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Espersen C, Skaarup KG, Lassen MCH, Johansen ND, Hauser R, Olsen FJ, Jensen GB, Schnohr P, Møgelvang R, Biering-Sørensen T. Normal age- and sex-based values of right ventricular free wall and four-chamber longitudinal strain by speckle-tracking echocardiography: from the Copenhagen City heart study. Clin Res Cardiol 2024; 113:456-468. [PMID: 37968333 PMCID: PMC10881734 DOI: 10.1007/s00392-023-02333-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
AIM To promote the implementation of right ventricular (RV) longitudinal strain in clinical practice, we sought to propose normal values for RV free wall (RVFWLS) and four-chamber longitudinal strain (RV4CLS) and investigate the association with clinical and echocardiographic parameters in participants from the general population. METHODS AND RESULTS Participants from the 5th Copenhagen City Heart Study (2011-2015)-a prospective cohort study-with available RV longitudinal strain measurements were included. RVFWLS and RV4CLS were assessed using two-dimensional speckle-tracking echocardiography. In total, 2951 participants were included. Amongst 1297 participants without cardiovascular disease or risk factors (median age 44, 63% female), mean values of RVFWLS and RV4CLS were - 26.7% ± 5.2 (95% prediction interval (PI) - 36.9, - 16.5) and - 21.7% ± 3.4 (95%PI - 28.4, - 15.0), respectively. Women had significantly higher absolute values of RVFWLS and RV4CLS than men (mean - 27.5 ± 5.5 vs. - 25.4 ± 4.5, p < 0.001 and - 22.3 ± 3.5 vs. - 20.6 ± 3.0, p < 0.001, respectively). Absolute values of RVFWLS but not RV4CLS decreased significantly with increasing age in unadjusted linear regression. Tricuspid annular plane systolic excursion, RV s' and left ventricular global longitudinal strain were the most influential parameters associated with both RVFWLS and RV4CLS in multiple linear regression. Participants with cardiovascular disease (n = 1531) had a higher proportion of abnormal values of RVFWLS and RV4CLS compared to the healthy population (8% vs. 4%, p < 0.001 and 8% vs. 3%, p < 0.001, respectively). CONCLUSION This study proposed normal age- and sex-based values of RVFWLS and RV4CLS in a healthy population sample and showed significant sex differences in both measurements across ages.
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark.
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Kristoffer Grundtvig Skaarup
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Raphael Hauser
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Bjerregaard CL, Biering-Sørensen T, Skaarup KG, Sengeløv M, Lassen MCH, Johansen ND, Olsen FJ. Right Ventricular Function in Arrhythmogenic Right Ventricular Cardiomyopathy: Potential Value of Strain Echocardiography. J Clin Med 2024; 13:717. [PMID: 38337410 PMCID: PMC10856386 DOI: 10.3390/jcm13030717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy, characterized by abnormal cell adhesions, disrupted intercellular signaling, and fibrofatty replacement of the myocardium. These changes serve as a substrate for ventricular arrhythmias, placing patients at risk of sudden cardiac death, even in the early stages of the disease. Current echocardiographic criteria for diagnosing arrhythmogenic right ventricular cardiomyopathy lack sensitivity, but novel markers of cardiac deformation are not subject to the same technical limitations as current guideline-recommended measures. Measuring cardiac deformation using speckle tracking allows for meticulous quantification of global systolic function, regional function, and dyssynchronous contraction. Consequently, speckle tracking to quantify myocardial strain could potentially be useful in the diagnostic process for the determination of disease progression and to assist risk stratification for ventricular arrhythmias and sudden cardiac death. This narrative review provides an overview of the potential use of different myocardial right ventricular strain measures for characterizing right ventricular dysfunction in arrhythmogenic right ventricular cardiomyopathy and its utility in assessing the risk of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- 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; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Morten Sengeløv
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- 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; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- 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; (C.L.B.)
- 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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Nyberg J, Jakobsen EO, Østvik A, Holte E, Stølen S, Lovstakken L, Grenne B, Dalen H. Echocardiographic Reference Ranges of Global Longitudinal Strain for All Cardiac Chambers Using Guideline-Directed Dedicated Views. JACC Cardiovasc Imaging 2023; 16:1516-1531. [PMID: 37921718 DOI: 10.1016/j.jcmg.2023.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Myocardial deformation by echocardiographic strain imaging is a key measurement in cardiology, providing valuable diagnostic and prognostic information. Reference ranges for strain should be established from large healthy populations with minimal methodologic biases and variability. OBJECTIVES The aim of this study was to establish echocardiographic reference ranges, including lower normal limits of global strains for all 4 cardiac chambers, by guideline-directed dedicated views from a large healthy population and to evaluate the influence of subject-specific characteristics on strain. METHODS In total, 1,329 healthy participants from HUNT4Echo, the echocardiographic substudy of the 4th wave of the Trøndelag Health Study, were included. Echocardiographic recordings specific for each chamber were optimized according to current recommendations. Two experienced sonographers recorded all echocardiograms using GE HealthCare Vivid E95 scanners. Analyses were performed by experts using GE HealthCare EchoPAC. RESULTS The reference ranges for left ventricular (LV) global longitudinal strain and right ventricular free-wall strain were -24% to -16% and -35% to -17%, respectively. Correspondingly, left atrial (LA) and right atrial (RA) reservoir strains were 17% to 49% and 17% to 59%. All strains showed lower absolute values with higher age, except for LA and RA contractile strains, which were higher. The feasibility for strain was overall good (LV 96%, right ventricular 83%, LA 94%, and RA 87%). All chamber-specific strains were associated with age, and LV strain was associated with sex. CONCLUSIONS Reference ranges of strain for all cardiac chambers were established based on guideline-directed chamber-specific recordings. Age and sex were the most important factors influencing reference ranges and should be considered when using strain echocardiography.
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Affiliation(s)
- John Nyberg
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Even Olav Jakobsen
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Andreas Østvik
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Medical Image Analysis, Health Research, SINTEF Digital, Trondheim, Norway
| | - Espen Holte
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Stian Stølen
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Lasse Lovstakken
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørnar Grenne
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Havard Dalen
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
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Aristizábal-Duque CH, Fernández Cabeza J, Blancas Sánchez IM, Delgado Ortega M, Aparicio-Martinez P, Romero Saldaña M, Fonseca Del Pozo FJ, Álvarez-Ossorio MP, Ruíz Ortiz M, Mesa Rubio MD. The effects of obesity on longitudinal ventricular and atrial strain in a rural population of Spanish children and adolescents, evaluated by a new strain software. Pediatr Obes 2023; 18:e13069. [PMID: 37555560 DOI: 10.1111/ijpo.13069] [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: 02/21/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Research on the relationship between body mass index (BMI) and strain values in children and adolescents is limited. Our aim was to analyse the relationship between BMI and strain values of both ventricles and left atrium in children and adolescents. METHODS Both ventricles and left atrial strain values were compared among different BMI categories in children and adolescents from a town in the South of Spain. RESULTS Of the 198 subjects, aged 6-17 years, 53% were of normal weight, 26% were overweight and 21% had obesity. Lower absolute values of left ventricular global longitudinal strain (25.9 ± 2.0% vs. 26.9 ± 2.2%, p = 0.002) and right ventricular free wall longitudinal strain (29.5 ± 4.2% vs. 30.8 ± 4.5%, p = 0.04) were found in subjects with obesity and overweight versus subjects with normal weight. A lower right ventricular four-chamber longitudinal strain was also observed in males with obesity and overweight (24.8 ± 3.3% vs. 26.4 ± 3.6%, p = 0.03). Statistically significant negative correlations of BMI were found for all ventricular, but not atrial, strain values in univariate analysis. This association turned non-significant for right ventricular four-chamber longitudinal strain in multivariate analysis. CONCLUSIONS Utilizing this new strain software, children and adolescents with high BMI were associated with significantly lower values for left and right ventricular free wall longitudinal strain, without impact in left atrial strain.
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Affiliation(s)
- Cristhian H Aristizábal-Duque
- Cardiology Department Cordoba, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
| | - Juan Fernández Cabeza
- Cardiology Department Cordoba, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
| | - Isabel María Blancas Sánchez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
- Urgency Department, Reina Sofia University Hospital, Cordoba, Spain
| | - Mónica Delgado Ortega
- Cardiology Department Cordoba, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
| | - Pilar Aparicio-Martinez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Andalusia, Spain
| | - Manuel Romero Saldaña
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Andalusia, Spain
| | - Francisco Javier Fonseca Del Pozo
- Andalusian Health Service District Norte de Córdoba, Córdoba-Guadalquivir Health District, Andalusian Regional Government Cordoba, Andalucia, Spain
| | - Manuel Pan Álvarez-Ossorio
- Cardiology Department Cordoba, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
| | - Martín Ruíz Ortiz
- Cardiology Department Cordoba, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
| | - María Dolores Mesa Rubio
- Cardiology Department Cordoba, Reina Sofia University Hospital, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Andalucía, Spain
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5
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The quest for determination of standard reference values of right ventricular longitudinal systolic strain: a systematic review and meta-analysis. J Echocardiogr 2023; 21:1-15. [PMID: 36280647 DOI: 10.1007/s12574-022-00592-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/29/2022] [Accepted: 09/29/2022] [Indexed: 02/24/2023]
Abstract
Right ventricular function is strongly associated with clinical outcomes in many conditions, and the evaluation of right ventricle (RV) structure and function in patients with cardiopulmonary disorders is an essential component of clinical management. The objective of this study was to determine the normal ranges of right ventricular longitudinal strain (RVLS) measurements derived by two-dimensional (2D) speckle tracking echocardiography (STE) through a systematic review and meta-analysis. A systematic review was performed using PubMed, Cochrane, ClinicalKey, and CINAHL. Search terms covered the concepts of right ventricle, strain, speckle-tracking, and 2D echocardiography with additional filtering for humans and adults over the last decade. The RV four-chamber longitudinal strain (RV4CLS), RV free wall longitudinal strain (RVFWLS), and free wall longitudinal segmental strain values of healthy individuals without cardiopulmonary diseases from 28 studies were assessed. Weighted means were estimated using random-effects models in a meta-analysis. The results show for RV4CLS -24,91%[CI - 25.94; - 23.88, I2 98%], for RVFWLS -27.63%[CI - 28.78; - 26.48, I2 98%], for basal RVFWLS -26.65%[CI - 30.57; - 22.73, I2 99%], mid RVFWLS -27.61%[CI - 30.99; - 24.22, I2 99%] and apical RVFWLS -24.54%[CI - 26.70; - 22.38, I2 98%]. This systematic review and meta-analysis showed longitudinal strain values of 2D STE derived RV. No clear reference value for RV strain can be distilled from the literature search due to high statistical heterogeneity between the studies. However, all results of our analysis suggest that the lower reference values for RVLS in the current recommendations with a cut-off value of - 20% is underestimated.
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Li G, Zhang Z, Gao Y, Zhu C, Zhou S, Cao L, Zhao Z, Zhao J, Ordovas K, Lou M, Li K, Pohost GM. Age- and sex-specific reference values of biventricular strain and strain rate derived from a large cohort of healthy Chinese adults: a cardiovascular magnetic resonance feature tracking study. J Cardiovasc Magn Reson 2022; 24:63. [PMID: 36404299 PMCID: PMC9677678 DOI: 10.1186/s12968-022-00881-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/26/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As a noninvasive tool, myocardial deformation imaging may facilitate the early detection of cardiac dysfunction. However, normal reference ranges of myocardial strain and strain rate (SR) based on large-scale East Asian populations are still lacking. This study aimed to provide reference values of left ventricular (LV) and right ventricular (RV) strain and SR based on a large cohort of healthy Chinese adults using cardiovascular magnetic resonance (CMR) feature tracking (FT). METHODS Five hundred and sixty-six healthy Chinese adults (55.1% men) free of hypertension, diabetes, and obesity were included. On cine CMR, biventricular global radial, circumferential, and longitudinal strain (GRS, GCS, and GLS), and the peak radial, circumferential, and longitudinal systolic, and diastolic SRs (PSSRR, PSSRC, PSSRL, PDSRR, PDSRC, and PDSRL), and regional radial and circumferential strain at the basal, mid-cavity, and apical levels were measured. Associations of global and regional biventricular deformation indices with age and sex were investigated. RESULTS Women demonstrated greater magnitudes of LV GRS (37.6 ± 6.1% vs. 32.1 ± 5.3%), GCS (- 20.7 ± 1.9% vs. - 18.8 ± 1.9%), GLS (- 17.8 ± 1.8% vs. - 15.6 ± 1.8%), RV GRS (25.1 ± 7.8% vs. 22.1 ± 6.7%), GCS (- 14.4 ± 3.6% vs. - 13.2 ± 3.2%), GLS (- 22.4 ± 5.2% vs. - 20.2 ± 4.6%), and biventricular peak systolic and diastolic SR in all three coordinate directions (all P < 0.05). For the LV, aging was associated with increasing amplitudes of GRS, GCS, and decreasing amplitudes of PDSRR, PDSRC, PDSRL (all P < 0.05). For the RV, aging was associated with an increase in the magnitudes of GRS, GCS, GLS, PSSRR, PSSRC, PSSRL, and a decrease in the magnitude of PDSRR, PDSRC (all P < 0.05). Biventricular radial and circumferential strain measurements at the basal, mid-cavity, and apical levels were all significantly related to age and sex in both sexes (all P < 0.05). CONCLUSIONS We provide age- and sex-specific normal values of biventricular strain and SR based on a large sample of healthy Chinese adults with a broad age range. These results may be served as a reference standard for cardiac function assessment, especially for the Chinese population.
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Affiliation(s)
- Gengxiao Li
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Zhen Zhang
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- The Third People's Hospital of Longgang District, Shenzhen, China
| | - Yiyuan Gao
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, USA
| | - Shanshan Zhou
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Lizhen Cao
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Zhao
- Zhouxin Medical Imaging and Healthy Screening Centre, Xiamen, China
| | - Jun Zhao
- Zhouxin Medical Imaging and Healthy Screening Centre, Xiamen, China
| | - Karen Ordovas
- Department of Radiology, University of Washington, Seattle, USA
| | - Mingwu Lou
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China.
| | - Kuncheng Li
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China.
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
- Zhouxin Medical Imaging and Healthy Screening Centre, Xiamen, China.
| | - Gerald M Pohost
- Zhouxin Medical Imaging and Healthy Screening Centre, Xiamen, China
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Duus LS, Olsen FJ, Lindberg S, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Møgelvang R, Biering-Sørensen T. Right ventricular strain predicts adverse outcomes in patients undergoing coronary artery bypass grafting. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1919-1928. [PMID: 37726602 DOI: 10.1007/s10554-022-02584-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
Patients undergoing coronary artery bypass grafting (CABG) face an elevated risk of heart failure (HF) and cardiovascular (CV) death. Detailed myocardial tissue analyses of the right ventricle are now possible and may hold prognostic value in these patients. Accordingly, we aimed to evaluate the usefulness of right ventricular (RV) layer-specific RV free wall strain (RVFWS) for predicting HF and/or CV death. Patients undergoing CABG at Gentofte Hospital from 2006 to 2011 with a preoperative echocardiogram underwent RVWFS analysis. RVFWS was obtained by speckle tracking. The outcome was defined as a composite of HF and/or CV death. Cox proportional hazards regression, Harrell's C-statistics, and competing risk regression were used to assess the prognostic value of RVFWS. Of 317 patients, 30 (9.5%) reached the endpoint at a median follow-up of 3.5 years. The mean age was 67 years, 83% were men, and the mean LVEF was 50%. In univariable analyses, endo-RVFWS (HR 1.08, P < 0.001), mid-RVFWS (HR 1.07, P = 0.002), and epi-RVFWS (HR 1.07, P = 0.004, per 1% absolute decrease) were associated with a higher risk of HF or/and CV death. Furthermore, all three layers remained independently associated with the outcome after multivariable adjustment for baseline clinical and echocardiographic measurements. Low endo-RVFWS was associated with a more than threefold increased risk of the outcome (HR = 3.04 (1.45-6.38) P = 0.003). The same was observed for mid-RVFWS (HR = 3.16 (1.45-6.91) P = 0.004), and epi-RVFWS (HR = 3.00 (1.46-6.17) P = 0.003). In patients undergoing CABG, RVFWS assessed by speckle-tracking is a predictor of adverse outcomes.
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Affiliation(s)
- Lisa Steen Duus
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Lindberg
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Saedi T, Firouzi A, Saedi S. Cardiac remodeling after atrial septal defects device closure. Echocardiography 2022; 39:1089-1094. [PMID: 35861332 DOI: 10.1111/echo.15421] [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: 03/24/2022] [Revised: 06/07/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trans-catheter device closure of secundum type atrial septal defects (ASDs) has now become the treatment of choice. Device closure affects the hemodynamics and function of the heart. In the current study, we investigated the remodeling of the heart as assessed by advanced echocardiographic parameters following successful device closure. METHODS A prospective cohort study was conducted and 45 patients who were eligible for ASD device closure were evaluated for volumetric, functional, Doppler, strain, and strain rate data of left and right atrium and ventricle pre-procedural and 48 h post-procedure RESULTS: In a prospective cohort study 45 patients who were eligible for ASD device closure; atrial and ventricular volumetric, functional, Doppler, strain, and strain rate data were recorded and compared pre-procedurally and 48 h post-procedure.We found significant changes in the left ventricular (LV) end diastolic volume index (p-value = .03), right ventricular (RV) diameter (p-value = <.001), left atrial (LA) volume index (p-value = .05), right atrial (RA) volume index (p-value = .001), and right and left sided E/e' ratio with a p-value of .001 and .004, respectively. Our findings showed a significant reduction in the strains of the right and left atria and the right ventricular free wall after ASD device closure. LV global longitudinal strain decreased after the procedure but did not reach statistical significance. CONCLUSION ASD patients have impaired global strains compared to normal defined ranges. LA, RA, and RV strains show significant reduction after device closure. Decline in LA function following closure was greater in those with larger ASDs. In adult patients undergoing the procedure, abnormal LA function is a clinically relevant issue demanding pre and post- procedural precautions and treatment.
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Affiliation(s)
- Tahereh Saedi
- Echocardiography Fellowship, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiac Intervention Research Center, Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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9
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The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis. J Clin Med 2022; 11:jcm11123272. [PMID: 35743343 PMCID: PMC9224625 DOI: 10.3390/jcm11123272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. METHODS A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. RESULTS Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible.
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10
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Mah K, Mertens L. Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:136-157. [PMID: 37970496 PMCID: PMC10642122 DOI: 10.1016/j.cjcpc.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2023]
Abstract
As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.
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Affiliation(s)
- Kandice Mah
- Division of Cardiology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Mertens
- Department of Paediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Exploration of the Utility of Speckle-Tracking Echocardiography During Mechanical Ventilation and Mechanical Circulatory Support. Crit Care Explor 2022; 4:e0666. [PMID: 35372843 PMCID: PMC8970088 DOI: 10.1097/cce.0000000000000666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This narrative review aims to discuss the potential applicability of speckle-tracking echocardiography (STE) in patients under mechanical ventilation (MV) and mechanical circulatory support (MCS). Both its benefits and limitations were considered through critical analyses of the current available evidence.
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12
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Kislitsina ON, D Rich J, Wilcox JE, E Vorovich E, Wu T, Churyla A, S Harap R, Andrei AC, McCarthy PM, Yancy CW, Pham DT. Propensity Score-Matched Comparison of Right Ventricular Strain in Women and Men Before and After Left Ventricular Assist Device Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:102-110. [PMID: 35275496 DOI: 10.1177/15569845221081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Adverse events following left ventricular assist device (LVAD) implantation are more common in women than in men, but the impact of gender differences on right ventricular (RV) failure is not well defined. Therefore, we calculated RV strain before and after LVAD implantation in matched groups of men and women to determine if gender differences in RV failure after LVAD might account for the gender differences in overall outcomes. Methods: RV free wall longitudinal strain (FWS) and fractional area change were calculated preoperatively and 3 months postoperatively using speckle-tracking echocardiography analysis. A total of 172 patients (86 women, 86 men) were then propensity score matched (1:1) for comparison. Results: Although women had higher preoperative CHA2DS2-VASc scores and more frequent moderate mitral regurgitation than men (P = 0.018), the preoperative hemodynamic parameters were similar. Preoperative RV-FWS was -6.7% in women and -6.0% in men (P = 0.65). Postoperatively, women had more progression to severe tricuspid regurgitation (TR) than men (15% vs 7%, P = 0.06). At 3 months the RV-FWS was -7.7% in women and -7.0% in men (P = 0.59). Postoperative TR was moderate-severe in 20% of women and in 9% of men (P = 0.001). Women had a higher incidence of venous thromboembolism, cardiac arrhythmias, and bleeding compared with men. Women also had higher mortality rates at discharge and 30 days after surgery, but the survival rates at 5 years were similar. Conclusions: RV strain measurements track standard hemodynamic and echocardiographic parameters and confirm that gender differences in outcomes following LVAD implantation are not related to gender differences in RV failure rates.
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Affiliation(s)
- Olga N Kislitsina
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA.,Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Jonathan D Rich
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Jane E Wilcox
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Esther E Vorovich
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Tingqing Wu
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Rebecca S Harap
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Adin-Christian Andrei
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Duc Thin Pham
- Division of Cardiac Surgery, Feinberg School of Medicine, 3270Northwestern University, Chicago, IL, USA
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13
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14
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Akyay OZ, Sahin T, Cakmak Y, Tarkun I, Selek A, Canturk Z, Cetinarslan B, Karakaya D. Comparison of the effects of exenatide and insulin glargine on right and left ventricular myocardial deformation as shown by 2D-speckle-tracking echocardiograms. Niger J Clin Pract 2022; 25:1094-1101. [DOI: 10.4103/njcp.njcp_1640_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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The Interventricular Septum Is Biomechanically Distinct from the Ventricular Free Walls. Bioengineering (Basel) 2021; 8:bioengineering8120216. [PMID: 34940369 PMCID: PMC8698618 DOI: 10.3390/bioengineering8120216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022] Open
Abstract
The interventricular septum contributes to the pumping function of both ventricles. However, unlike the ventricular wall, its mechanical behavior remains largely unknown. To fill the knowledge gap, this study aims to characterize the biaxial and transmural variation of the mechanical properties of the septum and compare it to the free walls of the left and right ventricles (LV/RV). Fresh hearts were obtained from healthy, adult sheep. The septal wall was sliced along the mid-line into two septal sides and compared to the epicardial layers of the LV- and RV-free walls. Biaxial tensile mechanical tests and constitutive modeling were performed to obtain the passive mechanical properties of the LV- and RV-side of the septum and ventricular walls. We found that both sides of the septum were significantly softer than the respective ventricular walls, and that the septum presented significantly less collagen than the ventricular walls. At low strains, we observed the symmetric distribution of the fiber orientations and a similar anisotropic behavior between the LV-side and RV-side of the septum, with a stiffer material property in the longitudinal direction, rather than the circumferential direction. At high strains, both sides showed isotropic behavior. Both septal sides had similar intrinsic elasticity, as evidenced by experimental data and constitutive modeling. These new findings offer important knowledge of the biomechanics of the septum wall, which may deepen the understanding of heart physiology.
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16
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Wang TKM, Grimm RA, Rodriguez LL, Collier P, Griffin BP, Popović ZB. Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: A meta-analysis. PLoS One 2021; 16:e0256547. [PMID: 34415965 PMCID: PMC8378693 DOI: 10.1371/journal.pone.0256547] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Right ventricular (RV) systolic strain has recently demonstrated prognostic value in various cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the mean and LLN of two- (2D) and three-dimensional (3D) right ventricular global (RVGLS), free wall (RVFWLS) and interventricular septal wall (IVSLS) longitudinal strains in healthy individuals and factors that affect strain measurements. METHODS In this meta-analysis, Pubmed, Embase and Cochrane databases were searched until 31 July 2020 for eligible studies reporting RVGLS, RVFWLS and/or IVSLS in at least 30 healthy subjects. We pooled the means and LLNs of RV strains by two- (2D) and three- (3D) dimensional echocardiography, and performed meta-regression analyses. RESULTS From 788 articles screened, 45 eligible studies totaling 4439 healthy subjects were eligible for analysis. Pooled means and LLNs with 95% confidence intervals for 2D- RV strains were RVGLS -23.4% (-24.2%, -22.6%) and -16.4% (-17.3%, -15.5%) in 27 studies; RVFWLS -26.9% (-28.0%, -25.9%) and -18.0% (-19.2%, -16.9%) in 32 studies; and IVSLS -20.4% (-22.0%, -18.9%) and -11.5% (-13.6%, -9.6%) in 10 studies, and similar results for 3D- RV strains. Right ventricular fractional area change and vendor software were associated with 2D-RVGLS and RVFWLS means and LLNs. CONCLUSION We reported the pooled means and LLNs of RV systolic strains in healthy subjects, to define thresholds for abnormal, borderline and normal strains. Important factors associated with RV systolic strains include right ventricular fractional area change and vendor software.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Richard A. Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - L. Leonardo Rodriguez
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Patrick Collier
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Brian P. Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Zoran B. Popović
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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17
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Vriz O, Veldman G, Gargani L, Ferrara F, Frumento P, D'Alto M, D'Andrea A, Radaan SA, Cocchia R, Marra AM, Ranieri B, Salzano A, Stanziola AA, Voilliot D, Agoston G, Cademartiri F, Cittadini A, Kasprzak JD, Grünig E, Bandera F, Guazzi M, Rudski L, Bossone E. Age-changes in right ventricular function-pulmonary circulation coupling: from pediatric to adult stage in 1899 healthy subjects. The RIGHT Heart International NETwork (RIGHT-NET). Int J Cardiovasc Imaging 2021; 37:3399-3411. [PMID: 34227030 DOI: 10.1007/s10554-021-02330-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/25/2021] [Indexed: 01/30/2023]
Abstract
The present study analyzes age-specific changes in RV function and RV-PA coupling in a large cohort of apparently healthy subjects with a wide age-range, to identify reference values and to study the influence of clinical and echocardiographic cofactors. 1899 Consecutive healthy subjects underwent a standardized transthoracic echocardiographic examination. Tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Ventriculo-arterial coupling was then inferred from the TAPSE/SPAP ratio. A quantile regression analysis was used to estimate quantiles 0.05, 0.10, 0.50 (median), 0.90, and 0.95 of TAPSE, SPAP and TAPSE/SPAP. The association between age and each of these values was determined. The mean age of the group was 45.2 ± 18.5 years (range 1 to 102 years), 971 were males. SPAP increased with age, whereas TAPSE and TAPSE/SPAP ratio decreased. Upon multivariate modeling, the most significant positive associations for TAPSE were body surface area (BSA) driven by the pediatric group, stroke volume (SV), E/A and negatively heart rate and E/e' ratio. SPAP was positively associated with increasing age, SV, E/A, E/e' and negatively with BSA. TAPSE/SPAP ratio was negatively associated with age, female sex, and E/e' and positively with BSA. A preserved relationship between TAPSE and SPAP was found across the different age groups. TAPSE, SPAP and TAPSE/SPAP demonstrate important trends and associations with advancing age, impaired diastolic function, affected by female sex and BSA However the relationship between TAPSE and SPAP is relatively well preserved across the age spectrum.
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Affiliation(s)
- Olga Vriz
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia. .,School of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Gruschen Veldman
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy
| | - Sarah Aldosari Radaan
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh, 12713, Saudi Arabia
| | - Rosangela Cocchia
- Division of Cardiac Rehabilitation-Echo Lab, A Cardarelli Hospital, Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | | | - Anna Agnese Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Centre for Rare Respiratory Diseases, A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | | | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Francesco Bandera
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Eduardo Bossone
- Division of Cardiac Rehabilitation-Echo Lab, A Cardarelli Hospital, Naples, Italy
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18
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Masson Silva JB, Tannus Silva DGS, Furtado RG, da Silva Júnior CG, Araújo FA, Costa SDA, Marra da Madeira Freitas E, Rassi DDC, Rabahi MF, Rassi S. Correlation Between 2D Strain and Classic Echocardiographic Indices in the Diagnosis of Right Ventricular Dysfunction in COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:1967-1976. [PMID: 34234427 PMCID: PMC8254030 DOI: 10.2147/copd.s290957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/04/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose This study aims to define which of the right ventricular myocardial deformation indices best correlates with the classic echocardiographic measurements and indices of right ventricular (RV) dysfunction in patients with stable chronic obstructive pulmonary disease (COPD). Patients and Methods Ninety-one patients with stable COPD underwent clinical evaluation, spirometry, a 6-minute walk test, and echocardiographic examination. Patients were divided into two groups: “with RV dysfunction” (≥1 classic parameter) and “without RV dysfunction”. We used speckle tracking to estimate myocardial deformation. For all analyses, results were considered significant if p < 0.05. Results The mean age across all participants was 65 ± 9 years, with 53% (48/91) being male. Patients in the group with RV dysfunction were able to walk shorter distances and had higher estimated right ventricular systolic pressure (RVSP) and mean pulmonary arterial pressure (mPAP). The RV free wall longitudinal strain (RVFWLS) was the only deformation indices that showed a significant correlation with all classic measurements and indices in the diagnosis of RV dysfunction (Wald test, 10.24; p < 0.01; odds ratio, 1.61). In the ROC curve analysis, the absolute value <20% was the lowest cut-off point of this index for detection of RV dysfunction (AUC = 0.93, S: 95.8%, and E: 88%). Conclusion In COPD patients, RVFWLS is the myocardial deformation index that best correlates with classic echocardiographic parameters for the diagnosis of RV dysfunction using <20% as a cut-off point.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Salvador Rassi
- Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brazil.,Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, GO, Brazil
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19
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Whipple NS, Joshi VM, Naik RJ, Mentnech T, McFarland MM, Nolan VG, Hankins JS. Sickle cell disease and ventricular myocardial strain: A systematic review. Pediatr Blood Cancer 2021; 68:e28973. [PMID: 33742492 PMCID: PMC9116158 DOI: 10.1002/pbc.28973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
Cardiac disease is the primary cause of death in sickle cell disease (SCD). Cardiac abnormalities begin in childhood and progress throughout life. Right and left ventricular (RV, LV) myocardial strain are early markers of systolic dysfunction but are not well investigated among individuals with SCD. The objectives of this review were to (1) identify all published studies that have evaluated ventricular myocardial strain, (2) summarize their values, and (3) compare findings with those obtained from controls. From search results of four electronic databases-Medline, Embase, Scopus, and Web of Science-42 potential articles were identified, of which 18 articles and 17 studies met eligibility criteria for inclusion. The evaluated studies demonstrate that RV and LV myocardial strain are generally abnormal in individuals with SCD compared with controls, despite having normal ejection/shortening fraction. Myocardial strain has been inconsistently evaluated in this population and should be considered any time an echocardiogram is performed.
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Affiliation(s)
- Nicholas S. Whipple
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Vijaya M. Joshi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN, USA,Cardiopulmonary Services, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ronak J. Naik
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN, USA,Cardiopulmonary Services, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tisha Mentnech
- North Carolina State University Libraries, Raleigh, NC, USA
| | - Mary M. McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, USA
| | - Vikki G. Nolan
- Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, USA
| | - Jane S. Hankins
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, TN, USA
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20
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Kandula V, Kislitsina ON, Rigolin VH, Thomas JD, Malaisrie SC, Andrei AC, Ramesh A, Kruse J, Cox JL, McCarthy PM. Does gender bias affect outcomes in mitral valve surgery for degenerative mitral regurgitation? Interact Cardiovasc Thorac Surg 2021; 33:325-332. [PMID: 33893493 DOI: 10.1093/icvts/ivab090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study was conducted to determine if gender bias explains the worse outcomes in women than in men who undergo mitral valve surgery for degenerative mitral regurgitation. METHODS Patients who underwent mitral valve surgery for degenerative mitral regurgitation with or without concomitant ablation surgery for atrial fibrillation were identified from the Cardiovascular Research Database of the Clinical Trial Unit of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital and were defined according to the Society of Thoracic Surgery National Adult Cardiac Surgery Database. Of the 1004 patients (33% female, mean age 62.1 ± 12.4 years; 67% male, mean age 60.1 ± 12.4 years) who met this criteria, propensity score matching was utilized to compare sex-related differences. RESULTS Propensity score matching of 540 patients (270 females, mean age 61.0 ± 12.2; 270 males, mean age 60.9 ± 12.3) demonstrated that 98% of mitral valve surgery performed in both groups was mitral valve repair and 2% was mitral valve replacement. Preoperative CHA2DS2-VASc scores were higher in women and fewer women were discharged directly to their homes. Before surgery, women had smaller left heart chambers, lower cardiac outputs, higher diastolic filling pressures and higher volume responsiveness than men. However, preoperative left ventricular and right ventricular strain values, which are normally higher in women, were similar in the 2 groups, indicating worse global strain in women prior to surgery. CONCLUSIONS The worse outcomes reported in women compared to men undergoing surgery for degenerative mitral regurgitation are misleading and not based on gender bias except in terms of referral patterns. Men and women who present with the same type and degree of mitral valve disease and similar comorbidities receive the same types of surgical procedures and experience similar postoperative outcomes. Speckle-tracking echocardiography to assess global longitudinal strain of the left and right ventricles should be utilized to monitor for myocardial dysfunction related to chronic mitral regurgitation.
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Affiliation(s)
- Viswajit Kandula
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Olga N Kislitsina
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA.,Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Vera H Rigolin
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - James D Thomas
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - S Chris Malaisrie
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Adin-Cristian Andrei
- Department of Preventive Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Ashvita Ramesh
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Jane Kruse
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - James L Cox
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Patrick M McCarthy
- Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
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Alkhateeb A, Roushdy A, Hasan-Ali H, Kishk YT, Hassan AK. Immediate and short-term biventricular function assessment post-atrial septal defect surgical versus device closure: A comparative two-dimensional speckle tracking study. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2020.101309] [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: 11/28/2022]
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22
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Mylvaganam R, Avery R, Goldberg I, Makowski C, Kalhan R, Villaflor V, Cuttica MJ. Adverse effects of immune checkpoint inhibitor therapies on right ventricular function and pulmonary arterial dilatation. Pulm Circ 2021; 11:2045894021992236. [PMID: 33623668 PMCID: PMC7878999 DOI: 10.1177/2045894021992236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/13/2021] [Indexed: 11/15/2022] Open
Abstract
Immunologic risk factors contribute to endothelial dysfunction and development of pulmonary vascular disease. Immune checkpoint inhibitors, used as immunotherapies for malignancies, have a wide range of reported immune-related adverse events. We retrospectively describe the impact of immune checkpoint inhibitors on the development of pulmonary vascular injury and right ventricular dysfunction as compared across both computed tomography and transthoracic echocardiography. Twenty-four of 389 patients treated with immune checkpoint inhibitors at a single academic center between 2015 and 2019 were evaluated. Thirteen (54%) patients were treated with anti-programmed cell death receptor 1 (PD-1), 8 (33%) with anti-programmed death receptor ligand 1 (PD-L1) therapy, and 3 (13%) with combination anti-PD-1 and anti-cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) therapy. At a median of 85 days of immune checkpoint inhibitor therapy, RVfwLS significantly increased from –20.6% to –16.7% (p = 0.002). After a median of 59 days of immune checkpoint inhibitor therapy, median pulmonary artery to aorta ratio worsened from 0.83 to 0.89 (p = 0.03). There was an correlation of duration of immune checkpoint inhibitor therapy (β = –0.574, p = 0.003) with percent change in RVfwLS. Patients who received anti-PD-1 therapy (β = –0.796, p = 0.001) showed the greatest correlation of duration of immune checkpoint inhibitor therapy with percent change in RVfwLS. Exposure to immune checkpoint inhibitors are associated with RV dysfunction and vascular changes as measured by strain and computed tomography, respectively.
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Affiliation(s)
- Ruben Mylvaganam
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ruben Mylvaganam, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern McGaw Medical Center, 240 E Huron St, Ste M-300, Chicago, IL 60611, USA.
| | - Ryan Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Isaac Goldberg
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Victoria Villaflor
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J. Cuttica
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sareen S, Maheshwari D, Mahla H, Sharma S. Immediate and short-term outcomes of percutaneous transvenous mitral commissurotomy on global and regional right ventricular strain by speckle-tracking echocardiography. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Seo J, Jung IH, Park JH, Kim GS, Lee HY, Byun YS, Kim BO, Rhee KJ. The prognostic value of 2D strain in assessment of the right ventricle in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020; 20:1043-1050. [PMID: 30796431 DOI: 10.1093/ehjci/jez015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Several studies have been reported using right ventricular (RV) strain as a method for evaluating RV function in patients with various cardiovascular diseases; however, the clinical relevance of RV strain in dilated cardiomyopathy (DCM) patients with sinus rhythm is unknown. The aim of this study was to investigate the relationship between RV strain and adverse events in DCM patients with sinus rhythm. METHODS AND RESULTS We enrolled 143 DCM patients with sinus rhythm who had been first diagnosed, evaluated, and followed at Sanggye Paik Hospital between March 2013 and August 2017. We performed echocardiography and measured RV strain values using the apical four-chamber view. The mean age was 64.6 years. During the median follow-up period of 40.0 months, adverse cardiovascular events developed in 21 patients (14.7%). By Cox proportional hazards multivariate analysis, only RV free wall longitudinal strain (RV-FWLS) independently predicted the primary outcome. Receiver-operating characteristic curve analysis showed that the optimal RV-FWLS cut-off value to identify patients with an event was -16.5% (area under the curve = 0.703, P = 0.003). When we divided the subjects into two groups based on the RV-FWLS of -16.5%, patients with RV-FWLS <-16.5% showed more favourable clinical outcomes than that in those with RV-FWLS ≥-16.5% (log-rank test, P < 0.001). CONCLUSION RV-FWLS was associated with a significant prognostic impact in DCM patients with sinus rhythm.
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Affiliation(s)
- Jongkwon Seo
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - In Hyun Jung
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Jin Hye Park
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Gwang Sil Kim
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Hye Young Lee
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Young Sup Byun
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Byung Ok Kim
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
| | - Kun Joo Rhee
- Department of Cardiology, Sanggye-Paik Hospital, Inje University College of Medicine, Sanggye-dong, Nowon-gu, Seoul 01757, Republic of Korea
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25
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Baysal SS, Has M. Assessment of biventricular function with speckle tracking echocardiography in newly-diagnosed adult-onset asthma. J Asthma 2020; 59:306-314. [PMID: 33158387 DOI: 10.1080/02770903.2020.1847928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There is limited number of studies on the effect of asthma disease on cardiac functions. The aim of this study was to investigate if there was any association between adult onset asthma and cardiac dysfunction. METHODS Total of 83 nonsmoking adult onset asthma patients aged between 18 and 65, and 83 control subjects with comparable age and sex distribution were included in the study.None of the subjects had any chronic cardiovascular or systemic diseases.Two-dimensional, M-mode and tissue Doppler examinations were performed. STE analysis was obtained using the QLAB software. Complete blood count and high-sensitive C-reactive protein (hsCRP) levels were measured. RESULTS There was no difference between two groups in terms of standard echocardiography and Doppler parameters. While tricuspid annular plane systolic excursion (TAPSE) was observed to be lower in asthmatics (24.9 ± 2.0 vs. 25.5 ± 2.1, p = 0.043), right ventricular myocardial performance index (RV MPI) was higher (0.36 ± 0.07 vs 0.32 ± 0.06, p˂0.001). There was no significant difference between the groups in terms of left ventricular STE parameters. Measurements of right ventricular global longitudinal strain (RVGLS) and right ventricular free wall strain (RVfree) were observed to be lower in the asthma group (-20.3 ± 2.9 vs -21.5 ± 2.9, p = 0.007; -24.0 ± 3.0 vs 25.1 ± 2.9, p = 0.009, respectively). CONCLUSION -We demonstrated that while adult onset mild-stage asthma patients have normal parameters in standard echocardiography, they have reduced right ventricular functions by STE.
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Affiliation(s)
- Sadettin Selçuk Baysal
- Cardiology Deparment, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Mehmet Has
- Deparment of Allergy and Respiratory Diseases, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
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Frogoudaki AA, Pantelakis I, Bistola V, Kroupis C, Birba D, Ikonomidis I, Alexopoulos D, Filippatos G, Parissis J. Global Longitudinal Strain of the Systemic Ventricle Is Correlated with Plasma Galectin-3 and Predicts Major Cardiovascular Events in Adult Patients with Congenital Heart Disease. ACTA ACUST UNITED AC 2020; 56:medicina56060305. [PMID: 32580463 PMCID: PMC7353898 DOI: 10.3390/medicina56060305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
Backround and Objective: We sought to assess in adult congenital heart disease (ACHD) patients the prognostic value of plasma galectin-3 (Gal-3) levels and systemic ventricular global longitudinal strain (SV GLS) as well as their association with NTproBNP and arrhythmogenesis. Materials and Methods: We studied 58 patients (26 men, mean age 37 ± 16.8 years) with various congenital heart diseases. Patients underwent echocardiogram, 24 h ambulatory ECG monitoring, while NTproBNP and Gal-3 were measured. They were followed up (median of 790.5 days -IQR 350.3 days) and major cardiovascular events (MACE) were recorded. Results. Mean Gal-3 levels were 17.07 ± 6.38 ng/m. Plasma Gal-3 was correlated with LogNTproBNP (r = 0.456, p = 0.001).Gal-3 levels associated with supraventricular tachycardia (SVT) (p < 0.001) and ventricular tachycardia (VT) (p < 0.001), but was not associated with MACE (HR 1.018, 95% CI 0.944-1.098, p = 0.641).Mean SVGLS in patients with systemic left ventricle was -15.91% ± 4.09%, which was significantly lower compared to patients with systemic right ventricle and patients with single ventricle (-11.42% ± 3.37% and -11.9% ± 5.06%, respectively, p = 0.021).SV GLS correlated with plasma Gal-3 (r = 0.313, p = 0.027) and logNTproBNP (r = 0.479, p < 0.001). SVGLS correlated with VT arrhythmias (p = 0.004). NTproBNP predicted MACE (AUC 0.750, p = 0.03). SVGLS also predicted MACE (AUC 0.745, p = 0.03. In multivariate analysis, SVGLS and logNTproBNP maintained their predictive value (p = 0.004 and p = 0.009, respectively) Conclusion: In ACHD patients, SV GLS was found to predict MACE independently from NTproBNP and correlated with VT. Gal-3 correlated with NTproBNP and SVGLS as well as SVT and VT, but has not been shown to bear significant prognostic potential.
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Affiliation(s)
- Alexandra A. Frogoudaki
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
- Correspondence: ; Tel.: +30-69-7441-3918; Fax: +30-21-0583-2351
| | - Ioannis Pantelakis
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Vasiliki Bistola
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Christos Kroupis
- Department of Clinical Biochemistry, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece;
| | - Dionysia Birba
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Ignatios Ikonomidis
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Dimitrios Alexopoulos
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
| | - Gerasimos Filippatos
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus
| | - John Parissis
- Second Cardiology Department, ATTIKON University Hospital, National and Kapodistrian University of Athens, 12461 Athens, Greece; (I.P.); (V.B.); (D.B.); (I.I.); (D.A.); (G.F.); (J.P.)
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Lejeune S, Roy C, Ciocea V, Slimani A, de Meester C, Amzulescu M, Pasquet A, Vancraeynest D, Beauloye C, Vanoverschelde JL, Gerber BL, Pouleur AC. Right Ventricular Global Longitudinal Strain and Outcomes in Heart Failure with Preserved Ejection Fraction. J Am Soc Echocardiogr 2020; 33:973-984.e2. [PMID: 32387031 DOI: 10.1016/j.echo.2020.02.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Right ventricular (RV) strain has emerged as an accurate tool for RV function assessment and is a powerful predictor of survival in patients with heart failure with reduced ejection fraction. However, its prognostic impact in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the prognostic value of RV global longitudinal strain (RVGLS) by two-dimensional speckle-tracking echocardiographic (STE) imaging in patients with HFpEF against conventional RV function parameters. METHODS Patients with HFpEF were prospectively recruited, and 149 of 183 (81%) with analyzable STE RVGLS images constituted the final study population (mean age, 78 ± 9 years; 61% women), compared with 28 control subjects of similar age and sex. All control subjects and 120 patients also underwent cardiac magnetic resonance imaging. Patients were followed up for a primary end point of all-cause mortality and first heart failure hospitalization, and Cox regression analysis was performed. RESULTS Mean STE RVGLS was significantly altered in patients with HFpEF compared with control subjects (-21.7 ± 4.9% vs -25.9 ± 4.2%, P < .001). STE RVGLS correlated well with RV ejection fraction by cardiac magnetic resonance (r = -0.617, P < .001). Twenty-eight patients with HFpEF (19%) had impaired STE RVGLS (>-17.5%). During a mean follow-up period of 30 ± 9 months, 91 patients with HFpEF (62%) reached the primary end point. A baseline model was created using independent predictors of the primary end point: New York Heart Association functional class III or IV, hemoglobin level, estimated glomerular filtration rate, and the presence of moderate or severe tricuspid regurgitation. Impaired STE RVGLS provided significant additional prognostic value over this model (χ2 to enter = 7.85, P = .005). Impaired tricuspid annular plane systolic excursion and fractional area change, however, did not. CONCLUSIONS In patients with HFpEF, impaired RVGLS has strong prognostic value. STE RVGLS should be considered for systematic evaluation of RV function to identify patients at high risk for adverse events.
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Affiliation(s)
- Sibille Lejeune
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Clotilde Roy
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Victor Ciocea
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Alisson Slimani
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christophe de Meester
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Mihaela Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Agnes Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christophe Beauloye
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium.
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Habert P, Capron T, Hubert S, Bentatou Z, Bartoli A, Tradi F, Renard S, Rapacchi S, Guye M, Bernard M, Habib G, Jacquier A. Quantification of right ventricular extracellular volume in pulmonary hypertension using cardiac magnetic resonance imaging. Diagn Interv Imaging 2020; 101:311-320. [DOI: 10.1016/j.diii.2019.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/30/2022]
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Leitman M, Efrati S, Fuchs S, Hadanny A, Vered Z. The effect of hyperbaric oxygenation therapy on myocardial function. Int J Cardiovasc Imaging 2020; 36:833-840. [PMID: 31953651 DOI: 10.1007/s10554-020-01773-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
Hyperbaric oxygenation therapy is successfully implemented for the treatment of several disorders. Data on the effect of hyperbaric oxygenation on echocardiographic parameters in asymptomatic patients is limited. The current study sought to evaluate the effect of hyperbaric oxygenation therapy on echocardiographic parameters in asymptomatic patients. Thirty-one consecutive patients underwent a 60-sessions course of hyperbaric oxygenation therapy in an attempt to improve cognitive impairment. In all subjects, echocardiography examination was performed before and after a course of hyperbaric oxygenation therapy. Conventional and speckle tracking imaging parameters were calculated and analyzed. The mean age was 70 ± 9.5 years, 28 [90%] were males. History of coronary artery disease was present in 12 [39%]. 94% suffered from hypertension, 42% had diabetes mellitus. Baseline wall motion abnormalities were found in eight patients, however, global ejection fraction was within normal limits. During the study, ejection fraction [EF], increased from 60.71 ± 6.02 to 62.29 ± 5.19%, p = 0.02. Left ventricular end systolic volume [LVESV], decreased from 38.08 ± 13.30 to 35.39 ± 13.32 ml, p = 0.01. Myocardial performance index [MPi] improved, from 0.29 ± 0.07 to 0.26 ± 0.08, p = 0.03. Left ventricular [LV] global longitudinal strain increased from - 19.31 ± 3.17% to - 20.16 ± 3.34%, p = 0.036 due to improvement in regional strain in the apical and antero-septal segments. Twist increased from 18.32 ± 6.61° to 23.12 ± 6.35° p = 0.01, due to improvement in the apical rotation, from 11.76 ± 4.40° to 16.10 ± 5.56°, p = 0.004. Hyperbaric oxygen therapy appears to improve left ventricular function, especially in the apical segments, and is associated with better cardiac performance. If our results are confirmed in further studies, HBOT can be used in many patients with heart failure and systolic dysfunction.
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Affiliation(s)
- Marina Leitman
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Fuchs
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Vered
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Liu T, Wang C, Li S, Zhao Y, Li P. Age- and gender-related normal references of right ventricular strain values by tissue tracking cardiac magnetic resonance: results from a Chinese population. Quant Imaging Med Surg 2019; 9:1441-1450. [PMID: 31559173 DOI: 10.21037/qims.2019.08.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Myocardial deformation is a sensitive marker for sub-clinical myocardial dysfunction and carries independent prognostic significance across a broad range of cardiovascular diseases. Reproducible and repeatable assessment of right ventricular (RV) function is vital for monitoring congenital and acquired heart diseases. The purpose of this study was to determine the normal references of RV strain and strain rate values using tissue tracking cardiac magnetic resonance imaging (MRI). Methods A cohort of 120 normal human subjects from each decade of life between 20 and 70 without cardiac diseases were enrolled in this study. Retrospectively, electrocardiogram (ECG) gating cardiac MRI imaging was performed at 3.0T with balanced steady-state free precession (bSSFP) imaging. RV global and segmental myocardial strains were analyzed by tissue tracking by two experienced observers. Results The global peak longitudinal strain (GLS) and global peak radial strain (GRS) was -24.3±4.7 and 23.0±8.5 respectively. For the peak circumferential strains (GCS), the values for global, basal, mid-cavity, and apical segments were -13.3±4.1, -13.1±4.0, -12.5±4.7, and -15.9±5.8, respectively. There were significant gender differences in peak GRS (P=0.009) and at the base (P=0.017) and the mid-cavity (P=0.011) with greater deformation in females than in males. There were also significant age differences in GRS (P<0.001), GCS for basal (P<0.001), and mid-cavity segments (P=0.037). On Bland-Altman analysis, peak GLS and GRS had the best intra-observer agreement (mean bias, -0.13±0.51; 95% CI, -1.13-0.87) and inter-observer (mean bias, 0.054±0.31; 95% CI, -0.55-0.66) agreement, respectively. Conclusions Normal values of RV deformation for healthy individuals using tissue tracking cardiac magnetic resonance (CMR-TT) provided good RV peak strain reproducibility. There was a significant correlation between RV strain or strain rate parameters with either age or sex.
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Affiliation(s)
- Ting Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Congcong Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Shu Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Yu Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Peiling Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
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31
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Park JH. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circ J 2019; 49:908-931. [PMID: 31456367 PMCID: PMC6753023 DOI: 10.4070/kcj.2019.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 01/14/2023] Open
Abstract
Echocardiography is the first and is the most-available imaging modality for many cardiovascular diseases, and echocardiographic parameters can give much important information for diagnosis, treatment, and prognostic evaluations. Left ventricular ejection fraction (LVEF) is the most commonly used echocardiographic parameter for left ventricular (LV) systolic function. Although LVEF is used routinely in daily practice, it is calculated from volumetric change without representing true myocardial properties. Recently, strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Although strain echocardiography has been applied to measure the right ventricle and left atrium, in addition to analyzing the LV, many cardiologists who are not imaging specialists are unaware of its clinical use and importance. Therefore, this review describes the measurement and clinical utility of 2-dimensional strain analysis in various cardiovascular diseases.
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Affiliation(s)
- Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
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Goedemans L, Hoogslag GE, Abou R, Schalij MJ, Marsan NA, Bax JJ, Delgado V. ST-Segment Elevation Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: Prognostic Implications of Right Ventricular Systolic Dysfunction as Assessed with Two-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2019; 32:1277-1285. [PMID: 31311703 DOI: 10.1016/j.echo.2019.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Right ventricular (RV) systolic function in patients admitted with ST-segment elevation myocardial infarction (STEMI) with chronic obstructive pulmonary disease (COPD) and its impact on prognosis have not been characterized. The present study aims to compare the prevalence of RV systolic dysfunction in COPD versus non-COPD patients with STEMI and evaluate the prognostic implications. METHODS One hundred seventeen STEMI patients with COPD with transthoracic echocardiography performed within 48 hours of admission were retrospectively selected. Matched on age, gender, and infarct size (determined by cardiac biomarkers and left ventricular ejection fraction [LVEF]), 207 non-COPD patients were selected. RV dysfunction was defined based on tricuspid annular plane systolic excursion <17 mm (TAPSE), tricuspid annular systolic velocity <6 cm/s (S'), RV fractional area change <35% (FAC), and RV longitudinal free wall strain (FWSL) measured with speckle-tracking echocardiography >-20%. Patients were followed for the occurrence of all-cause mortality. RESULTS RV assessment was feasible in 112 COPD and 199 non-COPD patients (mean age, 69 ± 10; 74% male; mean, LVEF 47% ± 8%). Patients with COPD had significantly lower RV FAC (38% ± 11% vs 40% ± 9%; P = .04), equal TAPSE and S' (17.9 ± 3.7 vs 18.1 ± 3.8 mm, P = .72; and 8.4 ± 2.2 vs 8.5 ± 2.2 cm/sec, P = .605, respectively) and more impaired RV FWSL (-21.1% ± 6.6% vs -23.4% ± 6.5%, P = .005), compared with patients without COPD. RV dysfunction was more prevalent in patients with COPD, particularly when assessed with RV FWSL (46% vs 32%; P = .021). During a median follow-up of 30 (interquartile range 1.5-44) months, 49 patients died (16%). Multivariate models stratified for COPD status showed that RV FWS >-20% was independently associated with 5-year all-cause mortality (hazard ratio, 2.05; 95% CI, 1.12-3.76; P = .020), after adjusting for age, diabetes, peak troponin level, and LVEF. Interestingly, RV FAC < 35%, S'< 6 cm/sec, and TAPSE < 17 mm were not independently associated with survival. CONCLUSION In a STEMI population with relatively preserved LVEF, COPD patients had significantly worse RV FWSL compared with patients without COPD. Moreover, RV FWSL > -20% was independently associated with worse survival. In contrast, conventional parameters were not associated with survival.
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Affiliation(s)
- Laurien Goedemans
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Georgette E Hoogslag
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Reiber JHC, Pereira GTR, Bezerra HG, De Sutter J, Schoenhagen P, Stillman AE, Van de Veire NRL. Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2019; 35:1175-1188. [DOI: 10.1007/s10554-019-01579-9] [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: 12/01/2022]
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Carluccio E, Biagioli P, Lauciello R, Zuchi C, Mengoni A, Bardelli G, Alunni G, Gronda EG, Ambrosio G. Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure. J Am Soc Echocardiogr 2019; 32:836-844.e1. [PMID: 30979539 DOI: 10.1016/j.echo.2019.02.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Global right ventricular (RV) longitudinal strain (RVGLS) and free wall RV longitudinal strain (RVFWS) have both been advocated as sensitive tools to evaluate RV function and predict prognosis in patients with heart failure and reduced ejection fraction (HFrEF). However, because the interventricular septum is an integral part of the left ventricle (LV) also, RVGLS might be influenced by LV dysfunction. Thus, we compared the prognostic performance of either RV strain parameter in HFrEF patients, also taking into account the degree of LV systolic dysfunction. METHODS In 288 prospectively enrolled outpatients with stable HFrEF, RVGLS and RVFWS were assessed by speckle-tracking and LV systolic function by global longitudinal strain and LV ejection fraction. Patients were followed up for 30.2 ± 23.0 months; the primary endpoint was all-cause death/heart failure-related hospitalization. Prognostic performance was assessed by C-statistic and net reclassification improvement. RESULTS There were 95 events during follow-up. By univariable analysis, both RVGLS (hazard ratio × 1 SD, 1.60; 95% CI, 1.29-1.99; P < .0001) and RVFWS (hazard ratio × 1 SD, 1.82; 95% CI, 1.45-2.29; P < .0001) were associated with outcome, and both remained significant after correction for EMPHASIS risk score, New York Heart Association class, natriuretic peptides, and therapy. However, after further correction for LV systolic function parameters, only RVFWS remained significantly associated with outcome (P < .01). A basic prediction model was improved by adding RVFWS (net reclassification improvement 0.390; P < .05), but not RVGLS. CONCLUSIONS Although both RVGLS and RVFWS have prognostic value, RVFWS better predicts outcome in HFrEF patients, mainly because it is less influenced by LV longitudinal dysfunction.
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Affiliation(s)
- Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy.
| | - Paolo Biagioli
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
| | - Rosanna Lauciello
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
| | - Cinzia Zuchi
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
| | - Giuliana Bardelli
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
| | - Gianfranco Alunni
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Perugia, Italy
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Salama AY, Arisha MJ, Nanda NC, Klas B, Ibeche B, Wei B. Incremental value of three-dimensional transthoracic echocardiography over the two-dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum. Echocardiography 2018; 36:150-163. [PMID: 30592784 DOI: 10.1111/echo.14230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/18/2018] [Indexed: 11/30/2022] Open
Abstract
The usefulness of two-dimensional transthoracic echocardiography (2DTTE) in the assessment of right heart compression and dysfunction produced by pectus excavatum chest wall deformity has been well described in the literature by several investigators. However, there is a paucity of reports describing incremental value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over the two-dimensional technique in the evaluation of right heart function in these patients. We present a severe case of pectus excavatum chest wall deformity in a young male, in whom 3DTTE provided incremental value over standard 2DTTE in assessing compression of the right heart before surgery and marked improvement in right heart function parameters following surgical repair. In addition, an updated summary of salient features of this deformity, including 2D and 3DTTE findings as well as right heart echocardiographic parameters by both 2D and 3DTTE in normal/healthy subjects summarized from the literature have been provided in a tabular form for comparison.
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Affiliation(s)
- Ahmed Y Salama
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohammed J Arisha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Bashar Ibeche
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Benjamin Wei
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Keramida K, Lazaros G, Nihoyannopoulos P. Right ventricular involvement in hypertrophic cardiomyopathy: Patterns and implications. Hellenic J Cardiol 2018; 61:3-8. [PMID: 30508591 DOI: 10.1016/j.hjc.2018.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/17/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022] Open
Abstract
Although hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy worldwide, the criteria for its definition and most of the literature concern the left ventricle, thus confirming the theory that the right ventricle is the neglected one. Right ventricular (RV) involvement includes structural and functional changes with significant impact on clinical presentation and prognosis. The pattern of RV hypertrophy can be variable with possible dynamic obstruction. Histological findings suggest similar pathogenetic changes in both ventricles supporting the common myopathic process with sarcomeric mutations. Systolic dysfunction of the RV is subtle, and the classical echocardiographic indices are usually within normal limits, while global longitudinal strain is significantly impaired. Diastolic dysfunction of the RV is also evident in patients with HCM possibly due to fibrosis of the RV free wall and/or the obstruction of the RV filling with significant prognostic implications. RV involvement in HCM is associated with increased incidence of supraventricular and ventricular arrhythmias, severe dyspnea, pulmonary thromboembolism, progressive heart failure, and increased risk of sudden cardiac death. Therefore, the RV should be routinely included in the detailed assessment of patients with HCM.
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Affiliation(s)
- Kalliopi Keramida
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece.
| | - George Lazaros
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Petros Nihoyannopoulos
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece; National Heart and Lung Institute Imperial College London, London, UK
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Lee JH, Park JH. Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography. J Cardiovasc Imaging 2018; 26:111-124. [PMID: 30310878 PMCID: PMC6160817 DOI: 10.4250/jcvi.2018.26.e11] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 01/12/2023] Open
Abstract
Right ventricular (RV) systolic dysfunction has been identified as an independent prognostic marker of many cardiovascular diseases. However, there are problems in measuring RV systolic function objectively and identification of RV dysfunction using conventional echocardiography. Strain echocardiography is a new imaging modality to measure myocardial deformation. It can measure intrinsic myocardial function and has been used to measure regional and global left ventricular (LV) function. Although the RV has different morphologic characteristics than the LV, strain analysis of the RV is feasible. After strain echocardiography was introduced to measure RV systolic function, it became more popular and was incorporated into recent echocardiographic guidelines. Recent studies showed that RV global longitudinal strain (RVGLS) can be used as an objective index of RV systolic function with prognostic significance. In this review, we discuss RVGLS measurement, normal reference values, and the clinical importance of RVGLS.
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Affiliation(s)
- Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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Tadic M, Cuspidi C, Ivanovic B, Pencic B, Grassi G, Celic V. Does gender affect the association between right ventricular strain and arterial hypertension? J Clin Hypertens (Greenwich) 2018; 20:1327-1333. [DOI: 10.1111/jch.13347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/27/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Marijana Tadic
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
| | - Cesare Cuspidi
- Clinical Research Unit; University of Milan-Bicocca and Istituto Auxologico Italiano; Meda Italy
| | | | - Biljana Pencic
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
| | - Guido Grassi
- Clinica Medica; University of Milano Bicocca and IRCCS Multimedica Sesto San Giovanni; Milano Italy
| | - Vera Celic
- Department of Cardiology; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
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