumption, pulmonary function, left ventricular systolic and diastolic function and coronary artery calcium score. Results: A total of 3424 participants were included. The mean age was 50+/-4 years; 57% were female; and 53% were black. There were 2106 (61%) never smokers, 750 (22%) former smokers and 589 (17%) current smokers. In the multivariable analysis, current smokers had significantly lower TAPSE (beta=-0.082, SE=0.031, p=0.008), RVS' (beta=-0.343, SE=0.156, p=0.028) and RVE' (beta=-0.715, SE=0.195, p < 0.001) compared with never smokers. Former smokers had a significantly lower RVE' compared with never smokers (beta=-0.414, SE=0.162, p=0.011), whereas no significant difference in RV systolic function was found between former smokers and never smokers. Conclusions: In a large multicenter community-based biracial cohort of middle-aged individuals, smoking was independently related to both worse RV systolic and diastolic functions.

    • C'est LAVi: What Left Atrial Dilatation Tells Us About Diastolic Function in Aortic Stenosis
      Tighe, Dennis A.; Aurigemma, Gerard P. (2016-10-10)
      Calcific degenerative aortic valve stenosis (AS) is the most common acquired form of heart valve disease that afflicts the elderly population1 and usually comes to attention when an echocardiogram is ordered to evaluate a systolic murmur in an older subject. As is evident to anyone practicing cardiology these days, the advent of transcatheter aortic valve replacement has focused much attention on the evaluation and optimal treatment of patients with AS. AS often has a long latency period in which symptoms are absent, and, importantly, sudden unexpected cardiac death is rare.2,3 With symptom onset, survival is markedly reduced without intervention.4–6 For symptomatic patients with severe AS and normal flow-high gradient characteristics and normal left ventricular ejection fraction (LVEF) (stage D1), aortic valve replacement (AVR) is a class 1 indication. Similarly, for asymptomatic patients with severe AS and LVEF less than fifty percent not because of another cause (stage C2), AVR also is indicated.

    • Comparison of a computed tomographic pulmonary trunk to aorta diameter ratio with echocardiographic indices of pulmonary hypertension in dogs
      Sutherland-Smith, James; Hankin, Elyshia J.; Cunningham, Suzanne M.; Sato, Amy F.; Barton, Bruce A. (2017-08-30)
      There are limited criteria for the detection of pulmonary hypertension in dogs undergoing computed tomography (CT) for pulmonary disease. This retrospective analytical exploratory study compared a CT pulmonary trunk to aorta ratio with echocardiographic estimates of pulmonary hypertension. Dogs having both a contrast thoracic CT and echocardiogram were selected and maximal pulmonary trunk and descending aorta diameters were measured by two observers on a single transverse CT image. Computed tomographic diameter ratios were compared with the echocardiographic parameters of tricuspid regurgitation gradient, right ventricular acceleration time-to-ejection time ratio, pulmonary insufficiency gradient, and pulmonary artery to aorta diameter. A total of 78 dogs were sampled, with 44 dogs having one or more finding suggestive of pulmonary hypertension. A moderate positive correlation was shown between tricuspid regurgitation gradient and CT pulmonary trunk to aorta ratio (r = 0.61, P-value < 0.0001). Mean CT pulmonary trunk to aorta ratio of dogs with moderate (P = 0.0132) and severe (P < 0.0003) pulmonary hypertension were significantly higher than normal dogs. There was no significant difference in mean CT pulmonary trunk to aorta ratio between normal and mild pulmonary hypertension dogs (P = 0.4244). The intraclass correlation coefficient (0.72) showed good reproducibility of the ratio. Findings indicated that CT pulmonary trunk to aorta ratio is a reproducible and potentially useful method to predict moderate and severe pulmonary hypertension in dogs, but not mild pulmonary hypertension. In dogs undergoing thoracic CT for pulmonary disease, an increased ratio should prompt follow up echocardiography.

    • Serial changes in diastolic function: lessons from the growing field of echo-epidemiology
      Fitzgibbons, Timothy P.; Aurigemma, Gerard P. (2015-04-14)
      Normal left ventricular function consists of 2 interrelated processes. Systole comprises a coordinated interplay between fiber shortening, wall thickening, longitudinal shortening, and cardiac twist, which results in the generation of stroke volume. During diastole, which comprises relaxation and untwist, as well as contraction of the atrium, the normal ventricle relaxes and fills to an adequate end-diastolic volume at low pressure—thus optimizing stroke volume in the next systole.1 The noninvasive assessment of systolic and diastolic function is a major undertaking of cardiologists, and in 2015, this assessment is usually performed with echocardiography. The assessment of systolic function, which began with M-mode echocardiography in the 1970s, now comprises both 2D and 3D echocardiography, as well as regional function assessment with speckle tracking. The assessment of diastolic function became routine in the 1980s, with the development of pulsed Doppler measurement of transmitral flow velocities: early (E) and late/atrial contraction (A) velocities and pulmonary venous flows.2