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von Köckritz F, Braun A, Schmuck RB, Dobrindt EM, Eurich D, Heinzel FR, Pieske B, Escher F, Zhang K. Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease. J Clin Med 2021; 10:jcm10050897. [PMID: 33668295 PMCID: PMC7956617 DOI: 10.3390/jcm10050897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/20/2021] [Accepted: 02/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Cardiac function can be influenced by liver cirrhosis and should be thoroughly evaluated before liver transplantation. We investigated left ventricular (LV) and, for the first time, left atrial (LA) strain and strain rate in end-stage liver cirrhosis patients of different etiologies. Methods: This retrospective, cross-sectional study evaluated left heart function in 80 cirrhosis patients and 30 controls using standardized echocardiographic techniques and speckle tracking technology (STE) analysis. Serum markers of liver function were used for correlation analysis. Results: While conventional parameters demonstrated no alteration in systolic function, speckle tracking analysis showed a significant increase in LV longitudinal strain throughout all cardiac layers, with significant correlation to model of end-stage liver disease (MELD) score. LA reservoir and conduit strain as well as LA strain rate in all phases were significantly reduced in end-stage liver disease (ESLD) patients compared to control. STE for the evaluation of LA phasic function seemed to be more sensitive than volumetric methods. Kaplan-Meier curves showed a trend towards reduced post-transplant survival in patients with a reduced LA reservoir and conduit strain. Conclusion: STE analysis detected increased LV and decreased LA deformation in cirrhosis patients, thus proving to be highly sensitive to cardiac changes and useful for more precise cardiac evaluation.
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Affiliation(s)
- Franzisca von Köckritz
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (F.v.K.); (A.B.); (F.R.H.); (B.P.); (F.E.)
| | - Alexander Braun
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (F.v.K.); (A.B.); (F.R.H.); (B.P.); (F.E.)
| | - Rosa B. Schmuck
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (R.B.S.); (E.M.D.); (D.E.)
| | - Eva M. Dobrindt
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (R.B.S.); (E.M.D.); (D.E.)
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (R.B.S.); (E.M.D.); (D.E.)
| | - Frank R. Heinzel
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (F.v.K.); (A.B.); (F.R.H.); (B.P.); (F.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (F.v.K.); (A.B.); (F.R.H.); (B.P.); (F.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
- German Heart Center Berlin, Department of Internal Medicine and Cardiology, 13353 Berlin, Germany
| | - Felicitas Escher
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (F.v.K.); (A.B.); (F.R.H.); (B.P.); (F.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Kun Zhang
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (F.v.K.); (A.B.); (F.R.H.); (B.P.); (F.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450659746
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202
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Singh A, El Hangouche N, McGee K, Gong FF, Lentz R, Feinglass J, Akhter N. Utilizing left atrial strain to identify patients at risk for atrial fibrillation on ibrutinib. Echocardiography 2021; 38:81-88. [PMID: 33594858 DOI: 10.1111/echo.14946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ibrutinib is associated with atrial fibrillation (AF), though echocardiographic predictors of AF have not been studied in this population. We sought to determine whether left atrial (LA) strain on transthoracic echocardiography could identify patients at risk for developing ibrutinib-related atrial fibrillation (IRAF). METHODS We performed a retrospective review of 66 patients who had an echocardiogram prior to ibrutinib treatment. LA strain was measured with TOMTEC Imaging Systems, obtaining peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) on 4-chamber and 2-chamber views. Statistical analysis was performed with chi-square analysis, t test, or binomial regression analysis, with a P-value < .05 considered statistically significant. RESULTS Twenty-two patients developed IRAF (33%). Age at initiation of ibrutinib was significantly associated with IRAF (65.1 years vs 74.1 years, P = .002). Mean ibrutinib dose was lower among patients who developed IRAF (388.2 ± 121.7 vs 448.6 ± 88.4, P = .025). E/e' was significantly higher among patients who developed IRAF (11.5 vs 9.3, P = .04). PALS was significantly lower in patients who developed AF (30.3% vs 36.3%, P = .01). On multivariate regression analysis, age, PALS, and PACS were significantly associated with IRAF. On multivariate regression analysis, only PACS remained significantly associated with IRAF while accounting for age. CONCLUSIONS Age, ibrutinib dose, E/e', and PALS on pre-treatment echocardiogram were significantly associated with development of IRAF. On multivariate regression analyses, age, PALS, and PACS remained significantly associated with IRAF. Impaired LA mechanics add to the assessment of patients at risk for IRAF.
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Affiliation(s)
- Arushi Singh
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nadia El Hangouche
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Katherine McGee
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Fei-Fei Gong
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Lentz
- Division of Hematology and Oncology, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | - Joseph Feinglass
- Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nausheen Akhter
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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203
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Haji K, Marwick TH. Clinical Utility of Echocardiographic Strain and Strain Rate Measurements. Curr Cardiol Rep 2021; 23:18. [PMID: 33594493 DOI: 10.1007/s11886-021-01444-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Assessment of left ventricular function is pivotal in many decisions, but ejection fraction has fundamental limitations for assessment of mild dysfunction, and especially for repeated assessments. Myocardial deformation imaging using speckle-tracking is widely available on modern echocardiography systems, and is now feasible as a clinical, rather than purely a research tool. Strain can be measured in all cardiac chambers, most commonly as a systolic parameter, although it can be measured in diastole. Generally, speckle tracking is more effective at measuring strain than strain-rate, which requires a higher temporal resolution. The purpose of this review is to help clinicians understand the main situations where strain provides incremental value to standard echocardiographic measurements. RECENT FINDINGS The normal range of LV global longitudinal strain (GLS) has now been defined as -18% and lower (ie more negative), abnormal as -16% or higher (ie less negative), with -16 to -18% being borderline. The variation between different vendors is now small for global parameters, but regional strain measurement remains unreliable - and therefore its use for stress echocardiography remains problematic. The most valuable indications for measuring strain are subclinical LV dysfunction (eg., GLS in HFpEF, stage B heart failure, aortic stenosis, mitral regurgitation), RV dysfunction (RV strain in pulmonary hypertension), atrial fibrillation (LA strain) and sequential follow-up (cardiotoxicity). Strain measurements have clinical utility in a number of settings and should be considered as part of the standard echocardiogram.
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Affiliation(s)
- Kawa Haji
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia.,Cardiology Department, Western Health, Melbourne, Australia.,Departments of Cardiometabolic Health and Medicine, University of Melbourne, Melbourne, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia. .,Cardiology Department, Western Health, Melbourne, Australia. .,Departments of Cardiometabolic Health and Medicine, University of Melbourne, Melbourne, Australia.
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204
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Hemodynamic determinants of left atrial strain in patients with hypertrophic cardiomyopathy: A combined echocardiography and CMR study. PLoS One 2021; 16:e0245934. [PMID: 33566865 PMCID: PMC7875429 DOI: 10.1371/journal.pone.0245934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background Left atrial (LA) strain is associated with symptomatic status and atrial fibrillation in patients with hypertrophic cardiomyopathy (HCM). However, hemodynamic determinants of LA reservoir (LARS), conduit, and pump strains have not been examined and data are needed on the relation of LA strain with exercise tolerance in HCM. Methods Fifty HCM patients with echocardiographic and CMR imaging within 30 days were included. Left ventricular (LV) volumes, mass, EF, scar extent, extracellular volume fraction (ECV), and LA maximum volume were measured by CMR. Echo studies were analyzed for mitral inflow, pulmonary vein flow, mitral annulus tissue Doppler velocities, LV global longitudinal strain, and LA strain. Twenty six patients able and willing to exercise underwent cardiopulmonary stress testing for peak oxygen consumption (MVO2), and VE/VCO2 slope. Patients were followed for clinical events. Findings LARS was significantly associated with indices of LA systolic function, LV GLS, and LV filling pressures (P<0.05). Conduit strain was significantly associated with mitral annulus early diastolic velocity and ECV, whereas LA pump strain was determined by LA systolic function and indices of LV end diastolic pressure (all P<0.05). LARS and conduit strain were significantly higher in patients who achieved ≥80% of MVO2. LARS, conduit, and pump strains were significantly associated with atrial fibrillation (P<0.05). Conclusions LV structure, systolic and diastolic function, and LA systolic function determine the 3 components of LA strain. LA strain is associated with exercise tolerance and clinical events in patients with HCM.
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205
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Yoon HJ, Kim KH, Hornsby K, Park JH, Park H, Kim HY, Cho JY, Ahn Y, Jeong MH, Cho JG. Gender Difference of Cardiac Remodeling in University Athletes: Results from 2015 Gwangju Summer Universiade. Korean Circ J 2021; 51:426-438. [PMID: 33764011 PMCID: PMC8112176 DOI: 10.4070/kcj.2020.0484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/09/2020] [Accepted: 12/24/2020] [Indexed: 01/18/2023] Open
Abstract
Background and Objectives There is little data about cardiac geometry in highly trained young athletes, especially female specific changes. We investigated gender difference on exercise induced cardiac remodeling (EICR) in highly trained university athletes. Methods A total of 1,185 university athletes divided into 2 groups; female (n=497, 22.0±2.3 years) vs. male (n=688, 22.6±2.4 years). Remodeling of the left ventricle (LV), left atrium (LA), right ventricle (RV), and any cardiac chamber were compared. Results LV, LA, RV, and any remodeling was found in 156 (13.2%), 206 (17.4%), 82 (6.9%), and 379 athletes (31.9%), respectively. LV, LA, and any remodeling were more common in male than female athletes (n=53, 12.1% vs. n=103, 15.5%, p=0.065), (n=65, 13.1% vs. n=141, 20.5%, p<0.001), (n=144, 30.0% vs. n=235, 34.2%, p=0.058), respectively, whereas RV remodeling was significantly more common in female than male athletes (n=56, 11.3% vs. n=26, 3.8%, p<0.001). Interestingly, the development of LV, LA, and RV remodeling were not overlapped in many of athletes, suggesting different mechanism of EICR according to cardiac chamber. Various predictors including sports type, heart rate, muscle mass, fat mass, body surface area, and training time were differently involved in cardiac remodeling, and there were gender differences of these predictors for cardiac remodeling. Conclusions EICR was common in both sex and was independently developed among cardiac chambers in highly trained university athletes. LV and LA remodeling were common in males, whereas RV remodeling was significantly more common in females demonstrating gender difference in EICR. The present study also demonstrated gender difference in the predictors of EICR.
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Affiliation(s)
- Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Kyle Hornsby
- International University Sports Federation (FISU), Lausanne, Switzerland
| | - Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyukjin Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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206
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The prognostic value of left atrial dyssynchrony measured by speckle tracking echocardiography in the general population. Int J Cardiovasc Imaging 2021; 37:1679-1688. [PMID: 33506346 DOI: 10.1007/s10554-020-02154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
LA dyssynchrony is a predictor of cardiovascular morbidity in various patient populations. However, the prognostic value of LA dyssynchrony as evaluated by two-dimensional speckle tracking (2D-STE) in the general population is unknown. A cohort of 375 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had an echocardiogram, including LA 2D-STE, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional LA reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD). During a median follow up of 16.1 years (IQR 15.0-16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint. LA dyssynchrony was a univariable predictor of all-cause mortality (HR 1.07, 95% CI 1.02-1.11, p = 0.001) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, p = 0.064) nor MACE (HR 1.04, p = 0.22). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p = 0.28). Similarly, after further adjustments for clinical and echocardiographic parameters LA dyssynchrony did not predict any of the study outcomes. In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.
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207
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Pathan F, Zainal Abidin HA, Vo QH, Zhou H, D'Angelo T, Elen E, Negishi K, Puntmann VO, Marwick TH, Nagel E. Left atrial strain: a multi-modality, multi-vendor comparison study. Eur Heart J Cardiovasc Imaging 2021; 22:102-110. [PMID: 31848575 DOI: 10.1093/ehjci/jez303] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/08/2019] [Accepted: 11/17/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS Left atrial (LA) strain is a prognostic biomarker with utility across a spectrum of acute and chronic cardiovascular pathologies. There are limited data on intervendor differences and no data on intermodality differences for LA strain. We sought to compare the intervendor and intermodality differences between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) derived LA strain. We hypothesized that various components of atrial strain would show good intervendor and intermodality correlation but that there would be systematic differences between vendors and modalities. METHODS AND RESULTS We evaluated 54 subjects (43 patients with a clinical indication for CMR and 11 healthy volunteers) in a study comparing TTE- and CMR-derived LA reservoir strain (ƐR), conduit strain (ƐCD), and contractile strain (ƐCT). The LA strain components were evaluated using four dedicated types of post-processing software. We evaluated the correlation and systematic bias between modalities and within each modality. Intervendor and intermodality correlation was: ƐR [intraclass correlation coefficient (ICC 0.64-0.90)], ƐCD (ICC 0.62-0.89), and ƐCT (ICC 0.58-0.77). There was evidence of systematic bias between vendors and modalities with mean differences ranging from (3.1-12.2%) for ƐR, ƐCD (1.6-8.6%), and ƐCT (0.3-3.6%). Reproducibility analysis revealed intraobserver coefficient of variance (COV) of 6.5-14.6% and interobserver COV of 9.9-18.7%. CONCLUSION Vendor derived ƐR, ƐCD, and ƐCT demonstrates modest to excellent intervendor and intermodality correlation depending on strain component examined. There are systematic differences in measurements depending on modality and vendor. These differences may be addressed by future studies, which, examine calibration of LA geometry/higher frame rate imaging, semi-quantitative approaches, and improvements in reproducibility.
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Affiliation(s)
- Faraz Pathan
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.,Department of Cardiovascular Imaging, University of Sydney, Nepean Clinical School, Sydney, Australia
| | - Hafisyatul Aiza Zainal Abidin
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, Faculty of Medicine, Universiti Teknologi MARA, Kuala Lampur, Malaysia
| | - Quang Ha Vo
- Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia
| | - Hui Zhou
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Radiology, XiangYa Hospital, Central South University, Hunan, China
| | - Tommaso D'Angelo
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital, Messina, Italy
| | - Elen Elen
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, National Cardiovascular Center Harapan Kita, Universitas, Jakarta, Indonesia
| | - Kazuaki Negishi
- Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.,Department of Cardiovascular Imaging, University of Sydney, Nepean Clinical School, Sydney, Australia
| | - Valentina O Puntmann
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas H Marwick
- Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.,Department of Cardiovascular Imaging, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Eike Nagel
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
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208
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Sonaglioni A, Lombardo M, Nicolosi GL, Rigamonti E, Anzà C. Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion. Int J Cardiovasc Imaging 2021; 37:1539-1550. [PMID: 33389359 PMCID: PMC7778706 DOI: 10.1007/s10554-020-02127-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/30/2020] [Indexed: 01/18/2023]
Abstract
During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT) detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional echocardiographic parameters associated with LAAT on TEE in non-valvular atrial fibrillation (NVAF) patients planned for electrical cardioversion (ECV). This retrospective study included 125 consecutive NVAF patients (71.5±7.8 yrs, 75 males), who underwent TEE at our Institution between April 2016 and January 2020, to exclude LAAT before scheduled ECV. All patients underwent a transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography (STE) analysis of left atrial (LA) strain and strain rate (SR) parameters. 28% of patients were diagnosed with LAAT, while 72% without LAAT. Compared to controls, patients with LAAT had significantly higher CHA2DS2-Vasc Score and average E/e’ ratio, and significantly lower left ventricular ejection fraction (LVEF). Moreover, LA-peak positive global atrial strain (GSA+) and LA-SR parameters were significantly reduced in patients with LAAT. Multivariate logistic regression revealed that, differently from CHA2DS2-Vasc Score, LVEF (OR 0.88, 95%CI 0.81–0.97, p = 0.01), average E/e’ ratio (OR 2.36, 95%CI 1.41–3.98, p = 0.001), and LA-GSA+ (OR 0.57, 95%CI 0.36-0-90, p = 0.01) were independently associated with LAAT. LA-GSA+ (optimal cut-off ≤ 9.1%, AUC 0.95) showed the highest diagnostic performance. Finally, a strong linear correlation of LA peak-to-peak SR with both LA appendage filling (r = 0.86) and emptying (r = 0.83) velocities was demonstrated. TTE implemented with STE analysis of LA mechanics improves thrombotic risk assessment of NVAF patients.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Via Milanese 300, 20099, Sesto San Giovanni (MI), Italy
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209
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Ferkh A, Stefani L, Trivedi SJ, Brown P, Byth K, Pathan F, Thomas L. Inter-vendor comparison of left atrial strain using layer specific strain analysis. Int J Cardiovasc Imaging 2021; 37:1279-1288. [PMID: 33389361 DOI: 10.1007/s10554-020-02114-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/20/2020] [Indexed: 12/09/2022]
Abstract
Left atrial strain (LAS) on transthoracic echocardiogram (TTE) is increasingly recognised to have clinical utility in cardiovascular disease. Differences in LAS measurements between vendors remains a barrier for clinical use. We sought to compare LAS between two commonly used software platforms; the layer-specific endocardial and mid-myocardial measurements of LAS on General Electric (GE) Echopac were compared to TomTec strain. LAS was measured in 88 individuals with no previous cardiac history and 40 paroxysmal AF (PAF) patients, in sinus rhythm at TTE. Conventionally, LAS measured using GE Echopac is mid-myocardial strain (GE-mid); additionally, endocardial (GE-endo) LAS was evaluated. Both LAS measurements by GE were compared to TomTec-Arena (v2.30.02) measurements. Reservoir (ƐR), contractile (ƐCT) and conduit (ƐCD) phasic strain were evaluated. Both GE-mid and GE-endo LAS correlated well with TomTec LAS. On Bland-Altman analysis, GE-mid LAS measurements were systematically lower than TomTec LAS (ƐR: mean difference (MD) - 6.08%, limits of agreement (LOA) - 12%, 0%, ƐCT: MD - 0.8%, LOA - 7%, 5%, ƐCD: MD - 5.2% LOA - 12%, 1%). GE-endo LAS demonstrated no systematic difference from TomTec LAS, but had wider limits of agreement (ƐR: MD 0.41%, LOA - 7%, 8%, ƐCT: MD 0.50%, LOA - 6%, 7%, ƐCD: MD - 0.08%, LOA - 7%, 7%). ƐR had the best reproducibility. Mid-myocardial LAS, routinely evaluated by GE Echopac software, systematically underestimates LAS compared to TomTec. Using GE endocardial LAS eliminated this bias, but introduced greater variation between measurements. Serial measurements of LAS should therefore be performed on the same vendor system.
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Affiliation(s)
- Aaisha Ferkh
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Luke Stefani
- Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Siddharth J Trivedi
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Paula Brown
- Cardiology Department, Westmead Hospital, Westmead, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Karen Byth
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Faraz Pathan
- Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia.,Charles Perkins Centre, University of Sydney ,University of Sydney, Nepean Clinical School, Sydney, NSW, Australia.,Cardiology Department, Nepean Hospital, Sydney, Australia
| | - Liza Thomas
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia. .,Cardiology Department, Westmead Hospital, Westmead, Australia. .,Western Sydney Local Health District - Research and Education Network, Westmead Hospital, Westmead, NSW, 2145, Australia. .,South Western Clinical School, University of New South Wales, Sydney, Sydney, Australia. .,Cardiology Department, Westmead Hospital, Corner Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia.
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210
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Labombarda F, Bonopéra M, Maragnes P, Milliez P, Manrique A, Beygui F. Impaired left atrial function in adults and adolescents with corrected aortic coarctation. Pediatr Cardiol 2021; 42:199-209. [PMID: 32975604 DOI: 10.1007/s00246-020-02471-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
This study examined the left atrial (LA) function using two-dimensional (2D) strain analysis after aortic coarctation (CoA) repair, as well as relationships between LA function and patient characteristics, especially aortic arch anatomy. 56 patients (34 males, age: 31 ± 16 years) with CoA repair (46 post 'end-to-end anastomosis/subclavian flap') and 56 controls were studied. 2D strain imaging was performed to assess left ventricular (LV) and LA functions including peak-positive LA strain, early and late diastolic LA strains, and global longitudinal (LV-GLS) and circumferential (LV-GCS) strains. LA dysfunction (LAD) was defined as a peak-positive LA strain value lower than the mean value of the control group minus 2 SDs. Peak-positive LA strain, early and late diastolic LA strains, and LV-GLS were significantly lower in the CoA group while LV-GCS did not differ. No significant correlation was found between LA strain and either current age, age at initial repair, or blood pressure; Ea and LV-GLS were moderately correlated to peak-positive LA strain (r = 0.49, p < 0.001 and r = - 0.55, p < 0.001, respectively). 23 CoA patients (41%) presented LAD (abnormal peak-positive LA strain < 25%). Among patients who underwent end-to-end anastomosis/subclavian flap, those with a non-romanesque aortic arch anatomy exhibited a significantly lower peak-positive LA strain. Ischemic stroke and atrial arrhythmia were more frequent in CoA patients with LAD. Our findings suggest that LAD may be prevalent late after CoA repair. Postoperative aortic arch anatomy may impact peak-positive LA strain.
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Affiliation(s)
- Fabien Labombarda
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France. .,Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France. .,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France.
| | - Maud Bonopéra
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France
| | - Pascale Maragnes
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France
| | - Paul Milliez
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France.,Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France
| | - Alain Manrique
- Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France
| | - Farzin Beygui
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France.,Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France
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211
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Sánchez FJ, Gonzalez VA, Farrando M, Baigorria Jayat AO, Segovia-Roldan M, García-Mendívil L, Ordovás L, Prado NJ, Pueyo E, Diez ER. Atrial Dyssynchrony Measured by Strain Echocardiography as a Marker of Proarrhythmic Remodeling and Oxidative Stress in Cardiac Surgery Patients. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8895078. [PMID: 33456678 PMCID: PMC7787772 DOI: 10.1155/2020/8895078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Abstract
Aging leads to structural and electrophysiological changes that increase the risk of postoperative atrial arrhythmias; however, noninvasive preoperative markers of atrial proarrhythmic conditions are still needed. This study is aimed at assessing whether interatrial dyssynchrony determined using two-dimensional speckle tracking echocardiography relates to proarrhythmic structural and functional remodeling. A cohort of 45 patients in sinus rhythm referred for cardiac surgery was evaluated by echocardiography and surface electrocardiogram the day before the intervention. Transmembrane potential, connexin, and potassium channel distribution, inflammatory, and nitrooxidative markers were measured from right atrial tissue obtained from patients. A difference greater than 40 milliseconds between right and left atrial free wall contraction confirmed the presence of interatrial dyssynchrony in 21 patients. No difference in relation with age, previous diseases, and 2-dimensional echocardiographic findings as well as average values of global longitudinal right and left atrial strain were found between synchronic and dyssynchronic patients. Postoperative atrial fibrillation incidence increased from 8.3% in the synchronic group to 33.3% in the dyssynchronic ones. P wave duration showed no difference between groups. Action potentials from dyssynchronous patients decreased in amplitude, maximal rate of depolarization, and hyperpolarized. Duration at 30% of repolarization increased, being markedly shorter at 90% of repolarization. Only the dyssynchronous group showed early and delayed afterdepolarizations. Atrial tissue of dyssynchronous patients displayed lateralization of connexin 40 and increased connexin 43 expression and accumulation of tumor necrosis factor-α in the intercalated disc. Tumor necrosis factor-α did not colocalize, however, with lateralized connexin 40. Nitroxidative marks and KATP channels increased perivascularly and in myocytes. Our results demonstrate that, as compared to a traditional surface electrocardiogram, the novel noninvasive echocardiographic evaluation of interatrial dyssynchrony provides a better identification of nonaged-related proarrhythmic atrial remodeling with increased susceptibility to postoperative atrial fibrillation.
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Affiliation(s)
- Francisco J. Sánchez
- Department of Morphophysiology, School of Medicine, National University of Cuyo, Centro Universitario, Mendoza 5500, Argentina
- Department of Cardiovascular Surgery, Clinic of Cuyo, Mendoza 5500, Argentina
| | | | - Martin Farrando
- Department of Cardiovascular Surgery, Clinic of Cuyo, Mendoza 5500, Argentina
| | | | - Margarita Segovia-Roldan
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
| | - Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
| | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
- Aragon Agency for Research and Development (ARAID), Zaragoza 50018, Spain
| | - Natalia J. Prado
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU)-CONICET, Mendoza 5500, Argentina
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragon Institute of Engineering Research (I3A), University of Zaragoza Instituto de Investigación Sanitaria (IIS), Zaragoza 50018, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza 50018, Spain
| | - Emiliano R. Diez
- Department of Morphophysiology, School of Medicine, National University of Cuyo, Centro Universitario, Mendoza 5500, Argentina
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU)-CONICET, Mendoza 5500, Argentina
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212
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Laish-Farkash A, Perelshtein Brezinov O, Valdman A, Tam D, Rahkovich M, Kogan Y, Marincheva G. Evaluation of left atrial remodeling by 2D-speckle-tracking echocardiography versus by high-density voltage mapping in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2020; 32:305-315. [PMID: 33331056 DOI: 10.1111/jce.14837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strain imaging during left atrial (LA) reservoir phase (LASr) is used as a surrogate for LA structural remodeling and fibrosis. Atrial fibrillation (AF) patients with >5% low-voltage zones (LVZs) obtained by 3D-electro-anatomical-mapping have higher recurrence rate post-ablation. We investigated the relationship between LA remodeling using two-dimensional-speckle-tracking echocardiography (2D-STE) and high-density voltage mapping in AF patients. METHODS A prospective study of 42 consecutive patients undergoing AF ablation. 2D-echo, 2D-STE, and high-density contact LA bipolar voltage maps were constructed before ablation. LVZs were determined with different bipolar amplitudes and their ratio per patient's LA area were investigated for correlation with LASr. We compared 2D-LASr results in patients with LVZs ≥ 5% (LVZs group) versus those with LVZ < 5% (non-LVZs group). RESULTS Compared with non-LVZs group (n = 15), LVZs group (n = 27) included significantly older patients, more women, more persistent AF, higher CHA2 DS2 -VASc score, higher E/A ratio and higher LA volume index (p < .05). LVZs group had lower %LASr values (12.4 ± 5.9% vs. 21.1 ± 6.3, respectively; p<.001). LVZs% in different amplitudes (<0.1 mV, <0.2 mV, and <0.5 mV) were negatively correlated with %LASr (r = -.63, r = -.68, and r = -.72, respectively; p< .001). Atrial strain thresholds for LVZs ≥ 5% in amplitudes <0.1 mV, <0.2 mV, and <0.5 mV were associated with %LASr 12.98, 16.16 and 19.55, respectively; p< .05). In a multivariate analysis, %LASr was the only independent indicator of LVZs (OR, 0.8; 95% CI, 0.6-0.9; p= .04). CONCLUSIONS LVZs ≥ 5% has a negative association with atrial %LASr. Thus, a simple 2D-STE measurement of %LASr can be used as a noninvasive method to evaluate significant LA remodeling and fibrosis in AF patients.
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Affiliation(s)
- Avishag Laish-Farkash
- Cardiology Department, Assuta Ashdod University Medical Center, Ashdod, Israel.,Department of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva, Israel
| | - Olga Perelshtein Brezinov
- Cardiology Department, Assuta Ashdod University Medical Center, Ashdod, Israel.,Department of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva, Israel
| | - Andrei Valdman
- Cardiology Department, Assuta Ashdod University Medical Center, Ashdod, Israel.,Department of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva, Israel
| | - Dudi Tam
- Biosense Webster, Johnson and Johnson, Yokneam, Israel
| | - Michael Rahkovich
- Cardiology Department, Assuta Ashdod University Medical Center, Ashdod, Israel.,Department of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva, Israel
| | - Yonatan Kogan
- Cardiology Department, Assuta Ashdod University Medical Center, Ashdod, Israel.,Department of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva, Israel
| | - Gergana Marincheva
- Cardiology Department, Assuta Ashdod University Medical Center, Ashdod, Israel.,Department of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva, Israel
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213
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Vlachou M, Kamperidis V, Vlachaki E, Tziatzios G, Pantelidou D, Boutou A, Apostolou C, Papadopoulou D, Giannakoulas G, Karvounis H. Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major. Diagnostics (Basel) 2020; 11:diagnostics11010001. [PMID: 33375056 PMCID: PMC7822012 DOI: 10.3390/diagnostics11010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.
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Affiliation(s)
- Maria Vlachou
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
- Correspondence: ; Tel./Fax: +30-2310-994830
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Georgios Tziatzios
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Despoina Pantelidou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - Afroditi Boutou
- Pulmonary Department, Papanikolaou Hospital, 57010 Thessaloniki, Greece;
| | - Chrysa Apostolou
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Despoina Papadopoulou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - George Giannakoulas
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
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214
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Maffeis C, Morris DA, Belyavskiy E, Kropf M, Radhakrishnan AK, Zach V, Rozados da Conceicao C, Trippel TD, Pieske-Kraigher E, Rossi A, Pieske B, Edelmann F. Left atrial function and maximal exercise capacity in heart failure with preserved and mid-range ejection fraction. ESC Heart Fail 2020; 8:116-128. [PMID: 33295106 PMCID: PMC7835603 DOI: 10.1002/ehf2.13143] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/28/2020] [Accepted: 11/15/2020] [Indexed: 01/02/2023] Open
Abstract
Aims Exercise intolerance is the leading manifestation of heart failure with preserved or mid‐range ejection fraction (HFpEF or HFmrEF), and left atrial (LA) function might contribute to modulating left ventricular filling and pulmonary venous pressures. We aim to assess the association between LA function and maximal exercise capacity in patients with HFpEF or HFmrEF. Methods and results Sixty‐five patients, prospectively enrolled in the German HFpEF Registry, were analysed. Inclusion criteria were New York Heart Association functional class ≥ II, left ventricular ejection fraction > 40%, structural heart disease or diastolic dysfunction, and elevated levels of N terminal pro brain natriuretic peptide (NT‐proBNP). LA function was evaluated through speckle‐tracking echocardiography by central reading in the Charité Academic Echocardiography core lab. All patients underwent maximal cardiopulmonary exercise test and were classified according to a peak VO2 cut‐off of prognostic value (14 mL/kg/min). NT‐pro‐BNP was measured. Twenty‐nine patients (45%) reached a peak VO2 < 14 mL/kg/min (mean value 12.4 ± 1.5) and 36 patients (55%) peak VO2 ≥ 14 mL/kg/min (mean value 19.4 ± 3.9). There was no significant difference in left ventricular ejection fraction (60 ± 9 vs. 59 ± 8%), left ventricular mass (109 ± 23 vs. 112 ± 32 g/m2), LA volume index (45 ± 17 vs. 47 ± 22 mL/m2), or E/e´ (13.1 ± 4.7 vs. 13.0 ± 6.0) between these groups. In contrast, all LA strain measures were impaired in patients with lower peak VO2 (reservoir strain 14 ± 5 vs. 21 ± 9%, P = 0.002; conduit strain 9 ± 2 vs. 13 ± 4%, P = 0.001; contractile strain 7 ± 4 vs. 11 ± 6%, P = 0.02; reported lower limits of normality for LA reservoir, conduit and contractile strains: 26.1%, 12.0%, and 7.7%). In linear regression analysis, lower values of LA reservoir strain were associated with impaired peak VO2 after adjustment for age, sex, body mass index, heart rhythm (sinus/AFib), and log‐NTproBNP [β 0.29, 95% confidence interval (CI) 0.02–0.30, P = 0.02], with an odds ratio 1.22 (95% CI 1.05–1.42, P = 0.01) for peak VO2 < 14 mL/kg/min for LA reservoir strain decrease after adjustment for these five covariates. Adding left ventricular ejection fraction, it did not influence the results. On the other hand, the addition of LA strain to the adjustment parameters alone described above provided a significant increase of the predictive value for lower peak VO2 values (R2 0.50 vs. 0.45, P = 0.02). With receiver operating characteristic curve analysis, we identified LA reservoir strain < 22% to have 93% sensitivity and 49% specificity in predicting peak VO2 < 14 mL/kg/min. Using this cut‐off, LA reservoir strain < 22% was associated with peak VO2 < 14 mL/kg/min in logistic regression analysis after comprehensive adjustment for age, sex, body mass index, heart rhythm, and log‐NTproBNP [odds ratio 95% CI 10.4 (1.4–74), P = 0.02]. Conclusions In this HFpEF and HFmrEF cohort, a reduction in LA reservoir strain was a sensible marker of decreased peak exercise capacity. Therefore, LA reservoir strain might be of clinical value in predicting exercise capacity in patients with HFpEF or HFmrEF.
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Affiliation(s)
- Caterina Maffeis
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.,Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Daniel Armando Morris
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Martin Kropf
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Aravind Kumar Radhakrishnan
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Veronika Zach
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Cristina Rozados da Conceicao
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Tobias Daniel Trippel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Andrea Rossi
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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215
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Murakami H, Hotta D, Ruhnke GW. Paradoxical doppler echocardiographic parameters during recovery of left atrial contractility after spontaneous conversion from paroxysmal atrial fibrillation to sinus rhythm. J Cardiol Cases 2020; 22:302-304. [DOI: 10.1016/j.jccase.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
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216
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Gan GCH, Kadappu KK, Bhat A, Fernandez F, Gu KH, Cai L, Byth K, Eshoo S, Thomas L. Left Atrial Strain Is the Best Predictor of Adverse Cardiovascular Outcomes in Patients with Chronic Kidney Disease. J Am Soc Echocardiogr 2020; 34:166-175. [PMID: 33223356 DOI: 10.1016/j.echo.2020.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events, which is underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients. METHODS Two hundred forty-three prospectively recruited stage 3/4 CKD patients (male, 63%; mean age, 59.2 ± 14.4 years) without previous cardiac disease made up the study cohort. All participants underwent a transthoracic echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for 3.9 ± 2.7 years for the primary end point of cardiovascular death and major adverse cardiovascular event (MACE). The secondary end point was the composite of all-cause death and MACE. RESULTS Fifty-four patients met the primary end point, and 65 the secondary end point. On log-rank tests, older age, diabetes mellitus, anemia, greater LV mass, reduced LV global longitudinal strain, larger indexed LA volume, higher E/e' ratio, and reduced LA reservoir strain (LASr; P < .01 for all) were independent predictors of cardiovascular death and MACE. On multivariable regression analysis of univariate predictors, LASr (P < .01) was the only independent predictor for the primary end point as well as for the secondary end point. Receiver operating characteristic curve analysis showed LASr was a stronger predictor of adverse events (area under the curve [AUC] = 0.84) compared to the Framingham (AUC = 0.58) and Atherosclerotic Cardiovascular Disease (AUC = 0.59) risk scores. CONCLUSIONS LASr is an independent predictor of cardiovascular death and MACE in CKD patients, superior to clinical risk scores, LV parameters, and LA volume.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Krishna K Kadappu
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; Department of Cardiology, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Fernando Fernandez
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Kennith H Gu
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Lawrence Cai
- University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Byth
- Biostatistics Unit, Research and Education Network, Westmead Hospital, and the University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
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217
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Gan GCH, Bhat A, Chen HHL, Fernandez F, Byth K, Eshoo S, Thomas L. Determinants of LA reservoir strain: Independent effects of LA volume and LV global longitudinal strain. Echocardiography 2020; 37:2018-2028. [PMID: 33211337 DOI: 10.1111/echo.14922] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Left atrial (LA) deformation during the reservoir phase (LASr) has demonstrated strong prognostic value in different clinical settings. Although determinants of left atrial reservoir strain including left atrial relaxation, left atrial compliance, and left ventricular longitudinal systolic function are fairly well defined, there is incomplete information regarding the effect of left atrial volume on this relationship which is the focus of our study. METHOD Consecutive patients without prior cardiac disease referred for transthoracic echocardiography were prospectively recruited. All participants underwent clinical assessment, transthoracic echocardiography (TTE), and screening exercise stress test. Only patients with normal left ventricular ejection fraction (LVEF) without left ventricular hypertrophy (LVH) or myocardial ischemia on stress testing were included. RESULTS A total of 260 patients (57% male, mean age 59 ± 14 years) were included. 70% had hypertension, 33% had diabetes mellitus, and 31% had both HTN and DM. On multivariate analysis, age, e', LAVI, and LV GLS (P < .01 for all) showed an independent association with LASr. Of interest, at lower tertiles of LAVI, a linear decrease in LASr was observed parallel to worsening LV GLS, whilst at higher tertiles of LAVI, the reduction in LASr was non-linear implying that LA enlargement, consequent to LA remodeling, had an incremental effect on LASr. CONCLUSION Age, e', LV GLS, and LAVI were independently associated with LASr. LA remodeling reflected by larger LAVI had an incremental negative association with LASr independent of LV GLS.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Fernando Fernandez
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Karen Byth
- Biostatistics Unit, Research and Education Network, Westmead Hospital and The University of Sydney, Sydney, NSW, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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218
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Sade LE, Keskin S, Can U, Çolak A, Yüce D, Çiftçi O, Özin B, Müderrisoğlu H. Left atrial mechanics for secondary prevention from embolic stroke of undetermined source. Eur Heart J Cardiovasc Imaging 2020; 23:381-391. [DOI: 10.1093/ehjci/jeaa311] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 02/01/2023] Open
Abstract
Abstract
Aims
Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS).
Methods and results
In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA2DS2-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86–0.97).
Conclusion
Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS.
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Affiliation(s)
- Leyla Elif Sade
- Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey
| | - Suzan Keskin
- Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey
| | - Ufuk Can
- Neurology Department, University of Baskent, Ankara, Turkey
| | - Ayşe Çolak
- Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey
| | - Deniz Yüce
- Preventive Oncology and Epidemiology Department, University of Hacettepe Cancer Institute, Ankara Turkey
| | - Orçun Çiftçi
- Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey
| | - Bülent Özin
- Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey
| | - Haldun Müderrisoğlu
- Cardiology Department, University of Baskent, 54. sokak E blok No: 45 Bahcelievler, 06490 Ankara, Turkey
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Pagola J, Juega J, Francisco-Pascual J, Bustamante A, Penalba A, Pala E, Rodriguez M, De Lera-Alfonso M, Arenillas JF, Cabezas JA, Moniche F, de Torres R, Montaner J, González-Alujas T, Alvarez-Sabin J, Molina CA. Predicting Atrial Fibrillation with High Risk of Embolization with Atrial Strain and NT-proBNP. Transl Stroke Res 2020; 12:735-741. [PMID: 33184686 DOI: 10.1007/s12975-020-00873-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
The aim of the study was to determine markers of atrial dysfunction in patients with cryptogenic stroke to predict episodes of paroxysmal atrial fibrillation with high risk of embolization (HpAF). We classified patients included in the Crypto-AF study, Cryptogenic Stroke registry, to detect paroxysmal atrial fibrillation (pAF) with wearable Holter, according to the longest episode of pAF in three groups: without pAF detection, episodes of pAF shorter than 5 h, and episodes of pAF longer than 5 h (HpAF). Atrial dysfunction surrogates were evaluated: EKG pattern, Holter record and echocardiography parameters (left atria volume (LAVI), and peak atrial longitudinal and contraction strain (PALS and PACS). The level of N-terminal pro b-type natriuretic peptide (NT-proBNP) was determined. All patients were followed for 2 years to detect pAF and stroke recurrence. From 308 patients, 253 patients with high quality Holter analysis were selected. The distribution was No pAF 78.6% (n = 199), pAF < 5 h 7.9% (n = 20), and HpAF > 5 h 13.4% (n = 34). Age of the patients and combination of PALS and NT-proBNP independently predicted HpAF OR 1.07 (1.00; 1.15) and OR 3.05 (1.08; 8.60) respectively. The validity of PALS and NT-proBNP to detect patients at risk of HpAF was higher than the validity of age (AUC 0.82, sensitivity 78.95%, specificity 63%). Patients with PALS < 25% and NT-proBNP > 283 pg/ml had more detection of pAF during follow-up 35% vs. 5.1% OR 2.33 (1.05-5.13) (p < 0.001). Multimodal assessment of atrial dysfunction with PALS and NT-proBNP improved the prediction of pAF episodes with high embolic risk in patients with cryptogenic stroke.
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Affiliation(s)
- Jorge Pagola
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
| | - Jesus Juega
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | | | | | - Anna Penalba
- Neurovascular Research Lab, Valld'Hebrón Research Institute, Barcelona, Spain
| | - Elena Pala
- Neurovascular Research Lab, Valld'Hebrón Research Institute, Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | | | - Juan F Arenillas
- Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
| | - Juan Antonio Cabezas
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | - Francisco Moniche
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | - Reyes de Torres
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | - Joan Montaner
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | | | - Jose Alvarez-Sabin
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
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Labombarda F, Mulet B, Maragnes P, Beygui F. Impaired left atrial stiffness in patients with corrected congenital left ventricular outflow obstructions. Echocardiography 2020; 38:47-56. [PMID: 33174642 DOI: 10.1111/echo.14925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We examined the left atrial stiffness index (LA Stiff) on echocardiography and its determinants in adults and adolescents with repaired congenital left ventricular outflow obstructions (c-LVOOs), including isolated subaortic stenosis (SAS), stenotic bicuspid aortic valve (BAV), and aortic coarctation (CoA). METHODS Seventy-two patients (43 males, age: 31 ± 15 years) with repaired c-LVOOs (SAS: n = 12; BAV: n = 27; CoA: n = 33) were compared to 72 age- and sex-matched controls. 2D strain imaging was performed to assess left ventricular (LV) and LA function, including peak positive longitudinal LA strain (LAS), late diastolic LA strain (LDS), and LV global longitudinal strain (GLS). The (E/Ea)/LAS ratio was used to calculate LA Stiff. RESULTS LA Stiff was significantly higher in the c-LVOO group than in the control group. Among the c-LVOO patients, the CoA group had the lowest GLS and the highest LA Stiff; no significant differences were found with respect to sex, hypertension history, smoking status, or repeated repair among c-LVOO subtypes. Multivariable regression analysis with the variables "BMI" and "c-LVOO subtype" revealed that BMI and c-LVOO subtypes were independently associated with LA Stiff (b = 0.290, P = .009 and b = 0.353, P = .002, respectively). CONCLUSIONS We documented abnormal LA Stiff values in adults and adolescents after c-LVOO repair. Patients with CoA demonstrated the most impaired LA Stiff values. Overweight may contribute to worse LA Stiff values. Further studies are required to determine the prognostic implications of LA Stiff in patients with repaired c-LVOOs.
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Affiliation(s)
- Fabien Labombarda
- Department of Cardiology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, UNICAEN, CHU Caen, Caen, France
| | - Benoit Mulet
- Department of Pediatry, CHU de Caen, Caen, France
| | | | - Farzin Beygui
- Department of Cardiology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, UNICAEN, CHU Caen, Caen, France
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221
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Gazagnes J, Gollion C, Fournier P, Cariou E, Larrue V, Lairez O. Left Atrial Function in Young Patients With Cryptogenic Stroke and Patent Foramen Ovale: A Left Atrial Longitudinal Strain Study. Front Neurol 2020; 11:536612. [PMID: 33250839 PMCID: PMC7674925 DOI: 10.3389/fneur.2020.536612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The study of left atrial (LA) longitudinal strain by speckle tracking is a reliable method for analyzing LA function that could provide relevant information in young patients with cryptogenic stroke (CS). The aim of this study was to investigate whether the presence of a patent foramen ovale (PFO) impacts the LA longitudinal strain in a population of young patients with first CS. Methods and Results: Patients aged 18 to 54 years, treated consecutively in a university hospital for first CS, were included in this study. The presence of a PFO and an atrial septal aneurysm (ASA) was investigated using transesophageal echocardiography and transcranial Doppler. Speckle tracking analysis was performed on transthoracic echocardiography, allowing the measurement of global, passive, and active longitudinal LA strain, corresponding to the reservoir, conduit, and contractile function, respectively. A total of 51 patients were included in the study. In a multivariable analysis, overweight was associated with reduced global and passive LA longitudinal strain (P = 0.013 and P = 0.018, respectively), and hypertension was associated with reduced active LA longitudinal strain (P = 0.049). LA longitudinal strain was not different between patients with PFO or PFO plus ASA and patients without PFO. Conclusion: LA longitudinal strain in young subjects with CS was impaired in the presence of overweight and hypertension, but not of PFO or PFO plus ASA.
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Affiliation(s)
- Julie Gazagnes
- Department of Neurology, University Hospital, Toulouse, France
| | - Cédric Gollion
- Department of Neurology, University Hospital, Toulouse, France
- Medical School, Toulouse III Paul Sabatier University, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Eve Cariou
- Department of Cardiology, University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Vincent Larrue
- Department of Neurology, University Hospital, Toulouse, France
- Medical School, Toulouse III Paul Sabatier University, Toulouse, France
- *Correspondence: Vincent Larrue
| | - Olivier Lairez
- Medical School, Toulouse III Paul Sabatier University, Toulouse, France
- Department of Cardiology, University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
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222
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How to incorporate left atrial strain in the diagnostic algorithm of left ventricular diastolic dysfunction. Int J Cardiovasc Imaging 2020; 37:945-951. [PMID: 33128641 DOI: 10.1007/s10554-020-02070-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
The combination of early trans-mitral inflow and mitral annular tissue Doppler velocities (E/e' ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However, when E/e' is between 8 and 14 its accuracy decreases substantially. Left atrial (LA) deformation analysis by speckle tracking echocardiography was recently proposed as an alternative approach to estimate LV filling pressures, but its role when E/e' is between 8 and 14 has been under-investigated. We aimed to assess whether LA strain could help to identify elevated filling pressures in patients with E/e' between 8 and 14. Among consecutive non-selected patients who underwent a comprehensive echocardiographic evaluation, we enrolled those with E/e' ratio > 8 and ≤ 14. Exclusion criteria were: organic mitral valve disease or mitral surgery; presence of mitral regurgitation greater than moderate in severity; diseases associated with pre-capillary pulmonary hypertension; and undetectable systolic pulmonary artery pressure (PAP-S). Peak LA longitudinal (PALS) and contraction strain (PACS) values was obtained by averaging all segments, and by separately averaging segments measured in the 4-chamber and 2-chamber views. Seventy-six patients had E/e' > 8 and ≤ 14 and formed the study cohort. Mean age 69 ± 12 years, LV ejection fraction (LVEF) 54.5 ± 11.2%, mean E/e' 11.2 ± 1.9, PAP-S 33 ± 7 mmHg, PALS 31.6 ± 11.7%. PALS was significantly associated to PAP-S after adjustment for LVEF, E/e', septal LV longitudinal shortening velocity (s'), LA volume indexed (p = 0.002) and also for ASE/EACVI diastolic dysfunction classification (p = 0.0002). Furthermore, PALS but not ASE/EACVI diastolic dysfunction grading, resulted independently associated to New York Heart Association (NYHA) class (p = 0.0004). PALS is able to predict increased intra-cardiac pressure and NYHA class in patients characterized by E/e' between 8 and 14. Therefore, we propose that PALS might be incorporated in a simplified diagnostic algorithm based on E/e' classes.
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223
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Defining the Reference Range for Left Ventricular Strain in Healthy Patients by Cardiac MRI Measurement Techniques: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 217:569-583. [PMID: 33084383 DOI: 10.2214/ajr.20.24264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND. Echocardiography is the primary noninvasive technique for left ventricular (LV) strain measurement. MRI has potential advantages, although reference ranges and thresholds to differentiate normal from abnormal left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular global radial strain (LVGRS) are not yet established. OBJECTIVE. The purpose of our study was to determine the mean and lower limit of normal (LLN) of MRI-derived LV strain measurements in healthy patients and explore factors potentially influencing these measurements. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Library databases were searched for studies published through January 1, 2020, that reported MRI-derived LV strain measurements in at least 30 healthy individuals. Mean and LLN measurements of LV strain were pooled using random-effects models overall and for studies stratified by measurement method (feature tracking [FT] or tagging). Additional subgroup and meta-regression analyses were performed. EVIDENCE SYNTHESIS. Twenty-three studies with a total of 1782 healthy subjects were included. Pooled means and LLNs for all studies were -18.6% (95% CI, -19.5% to -17.6%) and -13.3% (-13.9% to 12.7%) for LVGLS, -21.0% (-22.4% to -19.6%) and -15.6% (-17.0% to -14.3%) for LVGCS, and 38.7% (30.5-46.9%) and 20.6% (15.1-26.1%) for LVGRS. Pooled means and LLNs for LVGLS by strain measurement method were -19.4% (95% CI, -20.6% to -18.1%) and -13.1% (-14.2% to -12.0%) for FT and -15.6% (-16.2% to -15.1%) and -13.1% (-14.1% to -12.2%) for tagging. A later year of study publication, increasing patient age, and increasing body mass index were associated with more negative mean LVGLS values. An increasing LV end-diastolic volume index was associated with less negative mean LVGLS values. No factor was associated with LLN of LVGLS. CONCLUSION. We determined the pooled means and LLNs, with associated 95% CIs, for LV strain by cardiac MRI to define thresholds for normal, abnormal, and borderline strain in healthy patients. The method of strain measurement by MRI affected the mean LVGLS. No factor affected the LLN of LVGLS. CLINICAL IMPACT. This meta-analysis lays a foundation for clinical adoption of MRI-derived LV strain measurements, with management implications in both healthy patients and patients with various disease states.
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224
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Marwick TH, Chandrashekhar Y. Left Atrial Strain. JACC Cardiovasc Imaging 2020; 13:2278-2279. [DOI: 10.1016/j.jcmg.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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225
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Mannina C, Tugcu A, Jin Z, Russo C, Matsumoto K, Ito K, Homma S, Elkind MSV, Rundek T, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Left Atrial Strain and Subclinical Cerebrovascular Disease in Older Adults. JACC Cardiovasc Imaging 2020; 14:508-510. [PMID: 33011124 DOI: 10.1016/j.jcmg.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
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226
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New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation. J Clin Med 2020; 9:jcm9103131. [PMID: 32998251 PMCID: PMC7599992 DOI: 10.3390/jcm9103131] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Owing to its ease of application, noninvasive nature, and safety, echocardiography is an essential imaging modality to assess cardiac function in patients affected by ischemic heart disease (IHD). Over the past few decades, we have witnessed a continuous series of evolutions in the ultrasound field that have led to the introduction of innovative echocardiographic modalities which allowed to better understand the morphofunctional abnormalities occurring in cardiovascular diseases. This article offers an overview of some of the newest echocardiographic modalities and their promising application in IHD diagnosis, risk stratification, management, and monitoring after cardiac rehabilitation.
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227
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Ramkumar S, Pathan F, Kawakami H, Ochi A, Yang H, Potter EL, Marwick TH. Impact of disease stage on the performance of strain markers in the prediction of atrial fibrillation. Int J Cardiol 2020; 324:233-241. [PMID: 32987052 DOI: 10.1016/j.ijcard.2020.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/05/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessing atrial fibrillation (AF) risk may be useful in primary prevention (PP; people with risk factors) and secondary prevention (SP; eg. embolic stroke of unknown source). We sought whether disease stage influenced the prediction of AF by echocardiography. METHODS We compared a PP cohort (351 community-based participants ≥65 years with ≥1 risk factor for AF) and a SP cohort (453 patients after transient ischemic attack or stroke). LV global longitudinal strain (GLS) and left atrial reservoir strain (LARS) were measured from DICOM images. AF was diagnosed by 12 lead ECG, Holter or by single lead monitor over median follow-up of 22 months (PP) and 35 months (SP). The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models assessed for independent and incremental predictive value of LARS and GLS in both cohorts. RESULTS AF developed in 42 PP (12%) and 60 SP (13%), and was associated with age, higher CHARGE-AF score, increased LA volume and LV mass (p < 0.05). Patients developing AF had reduced GLS (17 ± 3.5% vs. 20 ± 3%, p < 0.001) and LARS (28 ± 11% vs. 35 ± 8%, p < 0.001). However, the predictive value of both GLS (area under the ROC curve 0.83 vs 0.56, p < 0.001) and LARS (0.83 vs 0.57, p < 0.001) was greater in SP than PP. LARS was independently associated with AF in both cohorts (p < 0.05), but GLS was only independently associated in the SP cohort. CONCLUSION AF risk assessment with LARS is suitable for different risk cohorts, but GLS is more useful in SP.
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Affiliation(s)
- Satish Ramkumar
- Baker Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Faraz Pathan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - Hiroshi Kawakami
- Baker Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Ayame Ochi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Hong Yang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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228
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Sun F, Li Y, Wang W, Xu L, Zhao M, Li R, He X, LinaMa, Ma L, Cong J. Left atrial myocardial function and compliance in pre-eclampsia with preserved left ventricular systolic and diastolic function. Int J Cardiovasc Imaging 2020; 37:175-182. [PMID: 32888108 DOI: 10.1007/s10554-020-01974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
Left atrial (LA) adaptive changes associated with pre-eclampsia (PE) have not been adequately addressed. This study aimed to evaluate the usefulness of LA myocardial function indices in detecting early cardiac alterations in PE. Using speckle tracking echocardiography (STE), LA volumetric and myocardial parameters were acquired in PE women with preserved left ventricular (LV) systolic and diastolic function based on standard criteria and normotensive controls. LA compliance was assessed by the ratio of reservoir strain (LASr) to the estimated LA pressure (E/e'). Subtle systolic and diastolic abnormalities were identified as LV global longitudinal strain < 17.8% and mitral tissue e' velocity < 7 cm/s septal or < 10 cm/s lateral, respectively. LASr/(E/e') was prior to other LA measurements in detecting early LA function changes in PE. The rate of LASr/(E/e') < 3 was significantly greater in the patients with subtle systolic impairments than those without (P < 0.05) in spite of similar proportion of LASr < 31% between them. Among PE women with subtle diastolic damages, the frequencies of anomaly and the values in both LASr/(E/e') and LASr were significantly different to those without (P < 0.05). Moreover, the rate of LASr/(E/e') < 3 was markedly higher than that of LASr < 31% in PE cases with subtle cardiac abnormalities (P < 0.05). In the setting of PE with preserved systolic and diastolic function, STE-derived LA strain and estimated LA compliance may be beneficial to identifying earlier cardiac alternations. LA compliance could outperform LASr in detecting cardiac anomalies earlier during a PE pregnancy with preserved LV performance.
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Affiliation(s)
- Fei Sun
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yong Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Wugang Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Lin Xu
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Min Zhao
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Rong Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiangqin He
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - LinaMa
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Lei Ma
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Juan Cong
- Systems Biology and Medicine Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu St, Qingdao, 266003, Shandong Province, China. .,Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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229
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Cho GY, Hwang IC. Left Atrial Strain Measurement: A New Normal for Diastolic Assessment? JACC Cardiovasc Imaging 2020; 13:2327-2329. [PMID: 32771582 DOI: 10.1016/j.jcmg.2020.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Seoul, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Seoul, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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230
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Thomas L, Muraru D, Popescu BA, Sitges M, Rosca M, Pedrizzetti G, Henein MY, Donal E, Badano LP. Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. J Am Soc Echocardiogr 2020; 33:934-952. [DOI: 10.1016/j.echo.2020.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
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231
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Rausch K, Scalia GM, Sato K, Edwards N, Lam AKY, Platts DG, Chan J. Left atrial strain imaging differentiates cardiac amyloidosis and hypertensive heart disease. Int J Cardiovasc Imaging 2020; 37:81-90. [PMID: 32728989 DOI: 10.1007/s10554-020-01948-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
Echocardiographic diagnosis of cardiac amyloidosis (CA) can be difficult to differentiate from increased left ventricular (LV) wall thickness from hypertensive heart disease. The aim of this study was to evaluate left atrial (LA) function and deformation using strain and strain rate (SR) imaging in cardiac amyloidosis. We reviewed 44 cases of CA confirmed by tissue biopsy or a combination of clinical and cardiac imaging data. Cases were classified according two subgroups: amyloid light chain (AL) or amyloid transthyretin (ATTR). These subjects underwent 2D-Speckle tracking echocardiographic derived (STE) LA strain analysis. These were compared to 25 hypertensive (HT) patients with increased LV wall thickness. The three phases of LA function were evaluated using strain and strain rate parameters. Despite a similar increase in LV wall thickness, all LA strain parameters were significantly reduced in the AL cohort compared to the HT cohort (reservoir strain/LAs: 11.0 vs. 24.8%, p < 0.05). The ATTR cohort had significantly thicker LV walls and higher atrial fibrillation burden compared to AL and HT patients but similar reduction in LA strain values compared to AL group. A reservoir strain (S-LAs) cut off value of 20% was 86.4% sensitive and 88.6% specific for detecting CA compared to HT heart disease in this cohort. LA strain parameters were able to identify LA dysfunction in all types of CA. LA function in CA is significantly worse compared with hypertensive patients despite similar increase in LV wall thickness. In combination with other clinical and imaging features, LA strain may provide incremental value in differentiating cardiac amyloidosis from increased wall thickness secondary to hypertension.
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Affiliation(s)
- Karen Rausch
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Rode Road, Chermside, QLD, 4032, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Kei Sato
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Natalie Edwards
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Rode Road, Chermside, QLD, 4032, Australia
| | - Alfred King-Yin Lam
- School of Medicine, Griffith University, Gold Coast, Rode Road, Chermside, QLD, 4032, Australia
| | - David G Platts
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia. .,School of Medicine, Griffith University, Gold Coast, Rode Road, Chermside, QLD, 4032, Australia.
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232
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Park H, Kim KH, Kim HY, Cho JY, Yoon HJ, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG. Left atrial longitudinal strain as a predictor of Cancer therapeutics-related cardiac dysfunction in patients with breast Cancer. Cardiovasc Ultrasound 2020; 18:28. [PMID: 32693802 PMCID: PMC7374848 DOI: 10.1186/s12947-020-00210-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy. Methods A total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared. Results CTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%). Conclusions PALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD.
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Affiliation(s)
- Hyukjin Park
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea.
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Medical School/Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
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233
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Left atrial myocardial dysfunction in patients with primary aldosteronism as assessed by speckle-tracking echocardiography. J Hypertens 2020; 37:2032-2040. [PMID: 31157742 DOI: 10.1097/hjh.0000000000002146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We investigated the left atrial myocardial deformation in patients with primary aldosteronism using the speckle-tracking echocardiographic (STE) strain imaging technique. METHODS Our study included 107 primary aldosteronism patients [52 aldosterone-producing adenoma (APA) and 55 idiopathic hyperaldosteronism (IHA)] and 50 primary hypertensive patients. We performed conventional echocardiography to measure left atrial volume and ejection fraction, and STE to estimate left atrial myocardial deformation including peak velocity, strain and strain rate and calculate the ratio of E/e' to left atrial strain during left ventricular systole as the left atrial stiffness index. RESULTS Patients with APA, compared with those with IHA and primary hypertension had a significantly (P < 0.001) lower serum potassium concentration and higher 24-h urinary aldosterone excretion and plasma aldosterone-to-renin ratio. Patients with APA had a significantly (P < 0.01) larger maximal, precontraction, and minimal left atrial volumes and lower total, active and passive left atrial emptying fractions than those with IHA and primary hypertension. Among the three groups, patients with APA showed lowest left atrial velocity, strain, and strain rate during ventricular systole, early diastole and late diastole (P < 0.05) and highest left atrial stiffness index (P < 0.001). In unadjusted analysis, the left atrial strain, strain rate and stiffness index were significantly (P < 0.05) associated with plasma aldosterone concentration and urinary aldosterone excretion. After adjustment for various confounding factors, these associations remained statistically significant for urinary aldosterone excretion (P < 0.05) but not plasma aldosterone concentration (P ≥ 0.05). CONCLUSION Patients with primary aldosteronism, especially APA, had impaired left atrial deformation mechanics and increased left atrial stiffness, providing a promising insight into early detection of subclinical left atrial dysfunction by strain echocardiography.
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234
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Cheema B, Kinno M, Gu D, Ryan J, Mitter S, Rigolin V, Thomas J, Puthumana J. Left atrial size and strain in elite athletes: A cross‐sectional study at the NBA Draft Combine. Echocardiography 2020; 37:1030-1036. [DOI: 10.1111/echo.14680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/07/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Baljash Cheema
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago IL USA
| | - Menhel Kinno
- Division of CardiologyLoyola University Chicago Stritch School of Medicine Maywood IL USA
| | - David Gu
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago IL USA
| | - Juliet Ryan
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago IL USA
| | - Sumeet Mitter
- Zena and Michael A. Weiner Cardiovascular InstituteIcahn School of Medicine at Mount Sinai New York NY USA
| | - Vera Rigolin
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago IL USA
| | - James Thomas
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago IL USA
| | - Jyothy Puthumana
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago IL USA
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235
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236
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Incremental prognostic value of global left atrial peak strain in women with new-onset gestational hypertension. J Hypertens 2020; 37:1668-1675. [PMID: 30950977 DOI: 10.1097/hjh.0000000000002086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Left atrial strain and strain rate parameters, measured by bidimensional-speckle tracking echocardiography, have been proposed as predictors of atrial fibrillation, stroke, congestive heart failure and cardiovascular death. However, they have not yet been tested in hypertensive disorders of pregnancy. The aim of this study was to assess the prognostic role of global left atrial peak strain (GLAPS) in a population of pregnant women with new-onset hypertension in a medium-term follow-up. METHODS Twenty-seven consecutive women with new-onset hypertension after 20 weeks pregnancy and 23 age-matched, race-matched and gestational week-matched consecutive normotensive pregnant women were enrolled in this prospective study. All participants underwent a complete echocardiographic study with bidimensional-speckle tracking echocardiography and carotid examination. At 1-year follow-up, we evaluated the occurrence of persistent hypertension. RESULTS In comparison with normotensive women, those hypertensive had a higher burden of cardiovascular risk factors, similar left atrial volume indexed (P = 0.14), but severely impaired left atrial strain (P < 0.0001) and strain rate values (P < 0.0001). At 1-year follow-up, persistent hypertension was documented in 59.3% of patients. At the univariate Cox analysis, the variables associated with the occurrence of the investigated outcome in all hypertensive pregnancies were SBP (hazard ratio 1.04, P = 0.04), DBP (hazard ratio 1.11, P = 0.01), mean arterial pressure (hazard ratio 1.09, P = 0.01) values and the GLAPS value (hazard ratio 0.85, P = 0.0019). The latter was significantly associated with the investigated outcome both in preeclamptic (hazard ratio 0.84, P = 0.02) and nonpreeclamptic pregnant women (hazard ratio 0.83, P = 0.04). The receiver operating characteristics curve analysis highlighted that a GLAPS value of 23.5% or less predicted persistent hypertension with sensitivity of 100% and specificity of 90.90%. CONCLUSION In hypertensive pregnant women a GLAPS value of 23.5% or less reveals a greater severity of atrial cardiomyopathy and might predict postpregnancy persistent hypertension.
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237
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Cho EJ. Clinical Application of Measurement of Left Atrial Function by Speckle-tracking Echocardiography. J Cardiovasc Imaging 2020; 28:199-201. [PMID: 32583636 PMCID: PMC7316560 DOI: 10.4250/jcvi.2020.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
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238
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Palmer C, Truong VT, Klas B, Wolking S, Ornella A, Young M, Ngo TNM, Tretter JT, Nagueh SF, Mazur W. Left and right atrial speckle tracking: Comparison of three methods of time reference gating. Echocardiography 2020; 37:1021-1029. [PMID: 32562443 DOI: 10.1111/echo.14770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Atrial function has a close interdependence with ventricular function and plays a central role in maintaining optimal cardiac function. There are two well-defined timing methods used to determine the start point. The aim of this prospective study was to objectively assess the influence of gating method selection on reported left and right strain values within the same group of healthy subjects. METHODS 101 volunteers (44 male, 57 female) had adequate tracking for analysis on TomTec Imaging Systems (Unterschleissheim, Germany). The median age was 41 years (range 19-79 years, interquartile range 30-52 years). Atrial strain by 2D-speckle tracking echocardiography was evaluated using two commonly applied zero baseline time reference methods: R-R gating and P-P gating, in addition to volume gating (defining end-systole at the atrial maximum and end-diastole at the atrial minimum). RESULTS True atrial minimum occurred prior to the onset of the QRS in most healthy volunteers. There was a significant difference for LA and RA reservoir strain between volume gating and R-R gating (mean difference, 4.63%; P < .001 for LA; mean difference, 4.23%; P < .001 for RA), as well as volume gating and P-P gating (mean difference, 5.26%; P < .001 for LA; mean difference, 6.24%; P < .001 for RA). Noticeably, reservoir strain was comparable between R-R gating and P-P gating (mean difference, 0.58%, P = .06) in LA, but not on RA (mean difference, 2.02%, P < .001). CONCLUSIONS There was variability in atrial strain values depending on the zero baseline time reference method used.
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Affiliation(s)
| | - Vien T Truong
- The Christ Hospital Health Network, Cincinnati, OH, USA.,The Linder Research Center, Cincinnati, OH, USA
| | | | - Sarah Wolking
- The Christ Hospital Health Network, Cincinnati, OH, USA
| | | | - Michael Young
- The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Tam N M Ngo
- The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Justin T Tretter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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239
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Voigt JU, Cvijic M. 2- and 3-Dimensional Myocardial Strain in Cardiac Health and Disease. JACC Cardiovasc Imaging 2020; 12:1849-1863. [PMID: 31488253 DOI: 10.1016/j.jcmg.2019.01.044] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/08/2019] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
Abstract
Advances in speckle-tracking echocardiography allowed the rise of deformation imaging as a feasible, robust, and valuable tool for clinical routine. The global or segmental measurement of strain can objectively quantify myocardial deformation and can characterize myocardial function in a novel way. However, the proper interpretation of deformation measurements requires understanding of cardiac mechanics and the influence of loading conditions, ventricular geometry, conduction delays, and myocardial tissue characteristics on the measured values. The purpose of this manuscript is to review the basic concepts of deformation imaging, briefly describe imaging modalities for strain assessment, and discuss in depth the underlying physical and pathophysiological mechanisms which lead to the respective findings in a specific disease.
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Affiliation(s)
- Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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240
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Sonaglioni A, Albini A, Fossile E, Pessi MA, Nicolosi GL, Lombardo M, Anzà C, Ambrosio G. Speckle-Tracking Echocardiography for Cardioncological Evaluation in Bevacizumab-Treated Colorectal Cancer Patients. Cardiovasc Toxicol 2020; 20:581-592. [PMID: 32519318 DOI: 10.1007/s12012-020-09583-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Angiogenesis inhibitor Bevacizumab (BVZ) may lead to the development of adverse effects, including hypertension and cardiac ischemia. Whether assessment of changes in myocardial strain by two-dimensional speckle-tracking echocardiography (2D-STE) can be of value in detecting BVZ-mediated cardiotoxicity at an earlier stage is not known. We investigated whether 2D-STE can non-invasively detect early evidence of cardiotoxicity in metastatic colorectal cancer (mCRC) patients treated with BVZ. Between January and June 2019, 25 consecutive patients (71.8 ± 7.5 year/old, 17 males) with mCRC were prospectively enrolled. Patients underwent physical examination, blood tests, and conventional 2D-transthoracic echocardiography implemented with 2D-STE analysis, at baseline and at 3 and 6 months following treatment with BVZ (15 mg/kg every 15 days) + 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX i.v.). At 6-month follow-up, we assessed occurrence of global longitudinal strain (GLS) impairment (> 15% decrease in GLS compared with baseline) as primary end-point and a new-onset systemic hypertension (secondary end-point). On average, GLS showed a progressive significant impairment after BVZ, from - 17.4 ± 3.2% at baseline to - 16 ± 2.9% (p = 0.003) at 6-month follow-up; > 15% decrease in GLS (primary end-point) was detected in 9 patients (36%). All other strain parameters remained unchanged. New-onset systemic hypertension (secondary end-point) was diagnosed in five patients (20%). No significant changes were observed in serial high-sensitivity cardiac troponin I measurements. No patient developed significant changes in LV size or LV ejection fraction; no case of clinically symptomatic HF was observed during BVZ-treatment. Measurement of GLS by 2D-STE analysis can effectively detect BVZ-mediated cardiotoxicity at an early stage.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy
| | - Adriana Albini
- Scientific and Technological Pole, IRCCS MultiMedica, Milan, Italy.
| | - Emanuela Fossile
- Department of Oncology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy
| | | | | | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe IRCCS MultiMedica, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni (MI), Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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241
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Kalaycıoğlu E, Çetin M, Çinier G, Kırış T, Gökdeniz T, Özyıldız AG, Durmuş İ. Serum osteoprotegerin level is independently related to subclinical left atrial mechanical function in patients with hypertension and diabetes. Herz 2020; 46:277-284. [PMID: 32462219 DOI: 10.1007/s00059-020-04939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Previous studies showed that subclinical abnormal left atrial (LA) function could be diagnosed with LA speckle tracking evaluation long before chamber enlargement. Osteoprotegerin (OPG) is a member of the tumor necrosis factor (TNF) receptor superfamily and was recently found to be an indicator for adverse cardiovascular outcomes and a risk factor for new onset atrial fibrillation. The authors hypothesized that OPG values could predict LA mechanical dysfunction and LA remodeling assessed by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension (HT) and diabetes mellitus (DM). METHODS A single center study was conducted including consecutive patients presenting to the authors' outpatient clinic. Enrolled patients needed to have been treated for HT and DM for at least 1 year. RESULTS The study included 80 patients (mean age, 57.5 ± 8.3 years). Patients in the impaired LA strain group were older (p = 0.035), had lower low density lipoprotein (LDL) cholesterol (mg/dl) (p = 0.021), and higher OPG (pmol/l) (p = 0.004) values than patients in the normal LA strain group. Univariate logistic regression analysis demonstrated that age (p = 0.039), LDL cholesterol (mg/dl) (p = 0.025), and OPG (pmol/l) (p = 0.008) values were associated with impaired LA strain. Backward multivariate logistic regression analysis showed that LDL cholesterol (mg/dl) (OR: 0.982, CI 95% 0.964-0.999, p = 0.049) and OPG (pmol/l) (OR: 1.438, CI 95% 1.043-1.983, p = 0.027) were independently associated with impaired LA strain. CONCLUSION In hypertensive and diabetic patients, higher OPG values were associated with impaired LA function assessed by 2D-STE. In this high-risk patient group, serum OPG can be used as a risk predictor for LA mechanical dysfunction.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, University of Health Sciences Turkey, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.
| | - Mustafa Çetin
- Department of Cardiology, Recep Tayyip Erdogan University Faculty of Medicine, Training and Research Hospital, Rize, Turkey
| | - Göksel Çinier
- Department of Cardiology, Kackar State Hospital, Rize, Turkey
| | - Tuncay Kırış
- Department of Cardiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Tayyar Gökdeniz
- Department of Cardiology, Hitit University Faculty of Medicine, Erol Olcok Education and Research Hospital, Corum, Turkey
| | - Ali Gökhan Özyıldız
- Department of Cardiology, Recep Tayyip Erdogan University Faculty of Medicine, Training and Research Hospital, Rize, Turkey
| | - İsmet Durmuş
- Department of Cardiology, University of Health Sciences Turkey, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
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242
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Sonaglioni A, Caminati A, Lipsi R, Nicolosi GL, Lombardo M, Anzà C, Harari S. Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure. Int J Cardiovasc Imaging 2020; 36:1711-1723. [PMID: 32448985 DOI: 10.1007/s10554-020-01887-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case-control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e' ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (- 22.6 ± 3.3% vs - 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = - 0.87 and - 0.82, respectively) but not in controls (r = - 0.29 and - 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Antonella Caminati
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Lipsi
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy
| | - Sergio Harari
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
- Department of Medical Sciences San Giuseppe Hospital MultiMedica IRCCS and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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243
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Lin J, Ma H, Gao L, Wang Y, Wang J, Zhu Z, Pang K, Wang H, Wu W. Left atrial reservoir strain combined with E/E' as a better single measure to predict elevated LV filling pressures in patients with coronary artery disease. Cardiovasc Ultrasound 2020; 18:11. [PMID: 32334586 PMCID: PMC7183713 DOI: 10.1186/s12947-020-00192-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/26/2020] [Indexed: 01/28/2023] Open
Abstract
Background The 2016 guidelines for left ventricular diastolic dysfunction diagnosis has been simplified from previous versions; however, multiparametric diagnosis approach still exists indeterminate left ventricular diastolic dysfunction category. Left atrial (LA) strain was recently found useful to predict elevated left ventricular (LV) filling pressures noninvasively. This study aimed to (1) analyze the diagnostic value of LA strain for noninvasive assessment of LV filling pressures in patients with stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF), using invasive hemodynamic assessment as the gold standard, and (2) explore whether LA strain combined with conventional diastolic parameters could detect elevated LV filling pressures alone. Methods Sixty-four patients with stable CAD having LVEF > 50% and 30 healthy controls were enrolled. Two-dimensional speckle-tracking echocardiography was used to measure LA strain during the reservoir (LASr), conduit, and contraction phases. LV end-diastolic pressure (LVEDP), as a surrogate for LV filling pressures, was invasively obtained by left heart catheterization. Logistic regression was used to calculate the odds ratio to predict LV filling pressures. Pearson’s correlation was used to analyze associations between echocardiographic parameters and LVEDP. The area under the receiver-operating characteristic curve was calculated to determine the capability of the echocardiographic parameters to detect elevated LVEDP. Inter-technique agreement was analyzed by contingency tables and tested by kappa statistics. Results LASr and the ratio of early-diastolic transmitral flow velocity (E) to tissue Doppler early-diastolic septal mitral annular velocity (E/E′septal) significantly predicted elevated LV filling pressures. LASr was combined with E/E′septal to generate a novel parameter (LASr/E/E′septal). LASr/E/E′septal had the best predictive ability of elevated LV filling pressures. LVEDP was negatively correlated with LASr and LASr/E/E′septal but positively correlated with E/E′septal. The area under the receiver-operating characteristic curve of LASr/E/E′septal was higher than that of LASr alone (0.83 vs. 0.75), better than all conventional LV diastolic parameters. Inter-technique agreement analysis showed that LASr/E/E′septal had good agreement with the invasive LVEDP measurement, better than the 2016 guideline (kappa = 0.63 vs. 0.25). Conclusions LASr provided additive diagnostic value for the noninvasive assessment of LV filling pressures. LASr/E/E′septal had the potential to be a better single noninvasive index to predict elevated LV filling pressures in patients with stable CAD and preserved LVEF.
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Affiliation(s)
- Jingru Lin
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Hong Ma
- Department of Cardiology, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Lijian Gao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yang Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Jiangtao Wang
- GE Healthcare, Beijing, 100176, People's Republic of China
| | - Zhenhui Zhu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Kunjing Pang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China.
| | - Weichun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing 100037, People's Republic of China.
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244
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miR-21 and NT-proBNP Correlate with Echocardiographic Parameters of Atrial Dysfunction and Predict Atrial Fibrillation. J Clin Med 2020; 9:jcm9041118. [PMID: 32295105 PMCID: PMC7230176 DOI: 10.3390/jcm9041118] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the association of circulating biomarkers with echocardiographic parameters of atrial remodelling and their potential for predicting atrial fibrillation (AF). In patients with and without AF (n = 21 and n = 60) the following serum biomarkers were determined: soluble ST2 (sST2), Galectin-3 (Gal-3), N-terminal pro-brain natriuretic peptide (NT-proBNP), microRNA (miR)-21, -29a, -133a, -146b and -328. Comprehensive transthoracic echocardiography was performed in all participants. Biomarkers were significantly altered in patients with AF. The echocardiographic parameter septal PA-TDI, indicating left atrial (LA) remodelling, correlated with concentrations of sST2 (r = 0.249, p = 0.048), miR-21 (r = -0.277, p = 0.012), miR-29a (r = -0.269, p = 0.015), miR-146b (r = -0.319, p = 0.004) and miR-328 (r = -0.296, p = 0.008). In particular, NT-proBNP showed a strong correlation with echocardiographic markers of LA remodelling and dysfunction (septal PA-TDI: r = 0.444, p < 0.001, LAVI/a': r = 0.457, p = 0.001, SRa: r = 0.581, p < 0.001). Multivariate Cox regressions analysis highlighted miR-21 and NT-proBNP as predictive markers for AF (miR-21: hazard ratio (HR) 0.16; 95% confidence interval (CI) 0.04-0.7, p = 0.009; NT-proBNP: HR 1.002 95%CI 1.001-1.004, p = 0.006). Combination of NT-proBNP and miR-21 had the best accuracy to discriminate patients with AF from those without AF (area under the curve (AUC)= 0.843). Our findings indicate that miR-21 and NT-proBNP correlate with echocardiographic parameters of atrial remodeling and predict AF, in particular if combined.
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245
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Normal reference values for left atrial strains and strain rates in school children assessed using two-dimensional speckle-tracking echocardiography. Heart Vessels 2020; 35:1270-1280. [DOI: 10.1007/s00380-020-01594-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
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246
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Abnormal atrial function in hypertensive patients with obstructive sleep apnea assessed by speckle tracking echocardiography. Hypertens Res 2020; 43:841-844. [DOI: 10.1038/s41440-020-0415-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/15/2022]
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247
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van der Ven JPG, Alsaied T, Juggan S, Bossers SSM, van den Bosch E, Kapusta L, Kuipers IM, Kroft LJM, Ten Harkel ADJ, van Iperen GG, Rathod RH, Helbing WA. Atrial function in Fontan patients assessed by CMR: Relation with exercise capacity and long-term outcomes. Int J Cardiol 2020; 312:56-61. [PMID: 32139238 DOI: 10.1016/j.ijcard.2020.02.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/21/2020] [Accepted: 02/23/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the role of atrial function on exercise capacity and clinical events in Fontan patients. DESIGN We included 96 Fontan patients from 6 tertiary centers, aged 12.8 (IQR 10.1-15.6) years, who underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 12 months of each other from 2004 to 2017. Intra-atrial lateral tunnel (ILT) and extracardiac conduit (ECC) patients were matched 1:1 with regard to age, gender and dominant ventricle. The pulmonary venous atrium was manually segmented in all phases and slices. Atrial function was assessed by volume-time curves. Furthermore, atrial longitudinal and circumferential feature tracking strain was assessed. We determined the relation between atrial function and exercise capacity, assessed by peak oxygen uptake and VE/VCO2 slope, and events (mortality, listing for transplant, re-intervention, arrhythmia) during follow-up. RESULTS Atrial maximal and minimal volumes did not differ between ILT and ECC patients. ECC patients had higher reservoir function (21.1 [16.4-28.0]% vs 18.2 [10.9-22.2]%, p = .03), lower conduit function and lower total circumferential strain (13.8 ± 5.1% vs 18.0 ± 8.7%, p = .01), compared to ILT patients. Only for ECC patients, a better late peak circumferential strain rate predicted better VE/VCO2 slope. No other parameter of atrial function predicted peak oxygen uptake or VE/VCO2 slope. During a median follow-up of 6.2 years, 42 patients reached the composite end-point. No atrial function parameters predicted events during follow-up. CONCLUSIONS ECC patients have higher atrial reservoir function and lower conduit function. Atrial function did not predict exercise capacity or events during follow-up.
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Affiliation(s)
- Jelle P G van der Ven
- Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Tarek Alsaied
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Saeed Juggan
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sjoerd S M Bossers
- Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Livia Kapusta
- Department of Pediatrics, Division of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Irene M Kuipers
- Department of Pediatrics, Division of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatrics, Division of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Gabrielle G van Iperen
- Department of Pediatrics, Division of Cardiology, University Medical Centre Utrecht - Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Pediatrics, Division of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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248
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Kurzawski J, Janion-Sadowska A, Zandecki L, Piatek L, Koziel D, Sadowski M. Global peak left atrial longitudinal strain assessed by transthoracic echocardiography is a good predictor of left atrial appendage thrombus in patients in sinus rhythm with heart failure and very low ejection fraction - an observational study. Cardiovasc Ultrasound 2020; 18:7. [PMID: 32061249 PMCID: PMC7024551 DOI: 10.1186/s12947-020-00188-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peak left atrial longitudinal strain (PALS) can help identify left atrial appendage thrombus (LAAT) in patients with atrial fibrillation. Nevertheless, few studies have been performed in patients in sinus rhythm without established indications for anticoagulation but with increased risk of LAAT, such as heart failure (HF) with severe left ventricular systolic dysfunction patients. The primary aim of this study was to identify clinical and transthoracic echocardiography predictors of LAAT in HF patients with very low left ventricular ejection fraction and sinus rhythm. The secondary objective was to analyze frequencies and predictors of a composite clinical endpoint of death or hospitalization for ischemic stroke. METHODS We included 63 patients with HF, left ventricular ejection fraction < 25%, sinus rhythm at presentation, no history of atrial fibrillation, and without any established indications for anticoagulation. We determined whether clinical and transthoracic echocardiography parameters, including left atrial strain analysis, predicted LAAT. Transesophageal echocardiography was performed in all patients. When LAAT was detected, anticoagulation was recommended. The participants were followed for a median of 28.6 months (range 4-40) to determine the composite endpoint. RESULTS LAAT was found in 20 (31.7%) patients. Global PALS was the best independent predictor of LAAT in univariate and multivariate logistic regression analyses (Gini coefficient 0.65, area under the receiver-operating characteristic curve 0.83). A global PALS value below 8% was a good discriminator of LAAT presence (odds ratio 30.4, 95% CI 7.2-128, p < 0.001). During follow-up, 18 subjects (28.6%) reached the composite clinical endpoint. CHA2DS2-VASc score, use of angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, and body surface area were significant predictors for the composite endpoint of death or hospitalization for ischemic stroke in the multivariate regression model. CONCLUSIONS LAAT was relatively common in our group of HF patients and PALS has shown prognostic potential in LAAT identification. Further research is needed to determine whether initiation of anticoagulation or additional screening supported by PALS measurements will improve clinical outcomes in these patients.
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Affiliation(s)
| | | | - Lukasz Zandecki
- The Jan Kochanowski University, ul. Stefana Zeromskiego 5, 25-001, Kielce, Poland.
| | - Lukasz Piatek
- The Jan Kochanowski University, ul. Stefana Zeromskiego 5, 25-001, Kielce, Poland
| | - Dorota Koziel
- The Jan Kochanowski University, ul. Stefana Zeromskiego 5, 25-001, Kielce, Poland
| | - Marcin Sadowski
- The Jan Kochanowski University, ul. Stefana Zeromskiego 5, 25-001, Kielce, Poland
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249
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Alsaied T, Niss O, Tretter JT, Powell AW, Chin C, Fleck RJ, Cnota JF, Malik P, Quinn CT, Nagueh SF, Taylor MD, Mazur WM. Left atrial dysfunction in sickle cell anemia is associated with diffuse myocardial fibrosis, increased right ventricular pressure and reduced exercise capacity. Sci Rep 2020; 10:1767. [PMID: 32019991 PMCID: PMC7000788 DOI: 10.1038/s41598-020-58662-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 01/08/2020] [Indexed: 01/26/2023] Open
Abstract
Increased extracellular volume (ECV) by CMR is a marker of interstitial myocardial fibrosis and is associated with diastolic dysfunction in sickle cell anemia (SCA). Left atrial (LA) dysfunction and stiffness contribute to the development of diastolic heart failure in other settings. We aimed to evaluate LA function and stiffness associations with ECV, tricuspid regurgitation jet velocity (TRV) and exercise abnormalities in SCA. In a prospective study, individuals with SCA underwent CMR, echocardiography and exercise test. ECV was measured using MOLLI sequence. Atrial strain was studied in the 4- and 2-chamber views. LA stiffness was calculated as the ratio of echocardiographic E/e’-to-LA reservoir strain. Twenty-four participants with SCA were included (median age 20 years). ECV was increased in participant with SCA compared to our lab normal values (mean 0.44 ± 0.08 vs 0.26 ± 0.02, P < 0.0001). Six (25%) had LA LGE. ECV positively correlated with LA stiffness (r = 0.45, p = 0.04). There was a negative correlation between LA stiffness and %predicted VO2 (r = −0.50, p = 0.04). LA stiffness was moderately associated with increased TRV (r = 0.55, p < 0.005). LA stiffness is associated with ECV, exercise impairment and increased TRV. This study sheds insights on the interaction between LA function, RV hypertension, and myocardial fibrosis in SCA.
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Affiliation(s)
- Tarek Alsaied
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Omar Niss
- Divisions of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin T Tretter
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam W Powell
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Clifford Chin
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert J Fleck
- Department of Radiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James F Cnota
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Punam Malik
- Divisions of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charles T Quinn
- Divisions of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center Houston, Texas, USA
| | - Michael D Taylor
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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250
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Reddy YN, Borlaug BA. Left atrial myopathy in heart failure with preserved ejection fraction. Eur J Heart Fail 2020; 22:486-488. [DOI: 10.1002/ejhf.1688] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Barry A. Borlaug
- Department of Cardiovascular MedicineMayo Clinic Rochester MN USA
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