BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systo...BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.展开更多
Cardiac masses diagnosis and treatment are a true challenge,although they are infrequently encountered in clinical practice.They encompass a broad set of lesions that include neoplastic(primary and secondary),non-neop...Cardiac masses diagnosis and treatment are a true challenge,although they are infrequently encountered in clinical practice.They encompass a broad set of lesions that include neoplastic(primary and secondary),non-neoplastic masses and pseudomasses.The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size,location,relation with other structures and mobility.The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy,which is still the diagnostic gold standard.The findings should always be interpreted in the clinical context to avoid misdiagnosis,particularly in specific conditions(e.g.,infective endocarditis or thrombi).The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses.Cardiovascular magnetic resonance(CMR)allows an optimal non-invasive localization of the lesion,providing multiplanar information on its relation to surrounding structures.Moreover,with the additional feature of tissue characterization,CMR can be highly effective to distinguish pseudomasses from masses,as well as benign from malignant lesions,with further differential diagnosis of the latter.Although histopathological assessment is important to make a definitive diagnosis,CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management.This literature review aims to provide a comprehensive overview of cardiac masses,from clinical and imaging protocol to pathological findings.展开更多
基金Supported by the Italian Ministry for Education,University and Research under the Programme“Dipartimenti di Eccellenza 2018-2022”Project,No.D15D18000410001Novo Nordisk“Gestione delle complicanze croniche del diabete:From bedside to bench?”,No.n1/2021.
文摘BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.
文摘Cardiac masses diagnosis and treatment are a true challenge,although they are infrequently encountered in clinical practice.They encompass a broad set of lesions that include neoplastic(primary and secondary),non-neoplastic masses and pseudomasses.The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size,location,relation with other structures and mobility.The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy,which is still the diagnostic gold standard.The findings should always be interpreted in the clinical context to avoid misdiagnosis,particularly in specific conditions(e.g.,infective endocarditis or thrombi).The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses.Cardiovascular magnetic resonance(CMR)allows an optimal non-invasive localization of the lesion,providing multiplanar information on its relation to surrounding structures.Moreover,with the additional feature of tissue characterization,CMR can be highly effective to distinguish pseudomasses from masses,as well as benign from malignant lesions,with further differential diagnosis of the latter.Although histopathological assessment is important to make a definitive diagnosis,CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management.This literature review aims to provide a comprehensive overview of cardiac masses,from clinical and imaging protocol to pathological findings.
