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Solsona-Caravaca J, Fernández-Galera R, González-Fernández V, Airale L, Rivas J, Scudeler L, Vallejo N, Teixidó-Turà G, Casas G, Valente F, Oliveró R, Belahnech Y, Martí G, García B, Ferreira-González I, Rodríguez-Palomares JF, Galian-Gay L. Mitral Transcatheter Edge-to-Edge Repair and Clinical Value of Novel Echocardiographic Biomarkers: A Hypothesis-Generating Study. Biomedicines 2024; 12:1710. [PMID: 39200177 PMCID: PMC11351940 DOI: 10.3390/biomedicines12081710] [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: 06/12/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Longitudinal data on reverse cardiac remodeling and outcomes after transcatheter edge-to-edge repair (TEER) are limited. METHODS A total of 78 patients with severe mitral regurgitation (MR) were included retrospectively. All patients had echocardiography at baseline and again six months after TEER. They were monitored for a primary composite endpoint, consisting of heart failure hospitalization and cardiovascular death, over 13 months. RESULTS Significant decreases in the left ventricular ejection fraction (LVEF), all myocardial work indices (except global wasted work), and the left atrial reservoir were observed after TEER. Additionally, there was a decrease in the pulmonary artery systolic pressure and an increase in the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. A post-TEER TAPSE/PASP ratio of <0.47 (HR: 4.76, p-value = 0.039), and a post-TEER left atrial reservoir of <9.0% (HR: 2.77, p-value = 0.047) were associated with the primary endpoint. CONCLUSIONS Echocardiography post-TEER reflects impairment in ventricular performance due to preload reduction and right ventricle and pulmonary artery coupling improvement. Short-term echocardiography after TEER identifies high-risk patients who could benefit from a close clinical follow-up. The prognostic significance of LA strain and the TAPSE/PASP ratio should be validated in subsequent large-scale prospective studies.
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Affiliation(s)
- Javier Solsona-Caravaca
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Rubén Fernández-Galera
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Víctor González-Fernández
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Lorenzo Airale
- Internal Medicine Department, Città della Salute e della Scienza Hospital, 10126 Turin, Italy;
| | - Johny Rivas
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Luca Scudeler
- Cardiology Department, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Núria Vallejo
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Gisela Teixidó-Turà
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Guillem Casas
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Filipa Valente
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Ruper Oliveró
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Yassin Belahnech
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Gerard Martí
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Bruno García
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
| | - Ignacio Ferreira-González
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - José F. Rodríguez-Palomares
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Laura Galian-Gay
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain; (J.S.-C.); (V.G.-F.); (G.C.); (F.V.); (R.O.); (G.M.); (L.G.-G.)
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Labus J, Brand L, Feige K, Mehler O, Rahmanian P, Wahlers T, Böttiger BW, Wetsch WA, Mathes A. Intraoperative Assessment of Noninvasive Left Ventricular Myocardial Work Indices in Patients Undergoing Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00440-3. [PMID: 39069381 DOI: 10.1053/j.jvca.2024.07.003] [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: 01/25/2024] [Revised: 06/12/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Evaluation of noninvasive left ventricular (LV) myocardial work (MW) enables insights into cardiac contractility and efficacy beyond conventional echocardiography. However, there is limited intraoperative data on patients undergoing surgical aortic valve replacement (AVR). The aim of this study was to describe the feasibility and the intraoperative course of this technique of ventricular function assessment in these patients and compare it to conventional two (2D)- and three-dimensional (3D) echocardiographic measurements and strain analysis. DESIGN Prospective observational study. SETTING Single university hospital. PARTICIPANTS Twenty-five patients scheduled for isolated AVR with preoperative preserved left and right ventricular function, sinus rhythm, without significant other heart valve disease or pulmonary hypertension, and an uneventful intraoperative course. INTERVENTIONS Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Evaluation was performed in stable hemodynamics, in sinus rhythm or atrial pacing and vasopressor support with norepinephrine ≤ 0.1 µg/kg/min. MEASUREMENTS AND MAIN RESULTS EchoPAC v206 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2D and 3D LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global work index (GWI), LV global constructive work (GCW), LV global wasted work (GWW), and LV global work efficiency (GWE). Estimation of myocardial work was feasible in all patients. Although there was no significant difference in the values of 2D and 3D EF, GWI and GCW decreased significantly after AVR (T1 v T2, 1,647 ± 380 mmHg% v 1,021 ± 233 mmHg%, p < 0.001; T1 v T2, 2,095 ± 433 mmHg% v 1,402 ± 242 mmHg%, p < 0.001, respectively), while GWW remained unchanged (T1 v T2, 296 mmHg% [IQR 178-452) v 309 mmHg% [IQR 255-438), p = 0.97). This resulted in a decreased GWE directly after bypass (T1 v T2, 84% ± 6% v 78% ± 5%, p < 0.001), but GWE already improved at the end of surgery (T2 v T3, 78% ± 5% v 81% ± 5%, p = 0.003). There was no significant change in the values of GWI, GCW, or 2D and 3D LVEF before and after sternal closure (T2 v T3). CONCLUSION LV MW analysis showed a reduction of LV workload after bypass in our group of patients, which was not detected by conventional echocardiographic measures. This evolving technique provides deeper insights into cardiac energetics and efficiency in the perioperative course of aortic valve replacement surgery.
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Affiliation(s)
- Jakob Labus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Lukas Brand
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Katharina Feige
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Oliver Mehler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Wolfgang A Wetsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Alexander Mathes
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
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Daios S, Anastasiou V, Bazmpani MA, Angelopoulou SM, Karamitsos T, Zegkos T, Didagelos M, Savopoulos C, Ziakas A, Kamperidis V. Moving from left ventricular ejection fraction to deformation imaging in mitral valve regurgitation. Curr Probl Cardiol 2024; 49:102432. [PMID: 38309543 DOI: 10.1016/j.cpcardiol.2024.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
The increasing prevalence of valvular heart diseases, specifically mitral regurgitation (MR), underscores the need for a careful and timely approach to intervention. Severe MR, whether primary or secondary, when left untreated leads to adverse outcomes, emphasizing the critical role of a timely surgical or transcatheter intervention. While left ventricular ejection fraction (LVEF) remains the guideline-recommended measure for assessing left ventricle damage, emerging evidence raises concerns regarding its reliability in MR due to its volume-dependent nature. This review summarizes the existing literature on the role of LVEF and deformation imaging techniques, emphasizing the latter's potential in providing a more accurate evaluation of intrinsic myocardial function. Moreover, it advocates the need for an integrated approach that combines traditional with emerging measures, aiming to optimize the management of patients with MR. It attempts to highlight the need for future research to validate the clinical application of deformation imaging techniques through large-scale studies.
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Affiliation(s)
- Stylianos Daios
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Vasileios Anastasiou
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Maria-Anna Bazmpani
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Stella-Maria Angelopoulou
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Thomas Zegkos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Matthaios Didagelos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Christos Savopoulos
- First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonios Ziakas
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece.
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Pastore MC, Vannuccini F, Mandoli GE, Lisi M, Iuliano MA, Santoro A, Niglio FP, Diviggiano EE, Lorenz V, Montesi G, Cavigli L, Focardi M, D'Ascenzi F, Cameli M. Myocardial work and left heart deformation parameters across primary mitral regurgitation severity. Int J Cardiol 2024; 399:131772. [PMID: 38211675 DOI: 10.1016/j.ijcard.2024.131772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
AIMS Myocardial work (MW) estimation by pressure-strain loops using speckle tracking echocardiography (STE) has shown to evaluate left ventricular (LV) contraction overcoming the load-dependency limit of LV global longitudinal strain (GLS). This has proved useful in hemodynamic variation settings e.g. heart failure and valvular heart disease. However, the variation of MW and strain parameters across different stages of primary mitral regurgitation (MR) and its impact on symptoms, which was the aim of our study, has never been investigated. METHODS AND RESULTS Consecutive patients with mild, moderate and severe MR were prospectively enrolled. Exclusion criteria were: chronic atrial fibrillation, valvular heart prosthesis, previous cardiac surgery. Clinical evaluation, blood sample tests, ECG and echocardiography with STE and MW measurement were performed. Patients were then divided into groups according to MR severity. Differences among the groups and predictors of symptoms (as NYHA class≥2) were explored as study endpoints. Overall, 180 patients were enrolled (60 mild,60 moderate,60 severe MR). LV GLS and global peak atrial longitudinal strain (PALS) reduced according to MR severity. Global constructive work (GCW) and global wasted work (GWW) significantly improved, while global work efficiency (GWE) reduced, in patients with moderate and severe MR. Among echocardiographic parameters, global PALS emerged as the best predictor of NYHA class (p < 0.001;area under curve,AUC = 0.7). CONCLUSIONS MW parameters accurately describe the pathophysiology of MR, with initial attempt of LV increased contractility to compensate volume overload parallel to the disease progress, although with low efficacy, while global PALS is the most associated with the burden of MR symptoms.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Francesca Vannuccini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Alma Iuliano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Alfonso Santoro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Paolo Niglio
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Enrico Emilio Diviggiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Veronica Lorenz
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gianfranco Montesi
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Sasmita BR, Luo S, Huang B. An Updated Meta-Analysis of Treatment in Patients with Heart Failure Complicated Ventricular Functional Mitral Regurgitation. Rev Cardiovasc Med 2024; 25:48. [PMID: 39077333 PMCID: PMC11263179 DOI: 10.31083/j.rcm2502048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 07/31/2024] Open
Abstract
Background Ventricular functional mitral regurgitation (FMR) is a common morbidity in patients with heart failure (HF). In addition to guideline-directed medical therapy, mitral valve (MV) repair or replacement has become an option for such patients. However, the impact of different treatments on cardiac remodeling, function, and clinical outcomes remains unclear. Methods We systematically searched PubMed, EMBASE, Medline, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials with search terms related to mitral regurgitation, mitral valve repair, surgical mitral valve replacement, mitral annuloplasty device, and MitraClip. The outcomes were left ventricular ejection fraction (LVEF), left ventricular (LV) remodeling, all-cause mortality, cardiovascular death, and HF hospitalization. Sensitivity analysis was performed by removing high-bias risk studies. The analysis was done by Review Manager 5.4 Analyzer and MedCalc Statistical Software version 19.2.6. Results This meta-analysis included 10 studies with a total of 2533 patients (567 with transcatheter MitraClip, 823 with surgical MV repair, 651 with surgical MV replacement, and 492 with medical therapy). Our meta-analysis revealed that surgical MV repair had significant improvement in LVEF compared to the surgical MV replacement (mean differences (MD) 2.32, [95% CI 0.39, 4.25]), while transcatheter MitraClip treatment was associated with LVEF reduction (MD -4.82, [95% CI -7.29, -2.34]). In terms of LV remodeling, transcatheter MitraClip treatment was associated with improvement in left ventricular end-diastolic volume (MD -10.36, [95% CI -18.74, -1.99]). Furthermore, compared to surgical MV replacement, surgical MV repair was not associated with a reduction of all-cause mortality (risk ratio (RR) 0.83, [95% CI 0.61, 1.13]) and cardiovascular death (RR 0.95, [95% CI 0.56, 1.62]), while transcatheter MitraClip was associated with reduced risk of all-cause mortality (RR 0.87, [95% CI 0.78, 0.98]). Conclusions Surgical MV repair was associated with significant improvement in LVEF but had no significant effect on all-cause mortality compared to surgical MV replacement. Transcatheter MitraClip was associated with better long-term survival than the non-MitraClip group, thus, transcatheter MitraClip could be considered an alternative treatment in patients with HF-complicated ventricular FMR.
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Affiliation(s)
- Bryan Richard Sasmita
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China
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Sutil-Vega M, Rizzo M, Colomer-Asenjo Í, Taibi F, Castaldo F, Del Castillo-Vázquez P, Mallofré N, Torres-Ruiz G, Rojas P, Martínez-Rubio A. Early improvement of global longitudinal strain after iron deficiency correction in heart failure with reduced ejection fraction. Echocardiography 2024; 41:e15726. [PMID: 38078698 DOI: 10.1111/echo.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Iron deficiency correction with ferric carboxymaltose improves symptoms and reduces rehospitalization in patients with reduced left ventricular ejection fraction. The mechanisms underlying these improvements are poorly understood. This study aimed to determine changes in left ventricular contractility after iron treatment as reflected in global longitudinal strain. METHODS Prospective single-center study including 43 adults with reduced ejection fraction, non-anemic iron deficiency, and functional class II-III heart failure despite optimal medical treatment. Global longitudinal strain through speckle-tracking echocardiography was measured at baseline and 4 weeks after ferric carboxymaltose. RESULTS A significant improvement in global longitudinal strain was detected (from -12.3% ± 4.0% at baseline to -15.6% ± 4.1%, p < .001); ferritin and transferrin saturation index had increased, but ejection fraction presented no significant changes (baseline 35.7% ± 4.6%, follow-up 37.2% ± 6.6%, p = .073). CONCLUSIONS In patients with heart failure and reduced ejection fraction, the correction of iron deficiency with ferric carboxymaltose is associated with an early improvement in global longitudinal strain, possibly suggesting a direct effect of iron correction on myocardial contractility.
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Affiliation(s)
- Mario Sutil-Vega
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Marcelo Rizzo
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Íngrid Colomer-Asenjo
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Fadwa Taibi
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Francesca Castaldo
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Pablo Del Castillo-Vázquez
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Núria Mallofré
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Gabriel Torres-Ruiz
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Paola Rojas
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Antonio Martínez-Rubio
- Cardiology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain
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7
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Kaddoura R, Bhattarai S, Abushanab D, Al-Hijji M. Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:159-169. [PMID: 37741106 DOI: 10.1016/j.amjcard.2023.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/25/2023]
Abstract
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Sanket Bhattarai
- Department of hematology and oncology, Bhaktapur Cancer Hospital, Dudhpati, Bhaktapur, Nepal
| | - Dina Abushanab
- Drug Information Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Hijji
- Interventional Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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8
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Fang Q, Huang K, Yao X, Peng Y, Kan A, Song Y, Wang X, Xiao X, Gong L. The application of radiology for dilated cardiomyopathy diagnosis, treatment, and prognosis prediction: a bibliometric analysis. Quant Imaging Med Surg 2023; 13:7012-7028. [PMID: 37869323 PMCID: PMC10585513 DOI: 10.21037/qims-23-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 08/11/2023] [Indexed: 10/24/2023]
Abstract
Background Radiology plays a highly crucial role in the diagnosis, treatment, and prognosis prediction of dilated cardiomyopathy (DCM). Related research has increased rapidly over the past few years, but systematic analyses are lacking. This study thus aimed to provide a reference for further research by analyzing the knowledge field, development trends, and research hotspots of radiology in DCM using bibliometric methods. Methods Articles on the radiology of DCM published between 2002 and 2021 in the Web of Science Core Collection database (WoSCCd) were searched and analyzed. Data were retrieved and analyzed using CiteSpace V, VOSviewer, and Scimago Graphic software, and included the name, research institution, and nationality of authors; journals of publication; and the number of citations. Results A total of 4,257 articles were identified on radiology of DCM from WoSCCd. The number of articles published in this field has grown steadily from 2002 to 2021 and is expected to reach 392 annually by 2024. According to subfields, the number of papers published in cardiac magnetic resonance field increased steadily. The authors from the United States published the most (1,364 articles, 32.04%) articles. The author with the most articles published was Bax JJ (54 articles, 1.27%) from Leiden University Medical Center. The most cited article was titled "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure", with 138 citations. Citation-based clustering showed that arrhythmogenic cardiomyopathy, T1 mapping, and endomyocardial biopsy are the current hots pots for research in DCM radiology. The most frequently occurring keyword was "dilated cardiomyopathy". The keyword-based clusters mainly included "late gadolinium enhancement", "congestive heart failure", "cardiovascular magnetic resonance", "sudden cardiac death", "ventricular arrhythmia", and "cardiac resynchronization therapy". Conclusions The United States and Northern Europe are the most influential countries in research on DCM radiology, with many leading distinguished research institutions. The current research hots pots are myocardial fibrosis, risk stratification of ventricular arrhythmia, the prognosis of cardiac resynchronization therapy (CRT) treatment, and subtype classification of DCM.
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Affiliation(s)
- Qimin Fang
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kaiyao Huang
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinyu Yao
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Peng
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ao Kan
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yipei Song
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiwen Wang
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Xiao
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lianggeng Gong
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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9
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Pio SM, Medvedofsky D, Stassen J, Delgado V, Namazi F, Weissman NJ, Grayburn P, Kar S, Lim DS, Zhou Z, Alu MC, Redfors B, Kapadia S, Lindenfeld J, Abraham WT, Mack MJ, Asch FM, Stone GW, Bax JJ. Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. J Am Heart Assoc 2023; 12:e029956. [PMID: 37646214 PMCID: PMC10547326 DOI: 10.1161/jaha.122.029956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023]
Abstract
Background Left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information over LV ejection fraction in patients with heart failure (HF) and secondary mitral regurgitation. We examined the prognostic impact of LV GLS improvement in this population. Methods and Results The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial randomized symptomatic patients with HF with severe (3+/4+) mitral regurgitation to transcatheter edge-to-edge repair with the MitraClip device plus maximally tolerated guideline-directed medical therapy (GDMT) versus GDMT alone. LV GLS was measured at baseline and 6-month follow-up. The relationship between the improvement in LV GLS from baseline to 6 months and the composite of all-cause death or HF hospitalization between 6- and 24-month follow-up were assessed. Among 383 patients, 174 (45.4%) had improved LV GLS at 6-month follow-up (83/195 [42.6%] with transcatheter edge-to-edge repair+GDMT and 91/188 [48.4%] with GDMT alone; P=0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (P<0.009), with similar risk reduction in both treatment arms (Pinteraction=0.40). By multivariable analysis, LV GLS improvement at 6 months was independently associated with a lower risk of death or HF hospitalization (hazard ratio [HR], 0.55 [95% CI, 0.36-0.83]; P=0.009), death (HR, 0.48 [95% CI, 0.29-0.81]; P=0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31-0.81]; P=0.005) between 6 and 24 months. Conclusions Among patients with HF and severe mitral regurgitation in the COAPT trial, improvement in LV GLS at 6-month follow-up was associated with improved outcomes after both transcatheter edge-to-edge repair and GDMT alone between 6 and 24 months. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.
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Affiliation(s)
- Stephan M. Pio
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | - Jan Stassen
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of CardiologyJessa HospitalHasseltBelgium
| | - Victoria Delgado
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Hospital University Germans Trias i PujolBadalonaSpain
| | - Farnaz Namazi
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | | | - Saibal Kar
- Los Robles Regional Medical CenterThousand OaksCA
- Bakersfield Heart HospitalBakersfieldCA
| | | | | | | | - Björn Redfors
- Cardiovascular Research FoundationNew YorkNY
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | | | | | | | | | | | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Turku Heart Center, University of Turku and Turku University HospitalTurkuFinland
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10
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Fernandez-Peregrina E, Asmarats L, Estevez-Loureiro R, Pascual I, Bastidas D, Benito-González T, Caneiro-Queija B, Avanzas P, De Agustin JA, Fernández-Vazquez F, Barreiro-Pérez M, Leon V, Nombela-Franco L, Garrote C, Li CH, Baz JA, Adeba A, Sans-Roselló J, Gualis J, Arzamendi D. Global Longitudinal Strain Predicts Outcomes in Patients with Reduced Left Ventricular Function Undergoing Transcatheter Edge-to-Edge Mitral Repair. J Clin Med 2023; 12:4116. [PMID: 37373808 PMCID: PMC10298909 DOI: 10.3390/jcm12124116] [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: 05/23/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The timing and selection of optimal candidates for mitral transcatheter edge-to-edge valve repair remains to be fully determined, especially in cases with severely depressed left ventricular ejection fraction (LVEF). The objective of this study is to evaluate the prognostic value of myocardial strain (LVGLS) in this setting. METHODS Retrospectively, 172 consecutive patients with LVEF ≤40% and severe MR treated with MitraClip were included. Four groups were generated according to the LVEF (<30% or ≥30%) and median LVGLS. The primary end-point was cardiovascular mortality. RESULTS Procedural success was high (96.5%) and complications were rare. At one-year follow-up, 82.5% of patients maintained MR grade ≤2, 79.2% were at a NYHA class ≤II and a reduction of 80% in heart failure admissions was observed in all groups. Interestingly, among patients with a more depressed LVEF, LVGLS was found to be an independent predictor for cardiovascular mortality (HR: 3.3; 95% CI: 1.1-10, p = 0.023). CONCLUSIONS Mitral valve repair with MitraClip is safe and it improves the mid-term functional class of patients regardless of LVEF. LVGLS can help in the selection of optimal candidates and timing for this procedure, as well as in the recognition of those patients with worse prognoses.
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Affiliation(s)
- Estefania Fernandez-Peregrina
- Cardiology Unit, Interventional Cardiology Department, Hospital de la Santa Creu I Sant Pau, 08025 Barcelona, Spain (L.A.)
- School of Medicine, Universitat Autónoma of Barcelona, 08193 Barcelona, Spain
| | - Luis Asmarats
- Cardiology Unit, Interventional Cardiology Department, Hospital de la Santa Creu I Sant Pau, 08025 Barcelona, Spain (L.A.)
| | | | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Diana Bastidas
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, 28040 Madrid, Spain
| | | | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | | | | | | | - Victor Leon
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, 28040 Madrid, Spain
| | - Carmen Garrote
- Department of Cardiology, University Hospital of Leon, 24008 Leon, Spain (C.G.)
| | - Chi-Hion Li
- Cardiology Unit, Interventional Cardiology Department, Hospital de la Santa Creu I Sant Pau, 08025 Barcelona, Spain (L.A.)
- School of Medicine, Universitat Autónoma of Barcelona, 08193 Barcelona, Spain
| | - José Antonio Baz
- Interventional Cardiology Unit, Hospital Alvaro Cunqueiro, 36312 Vigo, Spain
| | - Antonio Adeba
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Jordi Sans-Roselló
- Department of Cardiology, Parc Taulí Hospital Universitari, 08208 Sabadell, Spain
| | - Javier Gualis
- Department of Cardiology, University Hospital of Leon, 24008 Leon, Spain (C.G.)
| | - Dabit Arzamendi
- Cardiology Unit, Interventional Cardiology Department, Hospital de la Santa Creu I Sant Pau, 08025 Barcelona, Spain (L.A.)
- School of Medicine, Universitat Autónoma of Barcelona, 08193 Barcelona, Spain
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11
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Ueyama H, Kuno T, Takagi H, Krishnamoorthy P, Prandi FR, Palazzuoli A, Sharma SK, Kini A, Lerakis S. Prognostic value of left ventricular global longitudinal strain in mitral regurgitation: a systematic review. Heart Fail Rev 2023; 28:465-483. [PMID: 35900680 DOI: 10.1007/s10741-022-10265-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
Conventional echocardiographic assessment may overestimate the left ventricular (LV) function in mitral regurgitation (MR). LV global longitudinal strain (GLS) is more sensitive marker to detect subclinical LV dysfunction. Multiple studies have investigated the prognostic value of LV-GLS in MR to examine its potential to determine the timing and indication of intervention. This systematic review aimed to assess the prognostic value of LV-GLS in patients with mitral regurgitation (MR) to define its clinical applicability. PUBMED and EMBASE were queried through July 2021 to identify studies investigating the prognostic value of LV-GLS in MR. A total of 24 observational studies with 5267 patients were identified. Sixteen studies investigated for primary MR, 7 studies for secondary MR, and 1 study for both. Most studies included patients who underwent intervention. There was significant heterogeneity in patient population, intervention status, follow-up period, LV-GLS cutoff value, outcomes, and statistical methods among the studies. Meta-analysis was not performed considering the significant variability. With exception to 1 study, all studies demonstrated significant association between impaired LV-GLS and worse clinical and echocardiographic outcomes in primary MR. Prognostic value of LV-GLS in secondary MR was less certain due to inconsistent findings and limited reporting. LV-GLS is a promising parameter of prognostication in primary MR and can be considered as alternative to determine the timing of intervention. However, the optimal cutoff value remains unclear. The prognostic value of LV-GLS in secondary MR is less clear. Further large-scale prospective study is warranted before its routine clinical application.
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Affiliation(s)
- Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.,Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Toshiki Kuno
- Department of Cardiology, Montefiore Medical Center, Albert Einstein Medical College, New York, NY, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Francesca Romana Prandi
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Throacic and Vascular, Department S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Samin K Sharma
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Annapoorna Kini
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Stamatios Lerakis
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA.
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12
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Galli E, Hubert P, Leurent G, Auffret V, Panis V, L’Official G, Donal E. Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. J Cardiovasc Dev Dis 2023; 10:100. [PMID: 36975864 PMCID: PMC10051684 DOI: 10.3390/jcdd10030100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The noninvasive assessment of myocardial work (MW) allows for the evaluation of left ventricular (LV) performance by considering the effect of LV afterload. This study aims to evaluate the acute and chronic impact of transcatheter edge-to-edge repair (TEER) on MW parameters and LV remodeling in patients with severe primary mitral regurgitation (PMR). METHODS A total of 71 patients (age: 77 ± 9 years, females: 44%) with moderate-to-severe or severe PMR (effective regurgitant orifice: 0.57 ± 0.31 cm2; regurgitant volume: 80 ± 34 mL; LV end-systolic diameter: 42 ± 12 mm) underwent TEER after a global assessment by the heart team. MW indices were evaluated before the procedure, at hospital discharge, and at 1-year follow-up. LV remodeling was described as the percentage variation in LVEDV between baseline and 1-year follow-up. RESULTS TEER caused an acute reduction in LVEF, global longitudinal strain (GLS), global MW index (GWI), work efficiency (GWE), and mechanical dispersion (MD) and a significant increase in wasted work (GWW). One year after the procedure, GLS, GWI, GWE, and MD recovered, whereas GWW remained significantly impaired. Baseline GWW (β = -0.29, p = 0.03) was an independent predictor of LV reverse remodeling at 1-year follow-up. CONCLUSIONS In patients with severe PMR undergoing TEER, the acute reduction in LV preload causes significant impairment to all the parameters of LV performance. Baseline GWW was the only independent predictor of LV reverse remodeling, suggesting that a lower myocardial energetic efficiency in the context of chronic preload increase might impact the left ventricular response to mitral regurgitation correction.
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Affiliation(s)
- Elena Galli
- Cardiology Department, University Hospital of Rennes, University of Rennes, LTSI-INSEMR, 35000 Rennes, France
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13
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Menzri A, Benkhedda S, Bedjaoui A, Ait Mokhtar O, Belahsene N, Foudad H. [Clinical and echocardiographic parameters associated with the alteration of global longitudinal strain in secondary mitral regurgitation]. Ann Cardiol Angeiol (Paris) 2023; 72:36-40. [PMID: 36437148 DOI: 10.1016/j.ancard.2022.10.005] [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: 08/14/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Left ventricular systolic function may be overestimated in patients with secondary mitral regurgitation when using left ventricle ejection fraction. The Global longitudinal strain is a measure less dependent on left ventricle load. However, the clinical and echocardiographic parameters associated with the alteration of Global longitudinal strain in secondary mitral regurgitation have not been evaluated. MATERIAL AND METHODS A total of 96 patients (mean age 62.3 ± 12.1 years, 59.3% male) with secondary mitral regurgitation and low left ventricle ejection fraction < 50% were included. The study population was subdivided according to the Global longitudinal strain value with which an increased risk of all-cause mortality was associated (Global longitudinal strain < 7.0%, left ventricle systolic function impaired compared to Global longitudinal strain ≥ 7.0%, in absolute value). The clinical and echocardiographic endpoints are analysed in both groups of patients. RESULTS The strong and clear correlation between Global longitudinal strain (mean ± standard deviation: 7,2 ± 2,7) and parameters of systolic function (left ventricle ejection fraction mean ± standard deviation: 32,4 ± 8,0%) and contractility (dp/dt mean ± standard deviation: 682,5 ± 204,7 mmHg/s). the mean of left ventricle ejection fraction = 26.4 ± 5.3% in the Global longitudinal strain < 7 group, and the bivariate study using the 30% threshold shows that the Global longitudinal strain < 7 group presents a more altered left ventricle ejection fraction with odds ratio = 12, 5 (CI: 4.7-33.0) p < 0.001. In multivariate analysis of ultrasound parameters and linear regression shows a significant correlation between Global longitudinal strain and left ventricle ejection fraction (p < 0.001). The dp/dt analysis found a mean of 509.3 ± 99.1 mmHg/s in the Global longitudinal strain < 7 group and of 822.9 ± 154.1 in the Global longitudinal strain ≥ 7 group with significant difference (p < 0.001). In bivariate and multivariate analysis, the alteration of Global longitudinal strain is associated with a significantly lower dp / dt p < 0.001. CONCLUSION A Global longitudinal strain < 7 (in absolute value) reflects a severe impairment of left ventricle function. In addition, several parameters were associated with this severe alteration of the Global longitudinal strain, namely a lower left ventricle ejection fraction, a lower dp/dt and more severe symptoms permitting to characterized this group of patients in addition to an integration in a multiparametric evaluation of the secondary mitral regurgitation.
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Affiliation(s)
- A Menzri
- Hôpital militaire de Bechar, Faculté de médecine de Bechar, Bechar, Algérie.
| | - S Benkhedda
- CHU Mustapha Bacha Alger, Faculté de médecine d'Alger, Alger, Algérie
| | - A Bedjaoui
- Hôpital militaire d'Alger, Faculté de médecine d'Alger, Alger, Algérie
| | - O Ait Mokhtar
- CHU Mustapha Bacha Alger, Faculté de médecine d'Alger, Alger, Algérie
| | - N Belahsene
- Hôpital militaire de Blida, Faculté de médecine de Blida, Blida, Algérie
| | - H Foudad
- Hôpital militaire de Constantine, Faculté de médecine de Constantine, Constantine, Algérie
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14
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Marzlin N, Hays AG, Peters M, Kaminski A, Roemer S, O'Leary P, Kroboth S, Harland DR, Khandheria BK, Tajik AJ, Jain R. Myocardial Work in Echocardiography. Circ Cardiovasc Imaging 2023; 16:e014419. [PMID: 36734221 DOI: 10.1161/circimaging.122.014419] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.
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Affiliation(s)
- Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Allison G Hays
- Johns Hopkins School of Medicine, Baltimore, MD (A.G.H.)
| | - Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Patrick O'Leary
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Stacie Kroboth
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin (S.K.)
| | - Daniel R Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
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15
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Labus J, Foit A, Mehler O, Rahmanian P, Böttiger BW, Wetsch WA, Mathes A. Intraoperative Noninvasive Left Ventricular Myocardial Work Indices in Patients Undergoing On-Pump Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth 2023; 37:221-231. [PMID: 36404229 DOI: 10.1053/j.jvca.2022.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Noninvasive echocardiographic analysis of left ventricular (LV) myocardial work (MW) enables insights into cardiac mechanics, contractility, and efficacy beyond ejection fraction (EF) and global longitudinal strain (GLS). However, there are limited perioperative data on patients undergoing coronary artery bypass graft (CABG) surgery. The authors aimed to describe the feasibility and the intraoperative course of this novel assessment tool of ventricular function in these patients, and compare it to conventional 2-dimensional (2D) and 3-dimensional (3D) echocardiographic parameters and strain analysis. DESIGN A prospective observational study. SETTING At a single university hospital. PARTICIPANTS Twenty-five patients with preoperative preserved LV and right ventricular function, sinus rhythm, without significant heart valve disease or pulmonary hypertension, and an uncomplicated intraoperative course scheduled for isolated on-pump CABG surgery. INTERVENTIONS Transesophageal echocardiography (TEE) was performed intraoperatively after the induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). All measurements were performed under stable hemodynamic conditions, in sinus rhythm or atrial pacing, and vasopressor support with norepinephrine ≤ 0.1 µg/kg/min. MEASUREMENTS AND MAIN RESULTS The EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2D and 3D LVEF, LV GLS, LV global work index (GWI), LV global constructive work (GCW), LV global wasted work (GWW), and LV global work efficiency (GWE). The MW analysis was feasible in all patients. Although there was no significant difference in the values of 2D and 3D EF during the intraoperative interval, GLS deteriorated significantly after CABG compared to assessment after induction of anesthesia (T1 v T2, -13.3 ± 3.0% v -11.6 ± 3.1%; p = 0.012). The GWI declined significantly after surgery (T1 v T2, 1,224 ± 312 mmHg% v 940 ± 267 mmHg%; p < 0.001), as well as GCW (T1 v T2, 1,460 ± 312 mmHg% v 1,244 ± 336 mmHg%; p = 0.005). The GWW increased after CABG (T1 v T2, 143 mmHg% (IQR 99-183) v 251 mmHg% (IQR 179-361); p < 0.001), and GWE decreased (T1 v T2, 89% (IQR 85-92) v 80% (IQR 75-87); p < 0.001). There were no significant changes in the values of 2D and 3D EF, GLS, GWI, GCW, GWW, and GWE before and after sternal closure (T2 v T3). CONCLUSION The intraoperative analysis of noninvasive echocardiographically-assessed LV MW indices is feasible. In the short-term period after uncomplicated on-pump CABG, GLS, as well as global and constructive MW, decreased, whereas wasted work increased, resulting in a less efficient left ventricle. None of these aspects was detected by conventional echocardiographic parameters. Therefore, strain and MW analysis might be more sensitive parameters in detecting myocardial dysfunction by TEE in the perioperative setting, adding information on perioperative cardiac energetics.
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Affiliation(s)
- Jakob Labus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - André Foit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Oliver Mehler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Wolfgang A Wetsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Alexander Mathes
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
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16
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Lazar M, Olma A, Streb W. ECHOCARDIOGRAPHIC METHODS FOR ASSESSING LEFT VENTRICULAR SYSTOLIC FUNCTION. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:144-150. [PMID: 37254762 DOI: 10.36740/merkur202302107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Transthoracic echocardiography (TTE) is the recommended primary method of assessing cardiac function. The measurement of LVEF determines the strategy for treatment of patients, as well as influences their prognosis. 3D echocardiography has higher accuracy and reproducibility than 2D echocardiography; hence it is currently recommended for volume and LVEF measurements. New echocardiographic techniques: global longitudinal strain measured by speckle tracking and myocardial work allow earlier detection of myocardial abnormalities. In addition, they have greater sensitivity in detecting ischemia, fibrosis and left ven¬tricular systolic dyssynchrony. In some myocardial pathologies, such as amyloidosis, hypertrophic cardiomyopathy or Chagas disease, we observe characteristic patterns of myocardial deformation (strain), which are their hallmarks. Myocardial work, on the other hand, allows assessment of contractility independent of the effect of afterload. The new echocardiographic techniques provide additional diagnostic tools for assessing left ventricular systolic function and informa¬tion on prognosis, and hence their use can be expected to become more widespread in daily clinical practice.
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Affiliation(s)
- Monika Lazar
- DEPARTMENT OF CARDIOLOGY AND ANGIOLOGY, SILESIAN CENTRE FOR HEART DISEASES IN ZABRZE, ZABRZE, POLAND
| | - Anna Olma
- DEPARTMENT OF CARDIOLOGY AND ANGIOLOGY, SILESIAN CENTRE FOR HEART DISEASES IN ZABRZE, ZABRZE, POLAND
| | - Witold Streb
- DEPARTMENT OF CARDIOLOGY AND ANGIOLOGY, SILESIAN CENTRE FOR HEART DISEASES IN ZABRZE, ZABRZE, POLAND; DEPARTMENT OF CARDIOLOGY, CONGENITAL HEART DISEASES AND ELECTROTHERAPY, FACULTY OF MEDICAL SCIENCES IN ZABRZE, MEDICAL UNIVERSITY OF SILESIA, KATOWICE, POLAND
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17
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Mazzola M, Giannini C. Predicting outcomes after trans-catheter edge-to-edge repair with MitraClip: a nearing milestone. J Cardiovasc Med (Hagerstown) 2022; 23:798-800. [PMID: 36349944 DOI: 10.2459/jcm.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Riccardi M, Sammartino AM, Piepoli M, Adamo M, Pagnesi M, Rosano G, Metra M, von Haehling S, Tomasoni D. Heart failure: an update from the last years and a look at the near future. ESC Heart Fail 2022; 9:3667-3693. [PMID: 36546712 PMCID: PMC9773737 DOI: 10.1002/ehf2.14257] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.
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Affiliation(s)
- Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
- Department of Preventive CardiologyUniversity of WrocławWrocławPoland
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | | | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical CenterGottingenGermany
- German Center for Cardiovascular Research (DZHK), Partner Site GöttingenGottingenGermany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
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19
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Higuchi S, Orban M, Adamo M, Giannini C, Melica B, Karam N, Praz F, Kalbacher D, Koell B, Stolz L, Braun D, Näbauer M, Wild M, Doldi P, Neuss M, Butter C, Kassar M, Ruf T, Petrescu A, Ludwig S, Pfister R, Iliadis C, Unterhuber M, Sampaio F, Ferreira D, Thiele H, Baldus S, von Bardeleben RS, Massberg S, Windecker S, Lurz P, Petronio AS, Lindenfeld J, Abraham WT, Metra M, Hausleiter J. Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation. Eur J Heart Fail 2022; 24:2152-2161. [PMID: 35791663 DOI: 10.1002/ejhf.2613] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Guideline-directed medical therapy (GDMT), based on the combination of beta-blockers (BB), renin-angiotensin system inhibitors (RASI), and mineralocorticoid receptor antagonists (MRA), is known to have a major impact on the outcome of patients with heart failure with reduced ejection fraction (HFrEF). Although GDMT is recommended prior to mitral valve transcatheter edge-to-edge repair (M-TEER), not all patients tolerate it. We studied the association of GDMT prescription with survival in HFrEF patients undergoing M-TEER for secondary mitral regurgitation (SMR). METHODS AND RESULTS EuroSMR, a European multicentre registry, included SMR patients with left ventricular ejection fraction <50%. The outcome was 2-year all-cause mortality. Of 1344 patients, BB, RASI, and MRA were prescribed in 1169 (87%), 1012 (75%), and 765 (57%) patients at the time of M-TEER, respectively. Triple GDMT prescription was associated with a lower 2-year all-cause mortality compared to non-triple GDMT (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.60-0.91). The association persisted in patients with glomerular filtration rate <30 ml/min, ischaemic aetiology, or right ventricular dysfunction. Further, a positive impact of triple GDMT prescription on survival was observed in patients with residual mitral regurgitation of ≥2+ (HR 0.62; 95% CI 0.44-0.86), but not in patients with residual mitral regurgitation of ≤1+ (HR 0.83; 95% CI 0.64-1.08). CONCLUSION Triple GDMT prescription is associated with higher 2-year survival after M-TEER in HFrEF patients with SMR. This association was consistent also in patients with major comorbidities or non-optimal results after M-TEER.
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Affiliation(s)
- Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Benedikt Koell
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Sebastian Ludwig
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Francisco Sampaio
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Diogo Ferreira
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - JoAnn Lindenfeld
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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20
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Ro R, Prandi FR, Zaid S, Anastasius MO, Tang GHL, Seetharam K, Argulian E, Massaro G, Sharma S, Kini A, Lerakis S. Acute effect of edge-to-edge repair of mitral regurgitation on left heart mechanics and health status. J Cardiovasc Med (Hagerstown) 2022; 23:787-797. [PMID: 36166336 DOI: 10.2459/jcm.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Examine the impact of acute changes in left heart strain and volumes with percutaneous edge-to-edge MitraClip repair on improvement in health status assessed using Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score. METHODS Changes in left atrial strain, left ventricular (LV) global longitudinal strain (LVGLS), LV end-systolic volume (LVESV), and end-diastolic volume (LVEDV) were evaluated in 50 patients undergoing MitraClip repair for symptomatic primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) on transthoracic echocardiography before and 1 month after MitraClip. Multivariable regression was used to evaluate changes in left heart strain and volumes as predictors of change in KCCQ-12 scores, adjusting for baseline clinical and echocardiographic characteristics. RESULTS Both PMR and SMR patients had significant increase in LVGLS and reduction in LVEDV and LVESV (P < 0.05) after MitraClip, reduction trend in left atrial conduit strain (PMR P = 0.053; SMR P = 0.12) but no significant change in LV ejection fraction. KCCQ-12 score improved significantly in both PMR (P < 0.001) and SMR cohorts (P < 0.001). Higher delta KCCQ-12 tertiles were associated with greater reduction in LVEDV (P = 0.022) after MitraClip. On multiple regression analysis, lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial strain conduit phase were associated with KCCQ-12 score improvement (P < 0.001). CONCLUSION There is a significant increase in LVGLS and reduction in LVEDV, LVESV and left atrial strain conduit after edge-to-edge MitraClip repair in both PMR and SMR. Lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial conduit strain were associated with KCCQ-12 score improvement after MitraClip. Further studies are warranted to understand the mechanism and significance of our findings.
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Affiliation(s)
- Richard Ro
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | | | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | | | - Edgar Argulian
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | - Gianluca Massaro
- Division of Cardiology, Tor Vergata University Hospital, Rome, Italy
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital, New York, New York
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21
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Li X, Zhang P, Li M, Zhang M. Myocardial work: the analytical methodology and clinical utilities. Hellenic J Cardiol 2022; 68:46-59. [PMID: 35931412 DOI: 10.1016/j.hjc.2022.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/03/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
The evaluation of left ventricular (LV) systolic function is an essential part of the clinical practice of cardiology. Although left ventricular ejection fraction (LVEF) is the most validated and widely used parameter, it has fundamental limitations. LV strain is more sensitive to detect subtle myocardial dysfunction when LVEF was preserved, but it is load-dependent. Invasive left ventricular pressure-volume loop (LV-PVL) is the reliable standard to evaluate cardiac function, but its wide clinical application is limited by the risk of invasive LV pressure detection. Until the advent of non-invasive LV pressure-strain loop (LV-PSL), things have changed. LV-PSL is in good agreement with regional myocardial oxygen consumption and metabolism. Compared with traditional echocardiographic parameters or LV strain, myocardial work (MW) derived from LV-PSL is a more advanced tool that combines deformation as well as hemodynamics through integration of global longitudinal strain and non-invasive LV systolic pressure. In recent years, researches on MW are going on in full swing and show many advantages of MW. This review described the method and discussed the applications, advantages, limitations, and prospects of MW in multiple cardiovascular diseases. The goal is to provide the readers new insights for evaluating LV systolic function and promote the incorporation of MW into daily practice.
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Affiliation(s)
- Xinhao Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
| | - Mengmeng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
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22
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Yedidya I, Stassen J, Butcher SC, Milhorini Pio S, Lustosa RP, van der Bijl P, Vo NM, Namazi F, Ajmone Marsan N, Delgado V, Bax JJ. Relation of Myocardial Work Indexes and Forward Flow Reserve in Patients With Significant Secondary Mitral Regurgitation Undergoing Transcatheter Mitral Valve Repair. Am J Cardiol 2022; 178:106-111. [PMID: 35835599 DOI: 10.1016/j.amjcard.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/01/2022]
Abstract
Left ventricular (LV) myocardial work (LVMW) indexes have shown incremental value over LV ejection fraction and were found to have prognostic significance in patients with secondary mitral regurgitation. We therefore aimed to investigate the association between LVMW indexes and forward flow reserve in patients with secondary mitral regurgitation, treated with transcatheter edge-to-edge repair (TEER). LVMW indexes were evaluated at baseline and forward stroke volume index (FSVI) was evaluated at baseline and 6-month follow-up after TEER. Patients were divided in 2 groups: improvers (improvement in FSVI ≥20%) and nonimprovers (improvement in FSVI <20%). A total of 70 patients (median age 76 years, 59% men) were included. FSVI was the only echocardiographic parameter that improved after TEER. There was a significant decrease in LV global longitudinal strain in the nonimprovers (p = 0.002) but not in the improvers (p = 0.177). Global work index and global constructive work worsened in nonimprovers (p = 0.005 and p = 0.004, respectively), whereas no difference was seen in these indexes in improvers (p = 0.093 and p = 0.112, respectively). Global work efficiency remained independently associated with forward flow reserve after adjusting for a variety of potential confounders. In conclusion, FSVI nonimprovers demonstrated worsening of LV systolic function after TEER compared with improvers, in whom LV systolic function remained stable. Global work efficiency was associated with FSVI improvement after TEER, independent of LV systolic function.
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Affiliation(s)
- Idit Yedidya
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel (affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Rodolfo P Lustosa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ngoc Mai Vo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Farnaz Namazi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku PET Center, University of Turku and Turku University Hospital, Turku, Finland.
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23
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Kotrc M, Bartunek J, Benes J, Beles M, Vanderheyden M, Casselman F, Ondrus T, Mo Y, Praet FV, Penicka M. Global longitudinal strain and outcome after endoscopic mitral valve repair. ESC Heart Fail 2022; 9:2686-2694. [PMID: 35670015 PMCID: PMC9288807 DOI: 10.1002/ehf2.14001] [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: 06/29/2021] [Revised: 04/01/2022] [Accepted: 05/22/2022] [Indexed: 11/12/2022] Open
Abstract
Aims Identification of heart failure (HF) patients with secondary mitral regurgitation (SMR) that benefit from mitral valve (MV) repair remains challenging. We have focused on the role of left ventricular global longitudinal strain (LV‐GLS) and reservoir left atrial longitudinal strain (LASr) for the prediction of long‐term survival and reverse remodelling in patients with SMR undergoing endoscopic MV repair. Methods and results The study population consisted of 110 patients (age 67 ± 11 years, 66% men) with symptomatic SMR undergoing isolated MV repair using a minimally invasive surgical approach. Speckle tracking‐derived LV‐GLS and LASr were assessed in apical views using vendor‐independent software. Over a median of 7.7 years (IQRs 2.9–11.2), 64 patients (58%) died. Significant reverse LV (↓ LVESVI >10 mL/m2), LA (↓ LAVI >10 mL/m2) remodelling or both were observed in 43 (39%), 37 (34%) and 19 (17%) patients, respectively. LV‐GLS (HR 0.68, 95% CI 0.58–0.79, P < 0.001) and LASr (HR 0.93, 95% CI 0.88–0.97, P < 0.01) but not LV ejection fraction (LVEF) and LA volume index (LAVi) emerged as independent predictors of all‐cause mortality in Cox regression analysis. LV‐GLS was the only independent predictor of LV reverse remodelling (OR 1.24, 95% CI 1.05–1.43, P < 0.001) whereas LAVi and LASr were both independent predictors of LA reverse remodelling (both P < 0.05). In patients with atrial fibrillation at baseline, only LASr was an independent predictor (P < 0.05) of LA reverse remodelling. Conclusions In patients with SMR undergoing endoscopic MV repair, LV‐GLS and LASr are independently associated with long‐term survival and reverse remodelling and may be helpful in selecting SMR patients who may benefit from this procedure.
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Affiliation(s)
- Martin Kotrc
- Cardiovascular Center Aalst Belgium
- Department of Cardiology Institute for Clinical and Experimental Medicine (IKEM) Prague Czech Republic
| | | | - Jan Benes
- Department of Cardiology Institute for Clinical and Experimental Medicine (IKEM) Prague Czech Republic
| | | | | | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery OLV Clinic Aalst Belgium
| | | | | | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery OLV Clinic Aalst Belgium
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24
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Hnat T, Veselka J, Honek J. Left ventricular reverse remodelling and its predictors in non-ischaemic cardiomyopathy. ESC Heart Fail 2022; 9:2070-2083. [PMID: 35437948 PMCID: PMC9288763 DOI: 10.1002/ehf2.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Adverse remodelling following an initial insult is the hallmark of heart failure (HF) development and progression. It is manifested as changes in size, shape, and function of the myocardium. While cardiac remodelling may be compensatory in the short term, further neurohumoral activation and haemodynamic overload drive this deleterious process that is associated with impaired prognosis. However, in some patients, the changes may be reversed. Left ventricular reverse remodelling (LVRR) is characterized as a decrease in chamber volume and normalization of shape associated with improvement in both systolic and diastolic function. LVRR might occur spontaneously or more often in response to therapeutic interventions that either remove the initial stressor or alleviate some of the mechanisms that contribute to further deterioration of the failing heart. Although the process of LVRR in patients with new‐onset HF may take up to 2 years after initiating treatment, there is a significant portion of patients who do not improve despite optimal therapy, which has serious clinical implications when considering treatment escalation towards more aggressive options. On the contrary, in patients that achieve delayed improvement in cardiac function and architecture, waiting might avoid untimely implantable cardioverter‐defibrillator implantation. Therefore, prognostication of successful LVRR based on clinical, imaging, and biomarker predictors is of utmost importance. LVRR has a positive impact on prognosis. However, reverse remodelled hearts continue to have abnormal features. In fact, most of the molecular, cellular, interstitial, and genome expression abnormalities remain and a susceptibility to dysfunction redevelopment under biomechanical stress persists in most patients. Hence, a distinction should be made between reverse remodelling and true myocardial recovery. In this comprehensive review, current evidence on LVRR, its predictors, and implications on prognostication, with a specific focus on HF patients with non‐ischaemic cardiomyopathy, as well as on novel drugs, is presented.
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Affiliation(s)
- Tomas Hnat
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Josef Veselka
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Jakub Honek
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
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25
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The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications. Heart Fail Rev 2021; 27:1261-1279. [PMID: 34041679 PMCID: PMC9197903 DOI: 10.1007/s10741-021-10119-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
Pressure–volume (PV) analysis is the most comprehensive way to describe cardiac function, giving insights into cardiac mechanics and energetics. However, PV analysis still remains a highly invasive and time-consuming method, preventing it from integration into clinical practice. Most of the echocardiographic parameters currently used in the clinical routine to characterize left ventricular (LV) systolic function, such as LV ejection fraction and LV global longitudinal strain, do not take the pressure developed within the LV into account and therefore fall too short in describing LV function as a hydraulic pump. Recently, LV pressure-strain analysis has been introduced as a new technique to assess myocardial work in a non-invasive fashion. This new method showed new insights in comparison to invasive measurements and was validated in different cardiac pathologies, e.g., for the detection of coronary artery disease, cardiac resynchronization therapy (CRT)-response prediction, and different forms of heart failure. Non-invasively assessed myocardial work may play a major role in guiding therapies and estimating prognosis. However, its incremental prognostic validity in comparison to common echocardiographic parameters remains unclear. This review aims to provide an overview of pressure-strain analysis, including its current application in the clinical arena, as well as potential fields of exploitation.
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26
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Medvedofsky D, Milhorini Pio S, Weissman NJ, Namazi F, Delgado V, Grayburn PA, Kar S, Lim DS, Lerakis S, Zhou Z, Liu M, Alu MC, Kapadia SR, Lindenfeld J, Abraham WT, Mack MJ, Bax JJ, Stone GW, Asch FM. Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in Patients with Heart Failure with Secondary Mitral Regurgitation: The COAPT Trial. J Am Soc Echocardiogr 2021; 34:955-965. [PMID: 33845158 DOI: 10.1016/j.echo.2021.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/01/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left ventricular (LV) global longitudinal strain (GLS) is a sensitive marker of LV function and may help identify patients with heart failure (HF) and secondary mitral regurgitation who would have a better prognosis and are more likely to benefit from edge-to-edge transcatheter mitral valve repair with the MitraClip. The aim of this study was to assess the prognostic utility of baseline LV GLS during 2-year follow-up of patients with HF with secondary mitral regurgitation enrolled in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation trial. METHODS Patients with symptomatic HF with moderate to severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated guideline-directed medical therapy (GDMT) were randomized to transcatheter mitral valve repair plus GDMT or GDMT alone. Speckle-tracking-derived LV GLS from baseline echocardiograms was obtained in 565 patients and categorized in tertiles. Death and HF hospitalization at 2-year follow-up were the principal outcomes of interest. RESULTS Patients with better baseline LV GLS had higher blood pressure, greater LV ejection fraction and stroke volume, lower levels of B-type natriuretic peptide, and smaller LV size. No significant difference in outcomes at 2-year follow-up were noted according to LV GLS. However, the rate of death or HF hospitalization between 10 and 24 months was lower in patients with better LV GLS (P = .03), with no differences before 10 months. There was no interaction between GLS tertile and treatment group with respect to 2-year clinical outcomes. CONCLUSIONS Baseline LV GLS did not predict death or HF hospitalization throughout 2-year follow-up, but it did predict outcomes after 10 months. The benefit of transcatheter mitral valve repair over GDMT alone was consistent in all subgroups irrespective of baseline LV GLS.
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Affiliation(s)
| | | | - Neil J Weissman
- MedStar Health Research Institute, Washington, District of Columbia; Georgetown University, Washington, District of Columbia
| | - Farnaz Namazi
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California; Bakersfield Heart Hospital, Bakersfield, California
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
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Lakatos BK, Ruppert M, Tokodi M, Oláh A, Braun S, Karime C, Ladányi Z, Sayour AA, Barta BA, Merkely B, Radovits T, Kovács A. Myocardial work index: a marker of left ventricular contractility in pressure- or volume overload-induced heart failure. ESC Heart Fail 2021; 8:2220-2231. [PMID: 33754487 PMCID: PMC8120402 DOI: 10.1002/ehf2.13314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022] Open
Abstract
Aims While global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function, it is significantly influenced by loading conditions. We hypothesized that global myocardial work index (GMWI), a novel marker of LV function, may show better correlation with load‐independent markers of LV contractility in rat models of pressure‐induced or volume overload‐induced heart failure. Methods and results Male Wistar rats underwent either transverse aortic constriction (TAC; n = 12) or aortocaval fistula creation (ACF; n = 12), inducing LV pressure or volume overload, respectively. Sham procedures were performed to establish control groups (n = 12/12). Echocardiographic loops were obtained to determine GLS and GMWI. Pressure‐volume analysis with transient occlusion of the inferior caval vein was carried out to calculate preload recruitable stroke work (PRSW), a load‐independent ‘gold‐standard’ parameter of LV contractility. Myocardial samples were collected to assess interstitial and perivascular fibrosis area and also myocardial atrial‐type natriuretic peptide (ANP) and brain‐type natriuretic peptide (BNP) relative mRNA expression. Compared with controls, GLS was substantially lower in the TAC group (−7.0 ± 2.8 vs. −14.5 ± 2.5%; P < 0.001) and was only mildly reduced in the ACF group (−13.2 ± 2.4 vs. −15.4 ± 2.0%, P < 0.05). In contrast with these findings, PRSW and GMWI were comparable with sham in TAC (110 ± 26 vs. 116 ± 68 mmHg; 1687 ± 275 mmHg% vs. 1537 ± 662 mmHg%; both P = NS), while it was found to be significantly reduced in ACF (58 ± 14 vs. 111 ± 40 mmHg; 1328 ± 411 vs. 1934 ± 308 mmHg%, both P < 0.01). In the pooled population, GMWI (r = 0.70; P < 0.001) but not GLS (r = −0.23; P = 0.12) showed a strong correlation with PRSW. GLS correlated with interstitial (r = 0.61; P < 0.001) and perivascular fibrosis area (r = 0.54; P < 0.001), and also with myocardial ANP (r = 0.85; P < 0.001) and BNP relative mRNA expression (r = 0.75; P < 0.001), while GMWI demonstrated no or only marginal correlation with these parameters. Conclusions Being significantly influenced by loading conditions, GLS may not be a reliable marker of LV contractility in heart failure induced by pressure or volume overload. GMWI better reflects contractility in haemodynamic overload states, making it a more robust marker of systolic function, while GLS should be considered as an integrative marker, incorporating systolic function, haemodynamic loading state, and adverse tissue remodelling of the LV.
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Affiliation(s)
- Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Mihály Ruppert
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Szilveszter Braun
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Christian Karime
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Bálint András Barta
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
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28
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Papadopoulos K, Özden Tok Ö, Mitrousi K, Ikonomidis I. Myocardial Work: Methodology and Clinical Applications. Diagnostics (Basel) 2021; 11:573. [PMID: 33810120 PMCID: PMC8004587 DOI: 10.3390/diagnostics11030573] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 12/18/2022] Open
Abstract
A precise and accurate assessment of left ventricular (LV) contractility is of utmost importance in terms of prognosis in most cardiac pathologies. Given the limitations of ejection fraction (EF) and global longitudinal strain (GLS) due to their load dependency, a novel imaging tool called myocardial work (MW) has emerged as a promising method for LV performance evaluation. MW is a novel, less load-dependent method based on computation of myocardial strain-arterial blood pressure curves. This method provides a more detailed assessment of segmental and global LV function incorporating the patient's LV pressure and is derived by brachial artery pressure utilizing an empiric reference curve adjusted to the duration of the isovolumic and ejection phases as determined by echocardiography. The clinical implications of this unique method have been expanding in the last few years, which attest to the robust additive role of MW in routine practice.
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Affiliation(s)
| | - Özge Özden Tok
- Cardiology Department, Memorial Bahcelievler Hospital, 34180 Istanbul, Turkey;
| | - Konstantina Mitrousi
- European Interbalkan Medical Center, Echocardiography Laboratory, 57001 Thessaloniki, Greece;
| | - Ignatios Ikonomidis
- Echocardiography Laboratory, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece;
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Levi N, Meerkin D. Transcatheter Repair of the Mitral Valve: Relevant Pathophysiology, Investigation, and Management. Can J Cardiol 2021; 37:1027-1040. [PMID: 33753201 DOI: 10.1016/j.cjca.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
Abstract
Mitral regurgitation (MR) is a common condition causing significant morbidity and mortality in the Western world. Although surgical therapy has developed over 5 decades to provide solutions, only a minority of patients undergo surgery. The last decade has seen the emergence and application of multiple transcatheter techniques in attempts to address this undertreated population with the large clinical experience of MitraClip providing the most insight. Clear understanding of the pathophysiology of different MR types as well as the role of particularly secondary MR on patient's clinical syndrome allow for better prediction as to which patient subgroups will benefit from different repair techniques or intervention at all. Most of the techniques are based on surgical technique and are applied as single-device/technique solutions, whether leaflet, chordal, or annular solutions, but with broadening experience, combination therapies are likely to find a place in creating a more complete and surgical-like solution.
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Affiliation(s)
- Nir Levi
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Meerkin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Papadopoulos K, Ikonomidis I, Chrissoheris M, Chalapas A, Kourkoveli P, Parissis J, Spargias K. MitraClip and left ventricular reverse remodelling: a strain imaging study. ESC Heart Fail 2020; 7:1409-1418. [PMID: 32432839 PMCID: PMC7373921 DOI: 10.1002/ehf2.12750] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/11/2020] [Accepted: 04/21/2020] [Indexed: 12/27/2022] Open
Abstract
AIMS The purpose of this study is to identify echocardiography predictors of clinical response and reverse left ventricular (LV) remodelling in patients with functional mitral regurgitation (FMR) treated with MitraClip. METHOD AND RESULTS We retrospectively analysed 86 high surgical risk patients with severe FMR; of those, 58 were implanted a MitraClip, and 28 received medical treatment and served as controls. At baseline and at 1-year follow-up, we performed clinical and echocardiography evaluation to assess global longitudinal strain (GLS) and myocardial work [global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE)]. Mitral regurgitation was significantly reduced after MitraClip implantation (3.7 ± 0.4 vs. 1.7 ± 0.8, P < 0.001), and the procedure was associated with improvement in brain natriuretic peptide levels (980 ± 1027 vs. 420 ± 338 pg/mL, P < 0.001), New York Heart Association class status (3.2 ± 0.55 vs. 2.0 ± 0.6, P < 0.001), 6-min walking test (233 ± 154 vs. 286 ± 114 m, P = 0.01) at follow-up and reduction of left ventricle end-systolic (LVESV) and left ventricle end-diastolic volumes (LVEDV) (152 ± 68 vs. 136 ± 43 mL, P = 0.004 & 219 ± 74 vs. 193 ± 66 mL, P = 0.001, respectively). MitraClip procedure was associated with improvement of LV performance and significant increase of GWI (607 ± 282 vs. 650 ± 260 mmHg%, P = 0.045) and GCW (854 ± 288 vs. 949 ± 325 mmHg%, P < 0.001). Baseline ejection fraction (EF), GLS, GWI, GCW, and effective regurgitant orifice area were the variables that were associated with reduction of LVEDV 1 year after intervention (P < 0.05 for all) and baseline GCW of the LV was the only variable associated with reduction of LVESV (P = 0.002). Receiver operating characteristic curve analysis identified that a GLS cut-off value of -8.65% (AUC 0.815, P = 0.007) was associated with a 20% reduction of the LVEDV with a sensitivity and specificity of 72% and 70%, respectively, and that a GCW cut-off value of 846 mmHg% (AUC 0.759, P = 0.007) was associated with a 10% reduction of LVESV with sensitivity and specificity 79% and 74%, respectively. CONCLUSIONS Mitral valve repair with MitraClip has positive clinical and echocardiographic impact in patients with FMR 1 year after implantation. Preserved GLS and GCW values appear to be associated with LV reverse remodelling post intervention.
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Affiliation(s)
- Konstantinos Papadopoulos
- Transcatheter Heart Valves Department, HYGEIA Hospital, Athens, Greece.,Echocardiography Laboratory, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Ignatios Ikonomidis
- Echocardiography Laboratory, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Antonios Chalapas
- Transcatheter Heart Valves Department, HYGEIA Hospital, Athens, Greece
| | | | - John Parissis
- Heart Failure Unit, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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