Showing papers by "Jens-Uwe Voigt published in 2023"

Use of Real-Time Cine MRI to Assess the Respirophasic Variation of the Inferior Vena Cava-Proof-of-Concept and Validation Against Transthoracic Echocardiography.

Abstract: BACKGROUND In clinical practice, the right heart filling status is assessed using the respirophasic variation of the inferior vena cava (IVC) assessed by transthoracic echocardiography (TTE) showing moderate correlations with the catheter-based reference standard. PURPOSE To develop and validate a similar approach using MRI. STUDY TYPE Prospective. POPULATION 37 male elite cyclists (mean age 26 ± 4 years). FIELD STRENGTH/SEQUENCE Real-time balanced steady-state free-precession cine sequence at 1.5 Tesla. ASSESSMENT Respirophasic variation included assessment of expiratory size of the upper hepatic part of the IVC and degree of inspiratory collapse expressed as collapsibility index (CI). The IVC was studied either in long-axis direction (TTE) or using two transverse slices, separated by 30 mm (MRI) during operator-guided deep breathing. For MRI, in addition to the TTE-like diameter, IVC area and major and minor axis diameters were also assessed, together with the corresponding CIs. STATISTICAL TESTS Repeated measures ANOVA test with Bonferroni correction. Intraclass correlation coefficient (ICC) and Bland-Altman analysis for intrareader and inter-reader agreement. A P value <0.05 was considered statistically significant. RESULTS No significant differences in expiratory IVC diameter were found between TTE and MRI, i.e., 25 ± 4 mm vs. 25 ± 3 mm (P = 0.242), but MRI showed a higher CI, i.e., 76% ± 14% vs. 66% ± 14% (P < 0.05). As the IVC presented a noncircular shape, i.e., major and minor expiratory diameter of 28 ± 4 mm and 21 ± 4 mm, respectively, the CI varied according to the orientation, i.e., 63% ± 27% vs. 75% ± 16%, respectively. Alternatively, expiratory IVC area was 4.3 ± 1.1 cm2 and showed a significantly higher CI, i.e., 86% ± 14% than diameter-based CI (P < 0.05). All participants showed a CI >50% with MRI versus 35/37 (94%) with TTE. ICC values ranged 0.546-0.841 for MRI and 0.545-0.704 for TTE. CONCLUSION Assessment of the respirophasic IVC variation is feasible with MRI. Adding this biomarker may be of particular use in evaluating heart failure patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.

Echocardiography in Fabry Disease - How many dimensions do we need?

Abstract: Journal Article Accepted manuscript Echocardiography in Fabry Disease - How many dimensions do we need? Get access Jens-Uwe Voigt Jens-Uwe Voigt University Hospital Leuven, Dpt. of Cardiology, Herestraat 49, Leuven 3000, Belgium Address for correspondence: Prof Dr. Jens-Uwe Voigt, Department of Cardiovascular Diseases, University Hospital Leuven, Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium, Tel.: + 32 16 349016, Email: jens-uwe.voigt@uzleuven.be https://orcid.org/0000-0002-0575-1888 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jead164, https://doi.org/10.1093/ehjci/jead164 Published: 07 July 2023 Article history Received: 03 July 2023 Accepted: 05 July 2023 Published: 07 July 2023

Mortality and Major Adverse Cardiac Events in Patients With Breast Cancer Receiving Radiotherapy: The First Decade

Abstract: Background Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for this interval is unclear. Methods and Results We aimed to study cardiovascular event rates in the first decade following curative radiotherapy for BC. We compared mortality and cardiovascular event rates with an age‐ and risk factor‐matched control population. We included 1095 patients with BC (mean age 56±12 years). Two hundred and eighteen (19.9%) women died. Cancer and cardiovascular mortality caused 107 (49.1%) and 22 (10.1%) deaths, respectively. A total of 904 cases were matched to female FLEMENGHO (Flemish Study on Environment, Genes and Health Outcomes) participants. Coronary artery disease incidence was similar (risk ratio [RR], 0.75 [95% CI, 0.48–1.18]), yet heart failure (RR, 1.97 [95% CI, 1.19–3.25]) and atrial fibrillation/flutter (RR, 1.82 [95% CI, 1.07–3.08]) occurred more often in patients with BC. Age (hazard ratio [HR], 1.033 [95% CI, 1.006–1.061], P=0.016), tumor grade (HR, 1.739 [95% CI, 1.166–2.591], P=0.007), and neoadjuvant treatment setting (HR, 2.782 [95% CI, 1.304–5.936], P=0.008) were risk factors for mortality. Risk factors for major adverse cardiac events were age (HR, 1.053 [95% CI, 1.013–1.093]; P=0.008), mean heart dose (HR, 1.093 [95% CI, 1.025–1.167]; P=0.007), history of cardiovascular disease (HR, 2.386 [95% CI, 1.096–6.197]; P=0.029) and Mayo Clinic Cardiotoxicity Risk Score (HR, 2.664 [95% CI, 1.625–4.367]; P<0.001). Conclusions Ten‐year mortality following curative treatment for unilateral BC was mainly cancer related, but heart failure and atrial fibrillation/flutter were already common in the first decade following irradiation. Mean heart dose, pre‐existing cardiovascular diseases, and Mayo Clinic Cardiotoxicity Risk Score were risk factors for cardiac adverse events. These results suggest a need for early dedicated cardio‐oncological follow‐up after radiotherapy.

Right ventriculo-arterial coupling assessed by right ventricular strain is a superior predictor of clinical outcome in patients with pulmonary arterial hypertension.

Abstract: We thank Tello et al.1 for their interest in our work in which we described a novel echocardiographic parameter (right ventricular free wall strain/pulmonary artery pressure ratio) to predict clinical outcome in pre-capillary pulmonary arterial hypertension patients. Right ventricular (RV) function is closely associated with mortality in all pulmonary hypertension groups. RV function has the ability to increase its contractility by adaptive mechanisms in response to increased afterload from the pulmonary vascular system during the disease process. However, at some point, the RV can no longer adapt to the increased afterload and RV failure occurs. The interrelation between the pulmonary vascular system and RV is described as RV-pulmonary artery (PA) coupling and has been presented as the ratio of RV function to pulmonary vascular afterload. The gold standard for measuring RV-PA coupling is obtaining the ratio of RV end-systolic elastance (Ees) to pulmonary arterial elastance (Ea) invasively, where Ees/Ea ratio represents coupling. To overcome the invasive nature and complexity of the measurement, several non-invasive methods have been proposed to estimate RV-PA coupling. The tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio was mostly investigated echocardiographic surrogate for RV-PA coupling.2,3

Translating High-Frame-Rate Imaging into Clinical Practice: Where Do We Stand?

Abstract: Abstract Continuous developments in cardiovascular imaging, software, and hardware have led to technological advancements that open new ways for assessing myocardial mechanics, hemodynamics, and function. The technical shift from clinical ultrasound machines that rely on conventional line-per-line beam transmissions to ultrafast imaging based on plane or diverging waves provides very high frame rates of up to 5000 Hz with a wide variety of potential new applications, including shear wave imaging, ultrafast speckle tracking, intracardiac flow imaging, and myocardial perfusion imaging. This review provides an overview of these advances and demonstrates potential applications and their possible added value in clinical practice.

Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy?

Abstract: Aortic dilatation and pregnancy are major concerns in women with aortopathy (AOP). This single-centre retrospective analysis focuses on the evolution of aortic diameters during and after pregnancy in women with Marfan syndrome (MS), Turner syndrome (TS) and bicuspid aortic valve (BAV) aortopathy. Thirty-eight women who had one or more single pregnancies were included. The ascending aorta was measured during pregnancy and postpartum. During pregnancy, a significant increase of diameters of the sinus aortae (median 1.4 mm; [−1.3; 3.8]) and ascending aorta (median 2.1 mm; [0.0; 4.0]) was noted. Systemic hypertension gives dilation of the aorta, but it did not influence the overall trajectory during pregnancy. Significant aortic dilatation is noted during pregnancy in women with underlying AOP, even persisting in the long term. Pre-existing systemic hypertension is associated with larger aortic diameters prior to pregnancy. More research on a larger study population however is needed.