Browsing by Subject "Echocardiography"

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  • Öhman, Jonas; Harjola, Veli-Pekka; Karjalainen, Pasi; Lassus, Johan (2018)
    Background: It is unclear how to optimally monitor acute heart failure (AHF) patients. We evaluated the timely interplay of cardiac filling pressures, brain natriuretic peptides (BNPs), lung ultrasound (LUS) and symptoms during AHF treatment. Methods: We enrolled 60 patients who had been hospitalised for AHF. Patients were examined with a rapid cardiothoracic ultrasound (CaTUS) protocol, combining LUS and focused echocardiographic evaluation of cardiac filling pressures (i.e. medial E/e' and inferior vena cava index [IVCi]). CaTUS was done at 0, 12, 24 and 48 hours (3 hours) and on the day of discharge, alongside clinical evaluation and laboratory samples. Patients free of congestion (Blines or pleural fluid) on LUS at discharge were categorised as responders, whereas the rest were categorised as non-responders. Improvement in congestion parameters was evaluated separately in these groups. The effect of congestion parameters on prognosis was also analysed. Results: Responders experienced a significantly larger decline in E/e' (2.58 vs. 0.38, p=0.037) and dyspnoea visual analogue scale (1-10) score (7.68 vs. 3.57, p=0.007) during the first 12 hours of treatment, while IVCi and BNPs declined later without no such rapid initial decline. Among patients experiencing a >3 U decline in E/e' during the first 12 hours of treatment, 18/21 were to become responders (p Conclusion: E/e' seemed like the most useful congestion parameter for monitoring early treatment response, predicting prognostically beneficial resolution of pulmonary congestion.
  • Aula, Hanna; Skyttä, Tanja; Tuohinen, Suvi; Luukkaala, Tiina; Hämäläinen, Mari; Virtanen, Vesa; Raatikainen, Pekka; Moilanen, Eeva; Kellokumpu-Lehtinen, Pirkko-Liisa (2018)
    BackgroundRadiation-induced heart disease is mainly caused by activation of the fibrotic process. Transforming growth factor-beta 1 (TGF-1) and platelet-derived growth factor (PDGF) are pro-fibrotic mediators. The aim of our study was to evaluate the behavior of TGF-1 and PDGF during adjuvant radiotherapy (RT) for breast cancer and the association of these cytokines with echocardiographic changes.MethodsOur study included 73 women with early-stage breast cancer or ductal carcinoma in situ (DCIS) receiving post-operative RT but not chemotherapy. TGF-1 and PDGF levels in serum samples taken before and on the last day of RT were measured by an enzyme-linked immunosorbent assay. Echocardiography was also performed at same time points. Patients were grouped according to a15% worsening in tricuspid annular plane systolic excursion (TAPSE) and pericardium calibrated integrated backscatter (cIBS).ResultsIn all patients, the median TGF-1 decreased from 25.0 (IQR 21.1-30.3) ng/ml to 23.6 (IQR 19.6-26.8) ng/ml (p=0.003), and the median PDGF decreased from 18.0 (IQR 13.7-22.7) ng/ml to 15.6 (IQR 12.7-19.5) ng/ml (p
  • Jaakkola, Ilkka; Hiippala, Anita; Happonen, Juha-Matti (2020)
  • Öhman, J.; Harjola, Veli-Pekka; Karjalainen, P.; Lassus, Johan (2018)
    Aims There is little evidence-based therapy existing for acute heart failure (AHF), hospitalizations are lengthy and expensive, and optimal monitoring of AHF patients during in-hospital treatment is poorly defined. We evaluated a rapid cardiothoracic ultrasound (CaTUS) protocol, combining focused echocardiographic evaluation of cardiac filling pressures, that is, medial E/e' and inferior vena cava index, with lung ultrasound (LUS) for guiding treatment in hospitalized AHF patients. Methods and results We enrolled 20 consecutive patients hospitalized for AHF, whose in-hospital treatment was guided using the CaTUS protocol according to a pre-specified treatment protocol targeting resolution of pulmonary congestion on LUS and lowering cardiac filling pressures. Treatment results of these 20 patients were compared with those of a standard care sample of 100 patients, enrolled previously for follow-up purposes. The standard care sample had CaTUS performed daily for follow-up and received standard in-hospital treatment without ultrasound guidance. All CaTUS exams were performed by a single experienced sonographer. The CaTUS-guided therapy resulted in significantly larger decongestion as defined by reduction in symptoms, cardiac filling pressures, natriuretic peptides, cumulative fluid loss, and resolution of pulmonary congestion (P <0.05 for all) despite a shorter mean length of hospitalization. Congestion parameters were significantly lower also at discharge (P <0.05 for all), without any significant difference in these parameters on admission. The treatment arm displayed better survival regarding the combined endpoint of 6 month all-cause death or AHF re-hospitalization (log rank P = 0.017). No significant difference in adverse events occurred between the groups. Conclusions The CaTUS-guided therapy for AHF resulted in greater decongestion during shorter hospitalization without increased adverse events in this small pilot study and might be associated with a better post-discharge prognosis.
  • Vähämurto, L.; Juonala, M.; Ruohonen, S.; Hutri-Kähönen, N.; Kähönen, M.; Laitinen, T.; Tossavainen, P.; Jokinen, E.; Viikari, J.; Raitakari, O. T.; Pahkala, K. (2018)
    Aims: Eastern Finns have higher risk of coronary heart disease (CHD) and carotid intima-media thickness than western Finns although current differences in CHD risk factors are minimal. Left ventricular (LV) mass and diastolic function predict future cardiovascular events but their east-west differences are unknown. We examined the association of eastern/western baseline origin with LV mass and diastolic function. Methods : The study population included 2045 subjects of the Cardiovascular Risk in Young Finns Study with data from the baseline survey (1980) and the latest follow-up (2011) when echocardiography was performed at the age of 34-49 years. Results: Subjects with eastern baseline origin had in 2011 higher LV mass (139 +/- 1.0 vs. 135 +/- 1.0 g, p=0.006) and E/e-ratio indicating weaker LV diastolic function (4.86 +/- 0.03 vs. 4.74 +/- 0.03, p=0.02) than western subjects. Results were independent of age, sex, area of examination and CHD risk factors such as blood pressure and BMI (LV mass indexed with height: p
  • Laitinen, Tomi T.; Ruohonen, Saku; Juonala, Markus; Magnussen, Costan G.; Mikkila, Vera; Mikola, Hanna; Hutri-Kahonen, Nina; Laitinen, Tomi; Tossavainen, Paivi; Jokinen, Eero; Niinikoski, Harri; Jula, Antti; Viikari, Jorma S. A.; Ronnemaa, Tapani; Raitakari, Olli T.; Pahkala, Katja (2017)
    Background: Ideal cardiovascular health (CVH), defined by the American Heart Association, is associated with incident cardiovascular disease in adults. However, association of the ideal CVH in childhood with current and future cardiac structure and function has not been studied. Methods and results: The sample comprised 827 children participating in the longitudinal Special Turku Coronary Risk Factor Intervention Project (STRIP) and The Cardiovascular Risk in Young Finns Study (YFS). In STRIP, complete data on the seven ideal CVH metrics and left ventricular (LV) mass measured with echocardiography were available at the age of 15 (n= 321), 17 (n= 309) and 19 (n= 283) years. In YFS, the cohort comprised children aged 12-18 years (n = 506) with complete ideal CVH metrics data from childhood and 25 years later in adulthood, and echocardiography performed in adulthood. In STRIP, ideal CVH score was inversely associated with LV mass during childhood (P = 0.036). In YFS, childhood ideal CVH score was inversely associated with LV mass, LV end-diastolic volume, E/e' ratio, and left atrium end-systolic volume in adulthood (all P <0.01). In addition, improvement of the ideal CVH score between childhood and adulthood was inversely associated with LV mass, LV end-diastolic volume, E/e' ratio, and left atrium end-systolic volume (all P Conclusions: Childhood ideal CVH score has a long-lasting effect on cardiac structure and function, and the association is evident already in childhood. Our findings support targeting the ideal CVHmetrics as part of primordial prevention of cardiovascular diseases. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Katto, Reeta (Helsingin yliopisto, 2020)
    Aorttaläpän ahtauma eli aorttastenoosi on yleinen läppäsairaus, jonka hoitona nykyään on joko avoleikkaus tai katetriteitse asennettava aorttaläppä. Kuvantamisen osuus diagnostiikassa ja hoidossa on suuri, sillä aorttaläpän ahtauma todetaan yleisimmin sydämen kaikukuvauksessa ja katetriteitse tapahtuvaa toimenpidettä varten tehdään sydämen ja suurten suonien tietokonetomografiakuvaus. Magneettikuvausta käytetään erityistapauksissa diagnostiikkaa täydentämään. Tutkimuksen tavoitteena oli selvittää eri aorttaläpän ja aortan kuvantamismenetelmien ja tulkitsijoiden välisiä mittauseroja ja analysoida niiden kliinistä merkitystä sekä yhteyttä hoitotoimenpiteissä aiheutuneisiin komplikaatioihin. Tutkimus on osa laajemman ”Aorttaläpän ahtauman ennusteeseen vaikuttavat tekijät” -tutkimuksen validointia. Aineisto koostui HYKS Sydän- ja keuhkokeskuksen prospektiiviseen tutkimukseen osallistuvien aorttastenoosipotilaiden kuvantamislausunnoista sekä potilasasiakirjamerkinnöistä. Tutkimukseen sisällytettiin 133 potilasta. Tutkimuspotilaille teetettiin normaalin diagnostiikan lisäksi erikseen sydämen magneettikuvaus. Katetritoimenpide tehtiin 44,4 %:lle ja avoleikkaus 35,3 %:lle. Sekä tietokonetomografiassa että magneettikuvauksessa todettiin useammassa eri aortan mitassa tilastollisesti merkitseviä tulkitsijakohtaisia eroja. Menetelmistä tietokonetomografian ja magneettikuvauksen mitat olivat aorttaläpän avautumispinta-alan osalta yhteneväisiä, molemmilla menetelmillä oli tilastollisesti merkitsevä ero puolestaan kaikukuvauksen mittoihin. Aorttaläpän kalkkikuormalla ei aineistossamme todettu olevan merkittävää yhteyttä komplikaatioihin. Lievät paravalvulaariset vuodot olivat yleisiä katetritoimenpidepotilailla (55,9 %) ja avoleikkauspotilailla eteisvärinä oli yleisin komplikaatio (29,8 %). Jatkossa tutkimustulosten varmistamiseksi potilasaineisto olisi hyvä kaksoisarvioida kunkin modaliteetin osalta. Mittausmenetelmät käydään yksikössä läpi ja pyritään löytämään mahdollisten systemaattisten virheiden sijainnit prosessissa. Jos mittauksia saataisiin standardoitua optimaalisesti, voitaisiin radiologien ja kardiologien tekemää päällekkäistä mittaustyötä vähentää. (206 sanaa)
  • Aula, Hanna; Skyttä, Tanja; Tuohinen, Suvi; Luukkaala, Tiina; Hämäläinen, Mari; Virtanen, Vesa; Raatikainen, Pekka; Moilanen, Eeva; Kellokumpu-Lehtinen, Pirkko-Liisa (2020)
    Objectives: To search for biomarkers of RT-induced cardiotoxicity, we studied the behavior of ST2 during RT and three years after RT, and the associations with echocardiographic changes. Materials and methods: We measured soluble ST2 (ng/ml) in serum samples from 63 patients receiving RT for early breast cancer. Sampling and echocardiography were performed at baseline, after RT and at the three-year follow-up. Patients were grouped by >15% (group 1) and Results: ST2 levels tended to increase during RT, from a median (interquartile range; IQR) of 17.9 (12.4 - 22.4) at baseline to 18.2 (14.1-23.5) after RT (p = 0.075). By the three-year follow up, ST2 levels increased to 18.7 (15.8-24.2), p = 0.018. The increase in ST2 level was associated with worsening cardiac systolic function at three-year follow-up, GLS (rho = 0.272, p = 0.034) and left ventricular ejection fraction (LVEF) (rho = -0.343, p = 0.006). Group 1 (n = 14) had a significant increase in ST2 levels from 17.8 (12.3-22.5) at baseline to 18.4 (15.6-22.6) after RT, p = 0.035 and to 19.9 (16.0-25.1) three years after RT, p = 0.005. ST2 levels were stable in group 2 (n = 47): 17.8 (12.3-22.0) at baseline, 17.7 (12.6-23.5) after RT and 18.0 (15.5-22.4) at three years. Conclusion: ST2 may be useful for determining which patients are at risk for long-term cardiovascular toxicity following adjuvant breast cancer RT, but prospective clinical studies are needed to confirm this hypothesis. (C) 2019 Elsevier Ltd.
  • Järvinen, Vesa; Mätzke, Sorjo; Kylmälä, Minna; Häkkinen, Sara; Kivikko, Matti (2020)
    • Sydämen kaikututkimus on tärkeä diagnostinen työkalu sydänsairauksien selvittelyssä. • Hyvinkään, Espoon ja Kauniaisten terveyskeskuslääkärit voivat tilata näitä tutkimuksia ostopalveluna Hyvinkään ja Jorvin sairaaloista. • Uusi tai aiemmin tutkimaton systolinen sivuääni oli selvästi yleisin läheteaihe, kun käytiin läpi sata peräkkäistä sydämen kaikututkimusta, jotka oli tehty perusterveydenhuollon lähetteellä. • Hento systolinen sivuääni ilman muita sydänsairauden löydöksiä tai oireita ei edellytä kaikututkimusta, mutta diastolinen sivuääni kannattaa aina tutkia.
  • Aro, Aapo L.; Rusinaru, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Phan, Derek; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S. (2017)
    Background: Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community. Methods: All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records. Results: 2119 SCA cases (68.4 +/- 13.8 years, 66.9% male) and 746 controls (66.7 +/- 11.7 years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were > 5 years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF >= 50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79). Conclusions: Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large subgroup without any current means of SCA risk stratification. (C) 2016 Published by Elsevier Ireland Ltd.
  • Aula, Hanna; Skyttä, Tanja; Tuohinen, Suvi; Luukkaala, Tiina; Hämäläinen, Mari; Virtanen, Vesa; Raatikainen, Pekka; Moilanen, Eeva; Kellokumpu-Lehtinen, Pirkko-Liisa (2019)
    Background Transforming growth factor beta 1 (TGF-beta 1) and platelet-derived growth factor (PDGF) are cytokines involved in fibrotic processes causing radiotherapy (RT)-induced cardiovascular changes. We aimed to investigate the associations between TGF-beta 1 and PDGF and the echocardiographic changes that occur during RT and during three-year follow-up. Methods The study included 63 women receiving adjuvant RT for early-stage breast cancer or ductal carcinoma in situ. Serum TGF-beta 1 (ng/ml) and PDGF (ng/ml) levels were measured by enzyme-linked immunoassay and echocardiographic examination was performed before RT, after RT and at 3 years. Patients were grouped by biomarker behavior by a trajectory analysis. Results TGF-beta 1 decreased from 19.2 (IQR 17.1-22.3) before RT to 18.8 (14.5-22.0) after RT (p = 0.003) and the decrease persisted at 17.2 (13.7-21.2) 3 years after RT (p = 0.101). PDGF decreased from 15.4 (12.6-19.1) before RT to 13.8 (11.7-16.2) after RT, p = 0.001, and persisted at 15.6 (10.4-18.4) at 3 years, p = 0.661. The TGF-beta 1 level before RT (Spearman's rho 0.441, p <0.001) and the three-year change in TGF-beta 1 (rho = - 0.302, p = 0.018) correlated with global longitudinal strain (GLS) in echocardiography at 3 years. In trajectory analysis, two TGF-beta 1 behavior groups were found. Group 1 had significantly higher TGF-beta 1 levels before RT, 25.6 (22.3-28.6), than group 2, 17.8 (15.9-19.9), p <0.001. In multivariable analysis, TGF-beta 1 trajectory group 1 (beta = 0.27, p = 0.013), left-sided breast cancer (beta = 0.39, p = 0.001) and the use of aromatase inhibitors (beta = 0.29, p = 0.011) were significantly associated with a worsening in GLS from before RT to 3 years. Conclusion An elevated pretreatment TGF-beta 1 may predict RT-associated changes in echocardiography.
  • Kuusisto, Jouni K.; Järvinen, Vesa M.; Sinisalo, Juha P. (2018)
    Background: Left atrial volume is a prognostic factor in cardiac pathologies. We aimed to validate left atrial volume detection with 3D and 2D echocardiography (3DE and 2DE) by human cadaveric casts. 3DE facilitates measurement of atrial volume without geometrical assumptions or dependence on imaging angle in contrast to 2DE methods. Methods: For method validation, six water-filled balloons were submerged in a 20-l water tank and their volumes were measured with 3DE. Seven human cadaveric left atrial casts were prepared of silicone and were transformed into ultrasound-permeable casts. Casts were imaged in the same setting, so that 3DE and 2DE of casts represented transthoracic apical view. Left ventricle analysis softwares GE 4D Auto LVQ and TomTec 4D LV-Function were used for 3DE volumetry. Results; Balloon volumes ranged 37 to 255ml (mean 126 ml). 3DE resulted in an excellent volumetric agreement with balloon volumes, absolute bias was -3.7 ml (95% CI -5.9 to -1.4). Atrial cast volumes were 38 to 94 ml (mean 56.6 ml). 3DE and 2DE volumes were excellently correlated with cast volumes (r = 0.96 to 0.99). Biases were for GE 4D LVQ - 0.7 ml (95% CI -6.1 to 4.6), TomTec 4D LV-Function 3.3 ml (-1.9 to 8.5) and 2DE 2.9 ml (-4.0 to 9.9). 3DE resulted in lower limits of agreement and showed no volume-related bias in contrast to area-length method. Conclusions: We conclude that measurement of human cadaveric left atrial cast volumes by 3DE is in excellent agreement with true cast volumes.