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Wazzan AA, Taconne M, Rolle VL, Forsaa MI, Haugaa KH, Galli E, Hernandez A, Edvardsen T, Donal E. Risk profiles for ventricular arrhythmias in hypertrophic cardiomyopathy through clustering analysis including left ventricular strain. Int J Cardiol 2024; 409:132167. [PMID: 38797198 DOI: 10.1016/j.ijcard.2024.132167] [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: 01/21/2024] [Revised: 04/21/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
AIMS The prediction of ventricular arrhythmia (VA) in hypertrophic cardiomyopathy (HCM) remains challenging. We sought to characterize the VA risk profile in HCM patients through clustering analysis combining clinical and conventional imaging parameters with information derived from left ventricular longitudinal strain analysis (LV-LS). METHODS A total of 434 HCM patients (65% men, mean age 56 years) were included from two referral centers and followed longitudinally (mean duration 6 years). Mechanical and temporal parameters were automatically extracted from the LV-LS segmental curves of each patient in addition to conventional clinical and imaging data. A total of 287 features were analyzed using a clustering approach (k-means). The principal endpoint was VA. RESULTS 4 clusters were identified with a higher rhythmic risk for clusters 1 and 4 (VA rates of 26%(28/108), 13%(13/97), 12%(14/120), and 31%(34/109) for cluster 1,2,3 and 4 respectively). These 4 clusters differed mainly by LV-mechanics with a severe and homogeneous decrease of myocardial deformation for cluster 4, a small decrease for clusters 2 and 3 and a marked deformation delay and temporal dispersion for cluster 1 associated with a moderate decrease of the GLS (p < 0.0001 for GLS comparison between clusters). Patients from cluster 4 had the most severe phenotype (mean LV mass index 123 vs. 112 g/m2; p = 0.0003) with LV and left atrium (LA) remodeling (LA-volume index (LAVI) 46.6 vs. 41.5 ml/m2, p = 0.04 and LVEF 59.7 vs. 66.3%, p < 0.001) and impaired exercise capacity (% predicted peak VO2 58.6 vs. 69.5%; p = 0.025). CONCLUSION Processing LV-LS parameters in HCM patients 4 clusters with specific LV-strain patterns and different rhythmic risk levels are identified. Automatic extraction and analysis of LV strain parameters improves the risk stratification for VA in HCM patients.
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Affiliation(s)
- Adrien Al Wazzan
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | - Marion Taconne
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | - Virginie Le Rolle
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | - Marianne Inngjerdingen Forsaa
- Department of Cardiology, University of Oslo, Oslo University Hospital, ProCardio Center for Innovation, Oslo, Norway
| | - Kristina Hermann Haugaa
- Department of Cardiology, University of Oslo, Oslo University Hospital, ProCardio Center for Innovation, Oslo, Norway.
| | - Elena Galli
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | - Alfredo Hernandez
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | - Thor Edvardsen
- Department of Cardiology, University of Oslo, Oslo University Hospital, ProCardio Center for Innovation, Oslo, Norway.
| | - Erwan Donal
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
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Derda AA, Abelmann M, Sieweke JT, Waleczek FJG, Weber N, Zehrfeld N, Bär C, Duncker D, Bavendiek U, Berliner D, Bauersachs J, Sonnenschein K, Thum T. A pilot study for risk stratification of ventricular tachyarrhythmia in hypertrophic cardiomyopathy with routine echocardiography parameters. Sci Rep 2024; 14:3799. [PMID: 38360886 PMCID: PMC10869710 DOI: 10.1038/s41598-024-54153-2] [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: 08/22/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
Ventricular tachyarrhythmia (VTA) are frequent arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Representing a major risk factor for sudden cardiac death, Holter ECG at first clinical presentation appears insufficient. This study aims to investigate the ability of routinely obtained parameters associated with myocardial remodeling in stratifying for VTA in HCM. In this monocentric analysis, patients with HCM underwent 12-channel electrocardiography and echocardiography, including tissue doppler imaging. The study's primary endpoint was the documentation of non-sustained and sustained ventricular tachycardia-summarized as ventricular tachyarrhythmias (VTA) on Holter ECG or active devices. The occurrence of VTA was exploratory. Based on our collective, we developed a risk model regarding VTA. Of 140 HCM patients, 38 (27.1%) had an episode of VTA. Patients with VTA were likelier to have a history of atrial fibrillation (p < 0.001), a thicker interventricular septum (p < 0.001) and lower peak systolic mitral annular velocity (p < 0.001). The parameters were independently associated with endpoint in univariate and multivariate logistic regression. We created a logistic equation and calculated a cut-off value. The resulting ROC curve revealed a discriminative ability with AUC of 0.80 (sensitivity, 63%; specificity, 88%). Our risk model including these widely available parameters is able to distinguish low and high-risk of VTA in patients with HCM.
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Affiliation(s)
- Anselm A Derda
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Malin Abelmann
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan-Thorben Sieweke
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Florian J G Waleczek
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Natalie Weber
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nadine Zehrfeld
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Christian Bär
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kristina Sonnenschein
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
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3
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Nikoo MH, Zarrabi M, Moaref A, Razeghian-Jahromi I. Global Longitudinal Strain May Be the One that Appropriately Identifies Candidates of ICD Implantation. Cardiol Res Pract 2024; 2024:2214072. [PMID: 38264236 PMCID: PMC10805553 DOI: 10.1155/2024/2214072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/20/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) significantly contributes to an elevated risk of sudden cardiac death. Primary prevention is implemented by using an implantable cardioverter defibrillator (ICD). However, all of the HCM patients do not really need ICD therapy. Providing a superior index for ICD indication compared with the current indices like ejection fraction is essential to differentiate high-risk patients efficiently. The present study assessed the potential of global longitudinal strain (GLS) for the differentiation of HCM patients based on their need for ICD shocks. Patients with HCM were considered in four defined centers between March and June 2021. Those with previous ICD implantation or current candidates for ICD therapy were included in the study. Participants were subjected to speckle-tracking echocardiography, and GLS as well as some other echocardiographic parameters were recorded. Afterwards, data from implanted ICDs were extracted. Patients who received ICD shocks (appropriate) due to ventricular tachycardia (VT)/ventricular fibrillation (VF) were categorized in group A. The remaining patients were constituted group B who received inappropriate shocks, i.e., other than VT/VF. Overall, 34 patients were found eligible to participate with a mean age of 62 ± 16.1 years including 64.7% of males. Among a variety of echocardiographic parameters, GLS was the sole one that was significantly higher in group A compared with that in group B. Our findings revealed that only GLS could predict fatal arrhythmias. To substantiate, the odds of VT were raised by 43% with a single increase in GLS unit. GLS showed the highest accuracy for ICD indication among HCM patients and, therefore, could be a solid and early criterion to predict the incidence of life-threatening arrhythmias. In this regard, identifying appropriate HCM patients with respect to their need for ICD therapy is feasible.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zarrabi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moaref
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Bjerregaard CL, Skaarup KG, Lassen MCH, Biering-Sørensen T, Olsen FJ. Strain Imaging and Ventricular Arrhythmia. Diagnostics (Basel) 2023; 13:diagnostics13101778. [PMID: 37238262 DOI: 10.3390/diagnostics13101778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Ventricular arrhythmia is one of the main causes of sudden cardiac death. Hence, identifying patients at risk of ventricular arrhythmias and sudden cardiac death is important but can be challenging. The indication for an implantable cardioverter defibrillator as a primary preventive strategy relies on the left ventricular ejection fraction as a measure of systolic function. However, ejection fraction is flawed by technical constraints and is an indirect measure of systolic function. There has, therefore, been an incentive to identify other markers to optimize the risk prediction of malignant arrhythmias to select proper candidates who could benefit from an implantable cardioverter defibrillator. Speckle-tracking echocardiography allows for a detailed assessment of cardiac mechanics, and strain imaging has repeatedly been shown to be a sensitive technique to identify systolic dysfunction unrecognized by ejection fraction. Several strain measures, including global longitudinal strain, regional strain, and mechanical dispersion, have consequently been proposed as potential markers of ventricular arrhythmias. In this review, we will provide an overview of the potential use of different strain measures in the context of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Benjamin MM, Khalil M, Munir MS, Kinno M, Syed MA. Association of left atrial size and function by cardiac magnetic resonance imaging with long term outcomes in patients with hypertrophic cardiomyopathy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1181-1188. [PMID: 36795300 DOI: 10.1007/s10554-023-02814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Left atrial (LA) function and strain are being investigated as markers of disease progression in hypertrophic cardiomyopathy (HCM). To assess LA function and strain by cardiac magnetic resonance imaging (MRI) in patients with HCM and evaluate the association of these parameters with long-term clinical outcomes. We retrospectively evaluated 50 HCM patients and 50 patients with no significant cardiovascular disease (control) who underwent clinically indicated cardiac MRI. We calculated LA volumes using the Simpson area-length method to derive LA ejection fraction and expansion index. MRI-derived left atrial reservoir (ƐR), conduit (ƐCD), and contractile strain (ƐCT) were measured using dedicated software. A multivariate regression analysis with endpoints of ventricular tachyarrhythmias (VTA) and heart failure hospitalization (HFH) was performed. HCM patients had significantly higher LV mass, higher LA volumes and lower LA strain compared to controls. During the median follow up of 15.6 months (interquartile range 8.4-35.4 months), 11 patients (22%) experienced a HFH, while 10 patients (20%) had VTA. Multivariate analysis demonstrated that ƐCT (odds ratio (OR) 0.96, confidence interval (CI) 0.83-1.00) and LA ejection fraction (OR 0.89, CI 0.79-1.00) were significantly associated with VTA and HFH respectively.
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Affiliation(s)
- Mina M Benjamin
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Maria Khalil
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Muhammad S Munir
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Menhel Kinno
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mushabbar A Syed
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA.
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6
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Zegkos T, Kamperidis V, Ntelios D, Gossios T, Parcharidou D, Tziomalos G, Papanastasiou CA, Boutou AΚ, Katranas S, Rouskas P, Karamitsos T, Giannakoulas G, Karvounis H, Efthimiadis G. Left Atrial Myopathy is Associated With Exercise Incapacity and Ventilatory Inefficiency in Hypertrophic Cardiomyopathy. Heart Lung Circ 2023; 32:215-223. [PMID: 36404220 DOI: 10.1016/j.hlc.2022.10.002] [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: 06/22/2022] [Revised: 09/03/2022] [Accepted: 10/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left atrial (LA) myopathy is an established component of hypertrophic cardiomyopathy (HCM); however, the data about its association with exercise incapacity or ventilatory inefficiency that may be seen in HCM patients are limited. This study aimed to explore the association between LA myopathy, evaluated by echocardiography LA strain, and exercise capacity and ventilatory efficiency, evaluated by cardiopulmonary exercise testing (CPET), in HCM patients. METHODS This study included 241 consecutive HCM patients (aged 51.2±15.7 years 67.2% male) in sinus rhythm who underwent CPET and transthoracic echocardiography at the same visit. Exercise incapacity (maximal/predicted oxygen consumption [%peakVO2] <80%) and ventilatory inefficiency (ventilation/carbon dioxide output [VE/VCO2] slope >34) were assessed by CPET. Left atrial myopathy was examined by speckle-tracking myocardial deformation parameters: LA reservoir, conduit and booster strain. RESULTS All three LA strain values were univariate predictors of exercise capacity and ventilatory efficiency. Among them, LA reservoir strain had the higher r correlation coefficient for predicting both %peakVO2 and VE/VCO2 slope. Left atrial reservoir strain, presence of angina and family history of HCM were independent predictors of exercise capacity. Left atrial reservoir strain, male gender and non-sustained ventricular tachycardia were independent predictors of ventilatory efficiency. Left atrial reservoir strain was a significant predictor of %peakVO2<80% with an optimal cut-off value of 27% (sensitivity 87% and specificity 31%) and VE/VCO2>34 with an optimal cut-off value of 18% (sensitivity 71% and specificity 83%). CONCLUSION Left atrial myopathy, as reflected by the LA strain values, was associated with exercise incapacity and ventilatory inefficiency in HCM individuals. Left atrial reservoir strain was the only common independent predictor of %peakVO2 and VE/VCO2 slope.
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Affiliation(s)
- Thomas Zegkos
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Vasileios Kamperidis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece.
| | - Dimitris Ntelios
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Thomas Gossios
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Despoina Parcharidou
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Tziomalos
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Afroditi Κ Boutou
- Respiratory Medicine Department, Hippokration Hospital, Thessaloniki, Greece
| | - Sotirios Katranas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Pavlos Rouskas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Theodoros Karamitsos
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Haralampos Karvounis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Efthimiadis
- Department of Cardiology, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
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7
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Multimodality Imaging in Sarcomeric Hypertrophic Cardiomyopathy: Get It Right…on Time. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010171. [PMID: 36676118 PMCID: PMC9863627 DOI: 10.3390/life13010171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) follows highly variable paradigms and disease-specific patterns of progression towards heart failure, arrhythmias and sudden cardiac death. Therefore, a generalized standard approach, shared with other cardiomyopathies, can be misleading in this setting. A multimodality imaging approach facilitates differential diagnosis of phenocopies and improves clinical and therapeutic management of the disease. However, only a profound knowledge of the progression patterns, including clinical features and imaging data, enables an appropriate use of all these resources in clinical practice. Combinations of various imaging tools and novel techniques of artificial intelligence have a potentially relevant role in diagnosis, clinical management and definition of prognosis. Nonetheless, several barriers persist such as unclear appropriate timing of imaging or universal standardization of measures and normal reference limits. This review provides an overview of the current knowledge on multimodality imaging and potentialities of novel tools, including artificial intelligence, in the management of patients with sarcomeric HCM, highlighting the importance of specific "red alerts" to understand the phenotype-genotype linkage.
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Yang Y, Wu D, Wang H, Wang Y. Prognostic value of global longitudinal strain in hypertrophic cardiomyopathy: A systematic review and meta-analysis. Clin Cardiol 2022; 45:1184-1191. [PMID: 36177652 DOI: 10.1002/clc.23928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As previously reported, impairment of left ventricular global longitudinal strain (LVGLS) is associated with myocardial fibrosis, arrhythmias, and heart failure in hypertrophic cardiomyopathy (HCM) patients. HYPOTHESIS This study aimed to estimate the association between LVGLS measured by echocardiography and major adverse cardiovascular events (MACE) in patients with HCM. METHODS Pubmed, Embase, Scopus, and Cochrane Library databases were systematically searched for evaluating the difference of LVGLS between MACE and non-MACE and the relevance of LVGLS and MACE in HCM patients, mean difference (MD), and pooled hazard ratios (HR) with 95% confidence interval (CI) were calculated. Publication bias was detected by funnel plots and Egger's test, and trim-and-fill analysis was employed when publication bias existed. RESULTS A total of 13 studies reporting 2441 HCM patients were included in this meta-analysis. Absolute value of LVGLS was lower in the group of HCM with MACE (MD = 2.74, 95% CI: 2.50-2.99, p < .001; I2 = 0, p = .48). In the pooled unadjusted model, LVGLS was related to MACE (HR = 1.14, 95% CI: 1.06-1.22, p < .05, I2 = 58.4%, p < .01) and there is a mild heterogeneity, and sensitivity analysis showed stable results. In the pooled adjusted model, LVGLS was related to MACE (HR = 1.12, 95% CI: 1.08-1.16, p < .05; I2 = 0%, p = .442). Egger's tests showed publication bias, and trim-and-fill analysis was applied, with final results similar to the previous and still statistically significant. CONCLUSION The meta-analysis suggested that impaired LVGLS was associated with poor prognosis in HCM patients.
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Affiliation(s)
- Ying Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Dong Wu
- Department of Radiology, The First Bethune Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yanting Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Klettas D, Georgiopoulos G, Rizvi Q, Oikonomou D, Magkas N, Bhuva AN, Manisty C, Captur G, Aimo A, Nihoyannopoulos P. Echocardiographic and Cardiac Magnetic Resonance Imaging-Derived Strains in Relation to Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 171:132-139. [PMID: 35305784 DOI: 10.1016/j.amjcard.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/01/2022]
Abstract
We compared speckle tracking echocardiography (STE) and feature tracking cardiovascular magnetic resonance (FT-CMR) in patients with hypertrophic cardiomyopathy (HC) with a varying extent of fibrosis as defined by late gadolinium enhancement to look at the level of agreement between methods and their ability to relate those to myocardial fibrosis. At 2 reference centers, 79 patients with HC and 16 volunteers (the control group) underwent STE and CMR with late gadolinium enhancement and FT-CMR. Patients were classified into 3 categories: no detectable, limited, and extensive fibrosis. Global longitudinal strain (GLS) and global radial strain (GRS) were derived using FT-CMR and STE. STE-derived GRS was decreased in all HC categories compared with the control group (p <0.001), whereas FT-CMR GRS was reduced only in patients with HC with fibrosis (p <0.05). Reduced STE-derived GLS was associated with extensive fibrosis (p <0.05) and a value less than -15.2% identified those with extensive fibrosis (sensitivity 79%, specificity 92%, area under the curve 0.863, 95% confidence interval [CI] 0.76 to 0.97, p <0.001). Inter-modality agreement was moderate for STE versus CMR-GLS (overall population intra-class correlation coefficient = 0.615, 95% CI 0.42 to 0.75, p <0.001; patients with HC 0.63, 0.42 to 0.76, p <0.001) and GRS (overall population intra-class correlation coefficient = 0.601, 95% CI 0.397 to 0.735, p <0.001). A low level of agreement for GRS was seen between methods in patients with HC. In conclusion, strain indexes measured using echocardiography and CMR are reduced in patients with HC compared with the control group and correlate well with the burden of myocardial fibrosis. Reduced STE-GLS can identify patients with extensive fibrosis, but whether there is an added value for risk stratification for sudden cardiac death remains to be determined.
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Affiliation(s)
- Dimitrios Klettas
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom; First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Qaima Rizvi
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | | | - Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece
| | - Anish N Bhuva
- Department of Cardiovascular Imaging, Barts Heart Center, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Center, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gabriella Captur
- Royal Free London, National Health Service Foundation Trust, London, United Kingdom; University College London Medical Research Council Unit for Lifelong Health and Aging, University College London, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alberto Aimo
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom; First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece.
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Harapoz M, Zada M, Matthews J, Kumar S, Thomas L. Echocardiographic predictors of ventricular arrhythmias in patients with non-ischemic cardiomyopathy. IJC HEART & VASCULATURE 2022; 39:100962. [PMID: 35169613 PMCID: PMC8829059 DOI: 10.1016/j.ijcha.2022.100962] [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: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Objective Methods Results Conclusion
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Corbo MD, Vitale E, Pesolo M, Casavecchia G, Gravina M, Pellegrino P, Brunetti ND, Iacoviello M. Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11061519. [PMID: 35329848 PMCID: PMC8955301 DOI: 10.3390/jcm11061519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.
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Affiliation(s)
- Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Maurizio Pesolo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Matteo Gravina
- University Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy;
| | - Pierluigi Pellegrino
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
- Correspondence: or
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12
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Myocardial early systolic lengthening predicts mid-term outcomes in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2021; 38:161-168. [PMID: 34846619 DOI: 10.1007/s10554-021-02484-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
In this study, we investigated whether early systolic lengthening (ESL) which reflects subclinical ischemia and other echocardiographic and clinic parameters predict primary outcome [appropriate ICD shock, cardiovascular mortality and ventricular tachycardia (VT) or fibrillation] in patients with hypertrophic cardiomyopathy (HCM). 202 Patients with HCM (68% male, mean age 48 ± 13.9 years) were included in the study. Patients' clinical, electrocardiographic, 2D classic and speckle tracking echocardiography (STE) data were collected. ESL was defined as time from onset of the Q wave on ECG (onset of the R wave if the Q wave was absent) to maximum myocardial systolic lengthening. Patients were divided into two groups as occurrence or absence of primary outcome during 5 years follow up. During the follow-up period of 5 years (mean follow-up duration, 45.9 ± 10.8 months), 31 patients (15%) developed primary outcome [appropriate ICD shock 22 (11%), cardiovascular death 6 (3%), VT/VF 3(1.5%)]. Higher HCM Risk SCD score, longer ESL, and decreased global longitudinal peak strain (GLPS) were observed in patients with primary outcome. A Cox regression analysis, ESL, GLPS and HCM Risk SCD score were found to be independent predictors of occurrence of primary outcome. In ROC curve analysis, ESL > 53.5 msn could discriminate between groups with and without a primary outcome (AUC 0.768, 80% sensitivity and 60% specificity, CI 95% 0.666-0.871). ESL were found to be predictive for primary outcome in patients with HCM. Readily measurable ESL could be helpful to distinguish patients at high risk who could optimally benefit from ICD therapy.
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Lee HJ, Kim HK, Lee SC, Kim J, Park JB, Hwang IC, Choi YJ, Lee SP, Chang SA, Lee W, Park EA, Cho GY, Kim YJ. Supplementary role of left ventricular global longitudinal strain for predicting sudden cardiac death in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:1108-1116. [PMID: 34542591 DOI: 10.1093/ehjci/jeab187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS We investigated the prognostic role of left ventricular global longitudinal strain (LV-GLS) and its incremental value to established risk models for predicting sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS LV-GLS was measured with vendor-independent software at a core laboratory in a cohort of 835 patients with HCM (aged 56.3 ± 12.2 years) followed-up for a median of 6.4 years. The primary endpoint was SCD events, including appropriate defibrillator therapy, within 5 years after the initial evaluation. The secondary endpoint was a composite of SCD events, heart failure admission, heart transplantation, and all-cause mortality. Twenty (2.4%) and 85 (10.2%) patients experienced the primary and secondary endpoints, respectively. Lower absolute LV-GLS quartiles, especially those worse than the median (-15.0%), were associated with progressively higher SCD event rates (P = 0.004). LV-GLS was associated with an increased risk for the primary endpoint, independent of the LV ejection fraction, apical aneurysm, and 2014 European Society of Cardiology (ESC) risk score [adjusted hazard ratio (aHR) 1.14, 95% confidence interval (CI) 1.02-1.28] or 2011 American College of Cardiology/American Heart Association (ACC/AHA) risk factors (aHR 1.18, 95% CI 1.05-1.32). LV-GLS was also associated with a higher risk for the composite secondary endpoint (aHR 1.06, 95% CI 1.01-1.12). The addition of LV-GLS enhanced the performance of the ESC risk score (C-statistic 0.756 vs. 0.842, P = 0.007) and the 2011 ACC/AHA risk factor strategy (C-statistic 0.743 vs. 0.814, P = 0.007) for predicting SCD. CONCLUSION LV-GLS is an important prognosticator in patients with HCM and provides additional information to established risk stratification strategies for predicting SCD.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam 13620, Korea
| | - You-Jung Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul 06351, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam 13620, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea
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Comprehensive Echocardiography of Left Atrium and Left Ventricle Using Modern Techniques Helps in Better Revealing Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2021; 11:diagnostics11071288. [PMID: 34359371 PMCID: PMC8304227 DOI: 10.3390/diagnostics11071288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is an important arrhythmia in hypertrophic cardiomyopathy (HCM). We aimed to explore whether a complex evaluation of the left ventricle (LV) using modern echocardiography techniques, additionally to the left atrium (LA) boosts the probability of AF diagnosis. Standard echocardiography, 2D and 3D speckle tracking, were performed for LA and LV evaluation in HCM patients and healthy volunteers. Of 128 initially qualified HCM patients, 60 fulfilled included criteria, from which 43 had a history of AF, and 17 were without AF. LA volume index and peak strain, LV ejection fraction, and strains were significant predictors of AF. In addition, 2D global longitudinal strain (GLS) for LV at cut off -16% turned out to be the most accurate predictor of AF (OR 48.00 [95% CI 2.68-859.36], p = 0.001), whereas the combination of LA peak strain ≤ 22% and LV GLS ≥ -16% had the highest discriminatory power (OR 76.36 [95% CI 4.13-1411.36], p = 0.001). AF in HCM patients seems to be LA as well as LV disease. Revealing lower strain for LV, in addition to lower LA strain, may have an important impact on accurate characteristics of HCM patients with AF history.
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Rakesh K, Rajesh GN, Vellani H. 3D speckle tracking echocardiographic strain pattern in Hypertrophic Cardiomyopathy and its relation with Sudden Cardiac Death risk markers. Indian Heart J 2021; 73:451-457. [PMID: 34474757 PMCID: PMC8424279 DOI: 10.1016/j.ihj.2020.11.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Sudden cardiac death (SCD) predictability for assessing the need for primary insertion of Implantable Cardioverter Defibrillator (ICD) in patients with Hypertrophic cardiomyopathy (HCM) is difficult though there are several conventional risk markers. The role of deformation indices in predicting SCD in HCM is less addressed. OBJECTIVES To analyse the 3D speckle tracking echocardiographic strain parameters of HCM patients and its relation with SCD risk markers. DESIGN AND STUDY METHODOLOGY It was a cross-sectional observation study done over a period of one year with a follow up period of one year. Fifty HCM patients were included after screening eighty-two patients. Their global LV strain parameters, Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS), Global Radial Strain (GRS) and Global area strain (GAS) were analysed with respect to their age and gender-matched controls. The various strain parameters were correlated with the conventional SCD risk markers and the ESC SCD risk score among these HCM patients. RESULTS All the global strain parameters were significantly low in HCM patients compared to their controls {GLS -7.30 ± 3.424 vs -18.78 ± 2.342, p < 001; GCS -11.26 ± 2.754 vs -25.08 ± 3.542, p < 001; GRS 20.56 ± 8.929 vs 39.70 ± 7.546, p < 001}. On subgroup analysis of HCM patients with LV thickness >30 mm, abnormal exercise test, family history of SCD, LVOT gradients >30mmHgand more than one SCD risk marker had significantly low values for all global deformation parameters, when compared with their control HCM cohort. The ESC risk score also had significant inverse correlation with all deformation parameters (GLS 0.496, p < 0.001; GCS 0.491, p < 0.001; GRS -0.529, p < 0.001; GAS 0.519, p < 0.001). On follow up, only one event was recorded in this cohort. CONCLUSION There exists a possible linear correlation between conventional SCD risk markers and 3D deformation parameters, which may be utilized for risk stratification and SCD predictability in HCM patients after confirmation with further large prospective studies.
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Affiliation(s)
- K Rakesh
- Department of Cardiology, Government Medical College, Kozhikode, Kerala, 673008, India.
| | - Gopalan Nair Rajesh
- Department of Cardiology, Government Medical College, Kozhikode, Kerala, 673008, India.
| | - Haridasn Vellani
- Department of Cardiology, Government Medical College, Kozhikode, Kerala, 673008, India.
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16
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Gossios TD, Savvatis K, Zegkos T, Parcharidou D, Karvounis HI, Efthimiadis GK. Risk Prediction Models and Scores in Hypertrophic Cardiomyopathy. Curr Pharm Des 2021; 27:1254-1265. [PMID: 33550965 DOI: 10.2174/1381612827666210125121115] [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: 05/05/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) has historically been linked with sudden cardiac death (SCD). Currently, it is well established that only a subset of patients is at the highest risk stratum for such a catastrophic event. Detection of patients belonging to this high-risk category can allow for timely defibrillator implantation, changing the natural history of HCM. Inversely, device implantation in patients deemed at low risk leads to an unnecessary burden of device complications with no apparent protective benefit. Previous studies have identified a series of markers, now considered established risk factors, with genetic testing and newer imaging allowing for the detection of novel, highly promising indices of increased risk for SCD. Despite the identification of a number of risk factors, there is noticeable discrepancy in the utility of such factors for risk stratification between the current American and European guidelines. We sought to systematically review the data available on these two approaches, presenting their rationale and respective predictive capacity, also discussing the potential of novel markers to augment the precision of currently used risk stratification models for SCD in HCM.
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Affiliation(s)
- Thomas D Gossios
- Cardiology Department, St Thomas' Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Konstantinos Savvatis
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Thomas Zegkos
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Despina Parcharidou
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Haralambos I Karvounis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgios K Efthimiadis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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17
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The predictive value of left ventricular and left atrial mechanics for atrial fibrillation and heart failure in hypertrophic cardiomyopathy: a prospective cohort study. Int J Cardiovasc Imaging 2021; 37:2679-2690. [PMID: 33818698 DOI: 10.1007/s10554-021-02232-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) represent clinical turning points, altering the natural history of HCM and influencing long-term outcome of the disease. The aim of this study was to evaluate the ability of left ventricular (LV) and left atrial (LA) myocardial deformation parameters to predict new-onset AF and HF outcomes in patients with HCM. This was a prospective study that included HCM patients without severe valvular heart disease, prior myocardial infarction or history of AF. The study sample consisted of 250 patients (mean age 50.8 ± 15.8, 67.2% male). Two-dimensional (2D) speckle tracking deformation parameters including global longitudinal strain (GLS), radial strain, circumferential strain, LA reservoir strain (LAεres), LA conduit strain (LAεcon) and LA booster strain(LAεboost) were examined. During a mean follow-up of 2.5 ± 1.2 years, 44 patients developed new-onset AF. All the LV and LA deformation parameters were significant univariate predictors of AF. GLS and LAεres had the highest C statistic among the LV and LA functional indices. In multivariable analysis, only LAεres remained an independent predictor of the arrhythmia (HR 0.91, 95% CI 0.85-0.98, p: 0.008). Similarly, GLS and LAεres had the highest predictive value among the 2D speckle tracking parameters for HF outcomes. LAεres remained an independent predictor after adjusting for significant covariates. GLS and LAεres demonstrated high predictive value for the development of AF and HF in HCM. LAεres was the only independent predictor of both outcomes.Clinical trial registration: ClinicalTrials.gov identifier: NCT04112511.
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18
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Zegkos T, Ntelios D, Parcharidou D, Katranas S, Panagiotidis T, Rouskas P, Vassilikos V, Karvounis H, Efthimiadis GK. The Prognostic Value of Left Atrial Deformation Parameters for Sudden Arrhythmic Events in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2020; 33:1276-1277.e1. [DOI: 10.1016/j.echo.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022]
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19
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Anghel L, Stătescu C, Șerban IL, Mărănducă MA, Butcovan D, Clement A, Bostan M, Sascău R. The Advantages of New Multimodality Imaging in Choosing the Optimal Management Strategy for Patients with Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2020; 10:diagnostics10090719. [PMID: 32961665 PMCID: PMC7554758 DOI: 10.3390/diagnostics10090719] [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: 08/30/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
In recent years, significant advances have been made in the diagnosis and therapeutic management of hypertrophic cardiomyopathy (HCM) patients, which has led to an important improvement in their longevity and quality of life. The use of multimodality imaging has an essential role in the diagnosis, assessing the regional distribution and severity of the disease, with important prognostic implications. At the same time, imaging contributes to the identification of optimal treatment for patients with hypertrophic cardiomyopathy, whether it is pharmaceutical, interventional or surgical treatment. Novel pharmacotherapies (like myosin inhibitors), minimally invasive procedures (such as transcatheter mitral valve repair, high-intensity focused ultrasound or radiofrequency ablation) and gene-directed approaches, may soon become alternatives for HCM patients. However, there are only few data on the early diagnosis of patients with HCM, in order to initiate treatment as soon as possible, to reduce the risk of sudden cardiac death (SCD). The aim of our review is to highlight the advantages of contemporary imaging in choosing the optimal management strategies for HCM patients, considering the novel therapies which are currently applied or studied for these patients.
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Affiliation(s)
- Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania; (D.B.); (A.C.)
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania; (D.B.); (A.C.)
- Correspondence: ; Tel.: +40-0232-211834
| | - Ionela-Lăcrămioara Șerban
- Physiology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (I.-L.Ș.); (M.A.M.)
| | - Minela Aida Mărănducă
- Physiology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (I.-L.Ș.); (M.A.M.)
| | - Doina Butcovan
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania; (D.B.); (A.C.)
| | - Alexandra Clement
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania; (D.B.); (A.C.)
| | - Mădălina Bostan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania; (D.B.); (A.C.)
| | - Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (M.B.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania; (D.B.); (A.C.)
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20
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Longobardo L. The Ancient Contraposition between Anatomy and Function: The Effectiveness of Left Atrial Volume Index and the Advantages of Left Atrial Longitudinal Strain. J Cardiovasc Echogr 2020; 30:47-48. [PMID: 32766109 PMCID: PMC7307619 DOI: 10.4103/jcecho.jcecho_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/04/2019] [Accepted: 09/18/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Luca Longobardo
- Department of Clinical and Experimental Medicine, Section of Cardiology, "Policlinico G. Martino" University of Messina, Italy
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21
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Hiemstra YL, van der Bijl P, El Mahdiui M, Bax JJ, Delgado V, Marsan NA. Myocardial Work in Nonobstructive Hypertrophic Cardiomyopathy: Implications for Outcome. J Am Soc Echocardiogr 2020; 33:1201-1208. [PMID: 32680744 DOI: 10.1016/j.echo.2020.05.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Noninvasive left ventricular (LV) pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate LV function, integrating longitudinal strain by speckle-tracking analysis and sphygmomanometrically measured blood pressure to estimate myocardial work. The aims of this study were (1) to describe global and segmental myocardial work in patients with hypertrophic cardiomyopathy (HCM), (2) to assess the correlation between myocardial work and other echocardiographic parameters, and (3) to evaluate the association of myocardial work with adverse outcomes. METHODS One hundred ten patients with nonobstructive HCM (mean age, 55 ± 15 years; 66% men), with different phenotypes (apical, concentric, and septal hypertrophy), and 35 age- and sex-matched healthy control subjects were included. The following myocardial work indices were included: myocardial work index, constructive work (CW), wasted work, and cardiac efficiency. The combined end point included all-cause mortality, heart transplantation, heart failure hospitalization, aborted sudden cardiac death, and appropriate implantable cardioverter-defibrillator therapy. RESULTS Mean global CW (1,722 ± 602 vs 2,274 ± 574 mm Hg%, P < .001), global cardiac efficiency (93% [89%-95%] vs 96% [96%-97%], P < .001), and global MWI (1,534 ± 551 vs 1,929 ± 473 mm Hg%) were significantly reduced, while global wasted work (104 mm Hg% [66-137 mm Hg%] vs 71 mm Hg% [49-92 mm Hg%], P < .001) was increased in patients with HCM compared with control subjects. Segmental impairment in CW colocalized with maximal wall thickness (HCM phenotype), and global CW correlated with LV wall thickness (r = -0.41, P < .001), diastolic function (r = -0.27, P = .001), and QRS duration (r = -0.28, P = .001). Patients with global CW > 1,730 mm Hg% (the median value) experienced better event-free survival than those with global CW < 1,730 mm Hg% (P < .001). CONCLUSIONS Myocardial work, assessed noninvasively using echocardiography and blood pressure measurement, is reduced in patients with nonobstructive HCM; it correlates with maximum LV wall thickness and is significantly associated with a worse long-term outcome.
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Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Abou R, van der Bijl P, Bax JJ, Delgado V. Global longitudinal strain: clinical use and prognostic implications in contemporary practice. Heart 2020; 106:1438-1444. [DOI: 10.1136/heartjnl-2019-316215] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Hiemstra YL, Debonnaire P, Bootsma M, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Prevalence and Prognostic Implications of Right Ventricular Dysfunction in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2019; 124:604-612. [PMID: 31204037 DOI: 10.1016/j.amjcard.2019.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/28/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022]
Abstract
Right ventricular (RV) dysfunction is a well-known prognostic factor in several cardiac diseases. However, the prevalence of RV dysfunction in hypertrophic cardiomyopathy (HC) is unclear and its prognostic value is unknown. This study aims at addressing these issues assessing RV function with speckle tracking echocardiography. In 267 HC patients (52 ± 15 years, 68% male), standard and advanced echocardiographic measurements of RV function were performed including RV 4-chamber longitudinal strain (RV4CLS) and RV free wall longitudinal strain (RVFWLS). The primary end point was all-cause mortality and heart failure development. RV dysfunction was observed in 9% of patients based on tricuspid annular plane systolic excursion (≤17 mm), 5% based on fractional area change (<35%), 23% based on RVFWLS ≥-19%, 39% based on RVFWLS ≥-23%, and 55% based on RV4CLS ≥-20%. In total 59 (22%) patients reached the primary end point during a median follow-up of 6.7 (interquartile range 4.2 to 9.8) years. Kaplan-Meier survival curve showed a significant worse survival free of the end point for patients with impaired RV4CLS ≥-20% versus patients with preserved RV4CLS <-20% (log-rank 7.0, p = 0.008) and for patients with impaired RVFWLS ≥-19% versus patients with preserved RVFWLS <-19% (log-rank 4.4, p = 0.037). Multivariable Cox regression analysis showed that E/E' (hazards ratio [HR] 2.26 [1.30 to 3.92], p = 0.004), left ventricular global longitudinal strain LV GLS (HR 1.08 (1.01 to 1.17), p = 0.034) and RV4CLS (HR 1.08 (1.02 to 1.15), p = 0.007) were independently associated with the primary end point. In conclusion, RV dysfunction as measured by longitudinal strain is relatively frequent in HC patients. Impaired RV4CLS is - together with LV GLS and E/E' - associated with adverse outcome, which may indicate a more severe form of HC.
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Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Debonnaire
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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van der Bijl P, Delgado V, Bax JJ. Imaging for sudden cardiac death risk stratification: Current perspective and future directions. Prog Cardiovasc Dis 2019; 62:205-211. [PMID: 31054859 DOI: 10.1016/j.pcad.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) ≤35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk-stratification, and ongoing/ planned trials are subsequently discussed.
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Affiliation(s)
- Pieter van der Bijl
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center.
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Goff ZD, Calkins H. Sudden death related cardiomyopathies - Hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2019; 62:212-216. [PMID: 31004609 DOI: 10.1016/j.pcad.2019.04.001] [Citation(s) in RCA: 5] [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: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a form of inherited cardiomyopathy. Most individuals with HCM experience minimal symptoms throughout their lifetime. However, those with HCM are at risk of ventricular arrhythmias and sudden cardiac death (SCD), the most feared complication of HCM. Implantable cardioverter defibrillator (ICD) implantation has played a large role in transforming this disease from one with an ominous prognosis to one with mortality rates that are on par with the general public. Since the early 2000s, balance between SCD prevention and unnecessary ICD placement has been sought, this is reflected in the evolution of SCD risk stratification models for patients with HCM. This review discusses key concepts pertaining to HCM, with emphasis on prevention of SCD, and summarizes and compares the recommendations for ICD implantation in current guidelines.
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Affiliation(s)
- Zackary D Goff
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Hugh Calkins
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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26
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Guerra F, Malagoli A, Contadini D, Baiocco E, Menditto A, Bonelli P, Rossi L, Sticozzi C, Zanni A, Cai J, Maitra P, Villani GQ, Capucci A. Global Longitudinal Strain as a Predictor of First and Subsequent Arrhythmic Events in Remotely Monitored ICD Patients With Structural Heart Disease. JACC Cardiovasc Imaging 2019; 13:1-9. [PMID: 30772229 DOI: 10.1016/j.jcmg.2018.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess speckle-tracking-derived parameters as predictors of first and subsequent ventricular events in patients with structural heart disease and implantable cardioverter-defibrillators (ICD). BACKGROUND Left ventricular ejection fraction (LVEF), the current primary parameter of risk stratification for ventricular arrhythmias (VAs) in structural heart diseases is burdened by many limitations. METHODS In this retrospective, observational study, all consecutive patients with structural heart disease were admitted for ICD implantation. Patients not followed by a home-monitoring system were excluded. Two-dimensional (2D) speckle-tracking analysis was used to derive global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD) of all patients at enrollment. Home monitoring was checked weekly to detect all VAs and ICD therapies. A recurrent event statistical approach (Prentice, Williams, and Peterson model) was applied to evaluate subsequent events after the first ones. RESULTS A total of 203 patients were consecutively enrolled and followed for a median of 2.2 years. Kaplan-Meier curves showed an increased risk of antitachycardia pacing or shock (log-rank p = 0.003) and VAs (log-rank p = 0.001) associated with lower quartiles of GLS. An impaired GLS was independently associated with an increased risk for the first ICD therapy (hazard ratio [HR]: 1.94; 95% confidence interval [CI]: 1.30 to 2.91; p = 0.001) and (HR: 1.42; 95% CI: 1.01 to 1.98; p = 0.04) for the first VA. GLS impairment was not significantly associated with an increased risk of recurrent ICD therapies or VAs. LVEF, MD, and DCD were not associated with an increased risk of first, second, and third ICD therapies or VA. CONCLUSIONS Impaired GLS is associated with an increased risk of VAs and appropriate ICD therapies in a consecutive "real-world," unselected population of remotely monitored patients with structural heart disease, although it does not seem reliable in predicting further arrhythmic events after the first one. MD and DCD do not predict first or subsequent arrhythmic events in ICD patients with structural heart disease.
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Affiliation(s)
- Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy.
| | | | - Daniele Contadini
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy
| | - Erika Baiocco
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy
| | - Alessio Menditto
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy
| | - Paolo Bonelli
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy
| | - Luca Rossi
- Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alessia Zanni
- Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Poulami Maitra
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Giovanni Q Villani
- Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy
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Tanaka H. Utility of strain imaging in conjunction with heart failure stage classification for heart failure patient management. J Echocardiogr 2018; 17:17-24. [PMID: 30443873 DOI: 10.1007/s12574-018-0408-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022]
Abstract
The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) classification, based on structural changes and symptoms, classifies stages of heart failure (HF) development as Stages A-D. This HF classification emphasizes the development and progression of the disease and can be used to describe individuals and populations. Since HF is considered a progressive disorder that can be represented as a clinical continuum, individuals at a particular HF stage require specific management with the long-term goal of avoiding HF development and progression. Although early detection of subclinical left ventricular (LV) dysfunction is essential for delaying progression to HF, the assessment of such dysfunction can be challenging. While echocardiography plays a pivotal role in the quantification and early detection of LV structural findings, two-dimensional speckle-tracking echocardiographic parameters, especially global longitudinal strain (GLS), have recently been reported to be sensitive markers of early subtle abnormalities of LV myocardial performance. They are thus helpful for prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices such as LV ejection fraction, mitral inflow E and mitral e' annular velocities ratio. Strain imaging, especially GLS-guided management for patients at a particular stage of HF, may therefore have the potential to prevent progression to later HF stages and may offer new insights into the management of HF patients. This article reviews the utility of strain imaging, especially GLS in conjunction with HF stage classification, and future perspectives for HF patient management.
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Affiliation(s)
- Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Tower-Rader A, Mohananey D, To A, Lever HM, Popovic ZB, Desai MY. Prognostic Value of Global Longitudinal Strain in Hypertrophic Cardiomyopathy: A Systematic Review of Existing Literature. JACC Cardiovasc Imaging 2018; 12:1930-1942. [PMID: 30219395 DOI: 10.1016/j.jcmg.2018.07.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The association of left ventricular global longitudinal strain (LV-GLS) with clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has been examined in multiple studies. The authors conducted a systematic review aimed at summarizing and critically appraising the current evidence. BACKGROUND HCM is a common genetic cardiovascular disease with an estimated prevalence of 1 in 500 patients. LV-GLS derived from speckle tracking echocardiography is a sensitive noninvasive method of assessing regional left ventricular function. Several studies have suggested association of abnormal LV-GLS with outcomes in HCM patients. METHODS A computerized literature search of all English language publications in the PubMed and EMBASE databases was made looking at all randomized and nonrandomized studies conducted on patients with HCM where association of LV-GLS with clinical outcomes was studied. We then manually searched the reference lists of included articles. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) of reporting systematic reviews was used. RESULTS Our search yielded a total of 14 observational studies published between 2009 and 2017 with a total of 3,154 patients with HCM. Eleven of the 14 studies included a composite cardiac outcome which included mortality as their primary outcome of interest and 3 of the 14 studies looked at association of LV-GLS with ventricular arrhythmias and/or implantable cardiac defibrillator discharge. We noted wide variability in inclusion, methodology, follow-up, and consequently effect estimates, which was not conducive to performing a meta-analysis. However, despite the variation, all studies revealed a degree of association of abnormal LV-GLS with poor cardiac outcomes. CONCLUSIONS Our systematic review of more than 3000 HCM patients suggests an association of abnormal LV-GLS with adverse composite cardiac outcomes and ventricular arrhythmias.
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Affiliation(s)
| | | | - Andrew To
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio; Northshore Hospital, Auckland, New Zealand
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio.
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29
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Hiemstra YL, Debonnaire P, van Zwet EW, Bootsma M, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Development of and Progression of Overt Heart Failure in Nonobstructive Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 122:656-662. [PMID: 30205890 DOI: 10.1016/j.amjcard.2018.04.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/28/2022]
Abstract
Only few studies aimed at identifying predictors of heart failure (HF) in hypertrophic cardiomyopathy (HC) patients. Furthermore, serial echocardiographic analyses are lacking in these patients and little is known about the natural progression of left ventricular (LV) abnormalities and their association with HF development. Aim of this study was to assess the prognostic value of LV global longitudinal strain (GLS) and other clinical and echocardiographic characteristics for the development of HF in patients with nonobstructive HC; furthermore, changes in echocardiographic parameters over time were correlated with HF development. Echocardiography was performed in 236 HC patients (68% men, age: 50 ± 14 years) at their initial visit and during follow-up (6.5(4.1 to 9.8) years). The end point of new HF development or progression to New York Heart Association class III/IV was noted and echocardiographic changes over time were compared among patients with and without HF using linear mixed model analysis. In total, 40 patients reached the HF end point. Multivariable cox regression analysis showed that age (HR 1.04(1.01 to 1.06), p = 0.016), New York Heart Association class (HR 2.30(1.07 to 4.95), p = 0.033), GLS (HR 1.15(1.05 to 1.22), p = 0.001), and left atrial volume (LAVI, HR 2.22(1.10 to 4.50), p = 0.027) were independently associated with the HF end point. Echocardiographic parameters, including GLS and LAVI, remained stable over time in patients without HF end point, but changed significantly in patients who developed HF (group-time interaction, p = 0.042 for GLS and p = 0.027 for LAVI). In conclusion, LV dysfunction is a progressive phenomenon in nonobstructive HC patients which can be detected by repeated echocardiography. Importantly, GLS and LAVI at baseline as well as their changes over time are associated with HF.
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Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippe Debonnaire
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Erik W van Zwet
- Medical Statistics Department, Leiden University Medical Center, Leiden, The Netherland
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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30
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The Prognostic Implications of Two-Dimensional Speckle Tracking Echocardiography in Hypertrophic Cardiomyopathy. Cardiol Rev 2018; 26:130-136. [DOI: 10.1097/crd.0000000000000172] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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31
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Inciardi RM, Galderisi M, Nistri S, Santoro C, Cicoira M, Rossi A. Echocardiographic advances in hypertrophic cardiomyopathy: Three-dimensional and strain imaging echocardiography. Echocardiography 2018; 35:716-726. [DOI: 10.1111/echo.13878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Riccardo M. Inciardi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Maurizio Galderisi
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | - Stefano Nistri
- Cardiology Service; CMSR-Veneto Medica; Altavilla Vicentina Italy
| | - Ciro Santoro
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | | | - Andrea Rossi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
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32
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Vergé MP, Cochet H, Reynaud A, Morlon L, Peyrou J, Vincent C, Rooryck C, Ritter P, Lafitte S, Réant P. Characterization of hypertrophic cardiomyopathy according to global, regional, and multi-layer longitudinal strain analysis, and prediction of sudden cardiac death. Int J Cardiovasc Imaging 2018; 34:1091-1098. [PMID: 29488042 DOI: 10.1007/s10554-018-1323-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Abstract
To evaluate the severity of hypertrophic cardiomyopathy (HCM) according to global, regional, and multi-layer longitudinal strain (LS) analysis using speckle-tracking echocardiography. From February 2007 to November 2014, we prospectively evaluated 375 consecutive HCM patients referred to our specialized cardiomyopathy center. Demographics, clinical, and rest and exercise echocardiographic parameters were collected according to a completely standardized protocol. Global, regional, and multilayer strain analyses were performed. Correlations between LS and other characteristics were evaluated, and we assessed their prognostic value to predict sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator (ICD) shocks during follow-up, using Cox proportional hazards analyses. We finally included 217 patients (50.1 ± 15.6 years, 67% male) but only 179 (82%) had LS analysis of sufficient quality. An inverse relation was observed between the mean basal left ventricular (LV) LS and diastolic parameters [E/Ea (r = - 0.30) and left atrium indexed volume (r = - 0.23)], as well as between the resting LV outflow-tract maximal gradient (r = - 0.26) or during peak exercise (r = - 0.20). Mean LS in the LV hypertrophic area was particularly related with maximal wall thickness (r = - 0.47) and transmural global LS with the degree of myocardial fibrosis in cardiac magnetic resonance (r = - 0.32). During a median follow-up of 2.8 ± 1.5 years, mean transmural LS in the hypertrophic area was predictor of SCD and appropriate ICD shock (10 events/179 patients, hazard ratio = 0.83 [95% CI 0.72-0.95], p = 0.01). Basal LS and hypertrophic area LS are valuable parameters to evaluate HCM severity. Mean hypertrophic area LS particularly seems predictive of SCD occurrence and appropriate ICD shocks.
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Affiliation(s)
| | - Hubert Cochet
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Amélie Reynaud
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Lucas Morlon
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Jérôme Peyrou
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Cécile Vincent
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Caroline Rooryck
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Philippe Ritter
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Stéphane Lafitte
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Patricia Réant
- Bordeaux University Hospital, 33000, Bordeaux, France. .,University of Bordeaux, 33000, Bordeaux, France. .,IHU Lyric, 33600, Pessac, France. .,Hopital Cardiologique Haut-Leveque, Avenue de Magellan, 33604, Pessac, France.
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33
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Papadopoulos CH, Oikonomidis D, Lazaris E, Nihoyannopoulos P. Echocardiography and cardiac arrhythmias. Hellenic J Cardiol 2017; 59:140-149. [PMID: 29203161 DOI: 10.1016/j.hjc.2017.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/21/2017] [Accepted: 11/25/2017] [Indexed: 01/07/2023] Open
Abstract
Cardiac arrhythmias refer to any abnormality or disturbance in the normal activation sequence of the myocardium and may be indicative of structural heart disease and the cause of significant cardiovascular complications and sudden cardiac death. The following review summarizes the current state-of-the-art knowledge on the role of echocardiography in the management of cardiac arrhythmias and focuses on atrial fibrillation and ventricular arrhythmias where echocardiography presents a particular diagnostic and prognostic interest. Moreover, a brief reference is made to the effect of cardiac arrhythmias and conduction abnormalities on echocardiographic examination.
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Affiliation(s)
| | | | - Efstathios Lazaris
- 2nd Cardiology Department, Korgialenio-Benakio Red Cross Hospital, Athens, Greece
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34
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Tower-Rader A, Betancor J, Popovic ZB, Sato K, Thamilarasan M, Smedira NG, Lever HM, Desai MY. Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2017; 6:JAHA.117.006514. [PMID: 29054839 PMCID: PMC5721859 DOI: 10.1161/jaha.117.006514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In obstructive hypertrophic cardiomyopathy patients with preserved left ventricular (LV) ejection fraction, we sought to determine whether LV global longitudinal strain (LV-GLS) provided incremental prognostic utility. METHODS AND RESULTS We studied 1019 patients with documented hypertrophic cardiomyopathy (mean age, 50±12 years; 63% men) evaluated at our center between 2001 and 2011. We excluded age <18 years, maximal LV outflow tract gradient <30 mm Hg, bundle branch block or atrial fibrillation, past pacemaker/cardiac surgery, including myectomy/alcohol ablation, and obstructive coronary artery disease. Average resting LV-GLS was measured offline on 2-, 3-, 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, PA). Outcome was a composite of cardiac death and appropriate internal defibrillator (implantable cardioverter defibrillator) discharge. Maximal LV thickness, LV ejection fraction, indexed left atrial dimension, rest and maximal LV outflow tract gradient, and LV-GLS were 2.0±0.2 cm, 62±4%, 2.2±4 cm/m2, 52±42 mm Hg, 103±36 mm Hg, and -13.6±4%. During 9.4±3 years of follow-up, 668 (66%), 166 (16%), and 122 (20%), respectively, had myectomy, atrial fibrillation, and implantable cardioverter defibrillator implantation, whereas 69 (7%) had composite events (62 cardiac deaths). Multivariable competing risk regression analysis revealed that higher age (subhazard ratio, 1.04 [1.02-1.07]), AF during follow-up (subhazard ratio, 1.39 [1.11-1.69]), and worsening LV-GLS (subhazard ratio, 1.11 [1.05-1.22]) were associated with worse outcomes, whereas myectomy (subhazard ratio, 0.44 [0.25-0.72]) was associated with improved outcomes (all P<0.01). Sixty-one percent of events occurred in patients with LV-GLS worse than median (-13.7%). CONCLUSIONS In obstructive hypertrophic cardiomyopathy patients with preserved LV ejection fraction, abnormal LV-GLS was independently associated with higher events, whereas myectomy was associated with improved outcomes.
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Affiliation(s)
- Albree Tower-Rader
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Jorge Betancor
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Kimi Sato
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Candan O, Gecmen C, Kalaycı A, Bayam E, Guner A, Gunduz S, Cersit S, Ozkan M. Left ventricular twist in hypertrophic cardiomyopathy : Predictor of nonsustained ventricular tachycardia. Herz 2017; 44:238-246. [PMID: 29038823 DOI: 10.1007/s00059-017-4633-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM). METHODS The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24-72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings. RESULTS NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; -12.8 ± 3.1 vs. -10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087-1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056-1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < -11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027). CONCLUSION Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.
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Affiliation(s)
- O Candan
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey.
| | - C Gecmen
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - A Kalaycı
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - E Bayam
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - A Guner
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - S Gunduz
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - S Cersit
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
| | - M Ozkan
- Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey
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Moneghetti KJ, Stolfo D, Christle JW, Kobayashi Y, Finocchiaro G, Sinagra G, Myers J, Ashley EA, Haddad F, Wheeler MT. Value of Strain Imaging and Maximal Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 120:1203-1208. [PMID: 28802509 DOI: 10.1016/j.amjcard.2017.06.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/14/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
Longitudinal strain (LS) has been shown to be predictive of outcome in hypertrophic cardiomyopathy (HC). Percent predicted peak oxygen uptake (ppVO2), among other cardiopulmonary exercise testing (CPX) metrics, is a strong predictor of prognosis in HC. However, there has been limited investigation into the combination of LS and CPX metrics. This study sought to determine how LS and parameters of exercise performance contribute to prognosis in HC. One hundred and thirty-one consecutive patients with HC who underwent CPX and stress echocardiography were included. Global, septal, and lateral LS were assessed at rest and stress. Eighty matched individuals were used as controls. Patients were followed for the composite end point of death and worsening heart failure. All absolute LS components were lower in patients with HC than in controls (global 14.3 ± 4.0% vs 18.8 ± 2.2%, p <0.001; septal 11.9 ± 4.9% vs 17.9 ± 2.7%, p <0.001; lateral 16.0 ± 4.7% vs 19.4 ± 3.1%, p = 0.001). Global strain reserve was also reduced in patients with HC (13 ± 5% vs 19 ± 8%, p = 0.002). Over a median follow-up of 56 months (interquartile range 14 to 69), the composite end point occurred in 53 patients. Global LS was predictive of outcome on univariate analysis (0.55 [0.41 to 0.74], p <0.001). When combined with CPX metrics, lateral LS was the only strain variable predictive of outcome along with indexed left atrial volume (LAVI) and ppVO2. The worst outcomes were observed for patients with lateral LS <16.1%, LAVI >52 ml/m2, and ppVO2 <80%. The combination of lateral LS, LAVI, and ppVO2 presents a simple model for outcome prediction.
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Hindieh W, Chan R, Rakowski H. Complementary Role of Echocardiography and Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy. Curr Cardiol Rep 2017; 19:81. [DOI: 10.1007/s11886-017-0897-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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38
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Hiemstra YL, Debonnaire P, Bootsma M, van Zwet EW, Delgado V, Schalij MJ, Atsma DE, Bax JJ, Marsan NA. Global Longitudinal Strain and Left Atrial Volume Index Provide Incremental Prognostic Value in Patients With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005706. [PMID: 28679523 DOI: 10.1161/circimaging.116.005706] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current methods for predicting adverse events in patients with hypertrophic cardiomyopathy are still limited. Left ventricular global longitudinal strain (GLS) and left atrial volume index (LAVI) have been recently proposed as novel prognostic factors in several cardiovascular diseases. The objective of this study was to evaluate the prognostic value of GLS and LAVI in patients with hypertrophic cardiomyopathy. METHODS AND RESULTS Two-dimensional echocardiography was performed in 427 patients with hypertrophic cardiomyopathy (66% men, age 52±15 years), and LAVI and GLS were assessed. During follow-up, the primary end point of all-cause mortality, heart transplantation, sudden cardiac death, and appropriate implantable cardioverter defibrillator therapy was noted. A total of 103 patients reached the primary end point during a follow-up of 6.7 (interquartile range, 3.3-10.0) years. Multivariable Cox regression analysis revealed GLS and LAVI to be independently associated with the primary end point (hazard ratio GLS, 1.10 [1.03-1.19], P=0.007; hazard ratio LAVI, 4.27 [2.35-7.74], P<0.001) after correcting for other clinical variables. When applying the pre-specified cut-off values of 34 mL/m2 for LAVI and -15% for GLS, Kaplan-Meier survival curves showed significant better survival for patients with LAVI <34 mL/m2 (P<0.001) and GLS <-15% (P<0.001) as compared with their counterparts. The likelihood ratio test showed a significant incremental prognostic value of LAVI and GLS (P<0.001) as compared with a model with clinical and standard echocardiographic risk factors. The C-statistic for this model increased from 0.68 to 0.73 when adding GLS and LAVI. CONCLUSIONS GLS and LAVI are independently associated with adverse outcome in patients with hypertrophic cardiomyopathy and may help to optimize risk stratification in these patients.
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Affiliation(s)
- Yasmine L Hiemstra
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Philippe Debonnaire
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Marianne Bootsma
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Erik W van Zwet
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Victoria Delgado
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Martin J Schalij
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Douwe E Atsma
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Jeroen J Bax
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Nina Ajmone Marsan
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands.
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Wang N, Xie A, Tjahjono R, Tian DH, Phan S, Yan TD, Bajona P, Phan K. Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications. Ann Cardiothorac Surg 2017; 6:298-306. [PMID: 28944170 DOI: 10.21037/acs.2017.07.05] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the introduction of the implantable cardioverter-defibrillator (ICD) in patients with hypertrophic cardiomyopathy (HCM), the incidence of sudden cardiac death (SCD) has been significantly reduced. Given its widespread use, it is important to identify the outcomes associated with ICD use in patients with HCM. The present paper is a systematic review and meta-analysis of the rates of appropriate and inappropriate interventions, mortality, and device complications in HCM patients with an ICD. METHODS We conducted a systematic review and meta-analysis on 27 studies reporting outcomes and complications after ICD implantation in patients with HCM. ICD interventions, device complications, and mortality were extracted for analysis. RESULTS A total of 3,797 patients with HCM and ICD implantation were included (mean age, 44.5 years; 63% male), of which 83% of patients had an ICD for primary prevention of SCD. The cardiac mortality was 0.9% (95% CI: 0.7-1.3) per year and non-cardiac mortality was 0.8% (95% CI: 0.6-1.2) per year. Annualized appropriate intervention rate was 4.8% and annualized inappropriate intervention was 4.9%. The annual incidence of lead malfunction, lead displacement and infection was 1.4%, 1.3%, and 1.1%, respectively. CONCLUSIONS ICD use in patients with HCM produces low rates of cardiac and non-cardiac mortality, and an appropriate intervention rate of 4.8% per year. However, moderate rates of inappropriate intervention and device complications warrant careful patient selection in order to optimize the risk to benefit ratio in this select group of patients.
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Affiliation(s)
- Nelson Wang
- Collaborative Research (CORE) Group, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Ashleigh Xie
- Collaborative Research (CORE) Group, Sydney, Australia
| | | | - David H Tian
- Collaborative Research (CORE) Group, Sydney, Australia
| | - Steven Phan
- Collaborative Research (CORE) Group, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Tristan D Yan
- Collaborative Research (CORE) Group, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Pietro Bajona
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Kevin Phan
- Collaborative Research (CORE) Group, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
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Ternacle J, Bremont C, d’Humieres T, Faivre L, Doan HL, Gallet R, Oliver L, Dubois-Randé JL, Lim P. Left ventricular dyssynchrony and 2D and 3D global longitudinal strain for differentiating physiological and pathological left ventricular hypertrophy. Arch Cardiovasc Dis 2017; 110:403-412. [DOI: 10.1016/j.acvd.2016.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/28/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
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41
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Candan O, Gecmen C, Bayam E, Guner A, Celik M, Doğan C. Mechanical dispersion and global longitudinal strain by speckle tracking echocardiography: Predictors of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy. Echocardiography 2017; 34:835-842. [DOI: 10.1111/echo.13547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Ozkan Candan
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Cetin Gecmen
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Emrah Bayam
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Ahmet Guner
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Mehmet Celik
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
| | - Cem Doğan
- Cardiology Clinic; Kartal Kosuyolu Training and Research Hospital; Istanbul Turkey
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Konstantinou DM, Efthimiadis GK, Vassilikos V, Paraskevaidis S, Pagourelias E, Maron BJ, Karvounis H. Implantable cardioverter defibrillators for primary prevention of sudden death in hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2017; 17:433-9. [PMID: 26885981 DOI: 10.2459/jcm.0000000000000333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Sudden cardiac death (SCD) may complicate hypertrophic cardiomyopathy (HCM) natural course. Patient selection for implantable cardioverter defibrillator (ICD) therapy in the primary prevention setting is still a challenge. METHODS Thirty-seven HCM patients with a primary prevention ICD were included. All patients underwent preimplantation SCD risk assessment and semi-annual device interrogation during follow-up. Primary end point was the time to first appropriate ICD intervention including antitachycardia pacing or shock. Inappropriately delivered ICD therapies served as secondary end point. RESULTS During a median follow-up of 3.1 years, 10 (27%) patients received one or more appropriate ICD therapies. First appropriate ICD intervention rate was 7.2%/year (95% CI: 3.4-13.2) with a 5-year cumulative probability of 29.2 ± 7.4%. No SCD risk marker was significantly associated with the primary end point, whereas event rates were comparable among patients with one, two or three or more SCD risk markers (log-rank P = 0.58). Patients with a history of SCD in first-degree relatives with HCM were at 3.8 times higher risk of experiencing an ICD intervention compared with those with no family history of SCD (HR: 3.8; 95% CI: 1.0-14.1, P = 0.05). Seven (18.9%) patients experienced one or more inappropriate ICD therapies; beta-blocker therapy was associated with 75% fewer inappropriate ICD interventions (HR: 0.15; 95% CI: 0.03-0.89). CONCLUSION Current criteria identify a subgroup of patients with HCM at increased risk of major arrhythmic events as indicated by high ICD intervention rates. However, no individual risk marker demonstrated superior predictive ability over the others, whereas simple arithmetic summing of risk markers was not associated with increased ICD intervention rates.
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Affiliation(s)
- Dimitrios M Konstantinou
- aFirst Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece bHypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Delgado V, Bucciarelli-Ducci C, Bax JJ. Diagnostic and prognostic roles of echocardiography and cardiac magnetic resonance. J Nucl Cardiol 2016; 23:1399-1410. [PMID: 27473216 PMCID: PMC5116044 DOI: 10.1007/s12350-016-0595-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 01/18/2023]
Abstract
Accurate prediction of sudden cardiac death due to ventricular arrhythmia remains challenging. Left ventricular ejection fraction has shown an association with increased risk of ventricular arrhythmias and is included in the recommendations for implantable cardioverter defibrillator as primary prevention. However, left ventricular ejection fraction may be normal in a large number of patients who are at risk of ventricular arrhythmias. Echocardiography remains the imaging technique of first choice to rule out the presence of structural heart disease and assess left and right ventricular function. Advances in strain echocardiography and cardiac magnetic resonance have provided important insights into the mechanisms of ventricular arrhythmias, and will be summarized in this review.
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Affiliation(s)
- Victoria Delgado
- Department of Cardiology, Heart & Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Clinical Research and Imaging Centre (CRIC) Bristol, University of Bristol, Bristol, United Kingdom
| | - Jeroen J Bax
- Department of Cardiology, Heart & Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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44
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Reant P, Mirabel M, Lloyd G, Peyrou J, Lopez Ayala JM, Dickie S, Bulluck H, Captur G, Rosmini S, Guttmann O, Demetrescu C, Pantazis A, Tome-Esteban M, Moon JC, Lafitte S, McKenna WJ. Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy. Heart 2016; 102:741-7. [PMID: 26857213 DOI: 10.1136/heartjnl-2015-308576] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/08/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We hypothesised that abnormal global longitudinal strain (GLS) would predict outcome in hypertrophic cardiomyopathy (HCM) better than current echocardiographic measures. METHODS Retrospective analysis of risk markers in relation to outcomes in 472 patients with HCM at a single tertiary institution (2006-2012). Exclusion criteria were left ventricular (LV) hypertrophy of other origin, patients in atrial fibrillation, lost to follow-up and insufficient image quality to perform strain analysis. Standardised echocardiogram recordings were reviewed and standard variables and LV GLS were measured. The primary end-point included all cardiac deaths, appropriate defibrillator shocks and heart failure (HF) admissions. The secondary end-point was death by HF and admissions related to HF. RESULTS Mean age was 50.0±15.0 years; 322 (68%) were men. At a median of 4.3 years (IQR 0.1-7.8) follow-up, 21 (4.4%) patients experienced cardiovascular death: 6 (1.3%) died from HF, 13 (2.7%) had sudden cardiac death and 2 (0.4%) died secondary to stroke. Four (0.8%) patients experienced appropriate defibrillator shock, and 13 (2.7%) were admitted for HF. On multivariate Fine-Gray proportional hazard analyses, GLS was significantly associated with the primary end-point (HR=0.90, 95% CI 0.83 to 0.98, p=0.018) independently of age, maximal provoked LV outflow-tract gradient and LV end-systolic volume. Moreover, GLS was particularly associated with the secondary end-point (HR=0.82, 95% CI 0.75 to 0.90, p<0.0001) independently of age, previous atrial fibrillation, New York Heart Association (NYHA) class III-IV, LV end-systolic volume, E/E', and outflow-tract gradient. Survival curves confirmed that GLS was associated with HF events (GLS <15.6%, p=0.0035). CONCLUSIONS In patients with HCM, reduced GLS is an independent factor associated with poor cardiac outcomes, and particularly HF outcomes.
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Affiliation(s)
- Patricia Reant
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK University of Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Mariana Mirabel
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Guy Lloyd
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Jérôme Peyrou
- University of Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Jose-Maria Lopez Ayala
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Shaughan Dickie
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Heeraj Bulluck
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Stefania Rosmini
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Oliver Guttmann
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Camelia Demetrescu
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Antonis Pantazis
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Maite Tome-Esteban
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | | | - William J McKenna
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
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Roşca M, Călin A, Beladan CC, Enache R, Mateescu AD, Gurzun MM, Varga P, Băicuş C, Coman IM, Jurcuţ R, Ginghină C, Popescu BA. Right Ventricular Remodeling, Its Correlates, and Its Clinical Impact in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2015; 28:1329-38. [DOI: 10.1016/j.echo.2015.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Indexed: 10/23/2022]
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Vural MG, Cetin S, Yilmaz M, Akdemir R, Gunduz H. Relation between Left Atrial Remodeling in Young Patients with Cryptogenic Stroke and Normal Inter-atrial Anatomy. J Stroke 2015; 17:312-9. [PMID: 26437996 PMCID: PMC4635719 DOI: 10.5853/jos.2015.17.3.312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/19/2015] [Accepted: 01/26/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE To investigate an association between left atrial (LA) structural and P wave dispersion (PWD) during sinus rhythm, and electrical remodeling in cryptogenic stroke (CS) patients. METHODS Forty CS patients and 40 age- and sex-matched healthy controls were enrolled. P wave calculations were based on 12-lead electrocardiography (ECG) at a 50-mm/s-paper speed with an amplitude of 10 mm/mV. Difference between the maximum and minimum P wave duration was the P wave dispersion (PWD=Pmax-Pmin). LA deformation was evaluated by speckle tracking echocardiography within 3 days of the acute event. RESULTS PWD was 30.1±7.0 ms and 27.4±3.5 ms in CS and control group (P=0.02), whereas LA maximum volume index [LAVImax] was 20.4±4.5 mL/m(2) and 19.9±2.4 mL/m(2) in CS and control group, respectively (P = 0.04). While global peak LA strain was [pLA-S] (LA reservoir function) 41.4 ± 6.3% and 44.5 ± 7.1% in CS and control group, (P = 0.04), global peak late diastolic strain rate values [pLA-SRa] (LA pump function) were 2.5 ± 0.4% and 2.9 ± 0.5% in CS and control group, respectively (P = 0.001). A mild and a strong negative correlation between global pLA-S and LAVImax (r=-0.49; P<0.01), and between PWD and global pLA-S (r = -0.52; P < 0.01), respectively, was observed in CS. CONCLUSIONS Increased PWD is associated with impaired LA mechanical functions and enlargement, and involved in the pathophysiology of AF or an AF-like physiology in CS.
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Affiliation(s)
| | - Suha Cetin
- Koru Private Hospital, Cardiology Department, Ankara, Turkey
| | - Murat Yilmaz
- Ankara Numune Research and Education Hospital, Neurology Department, Ankara, Turkey
| | - Ramazan Akdemir
- Sakarya University School of Medicine, Cardiology Department, Sakarya, Turkey
| | - Huseyin Gunduz
- Sakarya University School of Medicine, Cardiology Department, Sakarya, Turkey
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Abstract
The differentiation between hypertrophic and restrictive cardiomyopathies is often challenging in the routine clinical setting. Advances in the field of multimodal imaging have improved the diagnostics of these diseases and understanding of the underlying pathophysiology. Each imaging method, such as echocardiography, cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT) and coronary angiography including cardiac catheterization for pressure measurements, is of significant value in clinical diagnostics and also regarding therapeutic approaches and prognostic implications. This review gives an overview of developments of the past few years, describes recent insights and puts these findings into a scientific context. Particularly CMR has added valuable information to current knowledge by its unique potential of contrast-enhanced tissue characterization. Another promising CMR tool, parametric mapping has appeared on the horizon and may further deepen our understanding of cardiac pathophysiology as well as offer new therapeutic options to patients.
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Boyd AC, Thomas L. Left atrial volumes: two-dimensional, three-dimensional, cardiac magnetic resonance and computed tomography measurements. Curr Opin Cardiol 2015; 29:408-16. [PMID: 24945489 DOI: 10.1097/hco.0000000000000087] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Evaluation of left atrial volume is important, as it is a biomarker of cardiovascular disease and outcomes and correlates with diastolic dysfunction severity. Left atrial volume measurements by different imaging modalities, including 2D and 3D echocardiography (2DE and 3DE), cardiac magnetic resonance (CMR) and computed tomography (CT), are reviewed in regard to recent advances, methodology, prognostic value and limitations. RECENT FINDINGS Left atrial volume assessments correlate well between the different imaging modalities; however, 2DE significantly underestimates left atrial measurements. Assessment of the left atrial minimum volume and left atrial phasic function derived volumetrically have reported superior predictive value for major adverse cardiovascular events and elevated left ventricular diastolic pressure compared with the left atrial maximum volume. SUMMARY The different imaging modalities used to assess left atrial volumes are not interchangeable, particularly for serial measurements. Although 2DE underestimates left atrial volumes, most normative as well as predictive data have been obtained using this modality. Standardization, with established normative data and classification criteria, needs to be established for other imaging modalities, additionally incorporating assessment of left atrial minimum and phasic volumes. Despite the limitations of the more simplistic 2DE, its measurements are well defined with significant prognostic value. The incremental prognostic value of the more complex imaging techniques needs to be further validated.
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Affiliation(s)
- Anita C Boyd
- aWestmead Private Cardiology bSouth Western Sydney Clinical School, University of New South Wales, Liverpool Hospital cWestern Clinical School, University of Sydney, New South Wales, Australia
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Barutçu A, Bekler A, Temiz A, Kırılmaz B, Yener AÜ, Tan YZ, Gazi E, Altun B. Left Ventricular Twist Mechanics Are Impaired in Patients with Coronary Slow Flow. Echocardiography 2015; 32:1647-54. [DOI: 10.1111/echo.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ahmet Barutçu
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Adem Bekler
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Ahmet Temiz
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Bahadır Kırılmaz
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Ali Ümit Yener
- Faculty of Medicine; Department of Cardiovascular Surgery; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Yusuf Ziya Tan
- Faculty of Medicine; Department of Nuclear Medicine; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Emine Gazi
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
| | - Burak Altun
- Faculty of Medicine; Department of Cardiology; Çanakkale Onsekiz Mart University; Çanakkale Turkey
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Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2015; 31:447-61. [DOI: 10.1007/s10554-015-0627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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