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Chan WX, Kaura A, Mulla A, Papadimitriou D, Glampson B, Mayer E, Shah ASV, Mayet J, Yap CH. Diagnostic and prognostic value of an ejection fraction adjusted for myocardial remodeling. Front Cardiovasc Med 2024; 11:1349338. [PMID: 38798923 PMCID: PMC11122018 DOI: 10.3389/fcvm.2024.1349338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/05/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Ejection fraction (EF) is widely used to evaluate heart function during heart failure (HF) due to its simplicity compared but it may misrepresent cardiac function during ventricular hypertrophy, especially in heart failure with preserved EF (HFpEF). To resolve this shortcoming, we evaluate a correction factor to EF, which is equivalent to computing EF at the mid-wall layer (without the need for mid-layer identification) rather than at the endocardial surface, and thus better complements other complex metrics. Method The retrospective cohort data was studied, consisting of 2,752 individuals (56.5% male, age 69.3 ± 16.4 years) admitted with a request of a troponin test and undergoing echocardiography as part of their clinical assessment across three centres. Cox-proportional regression models were constructed to compare the adjusted EF (EFa) to EF in evaluating risk of heart failure admissions. Result Comparing HFpEF patients to non-HF cases, there was no significant difference in EF (62.3 ± 7.6% vs. 64.2 ± 6.2%, p = 0.79), but there was a significant difference in EFa (56.6 ± 6.4% vs. 61.8 ± 9.9%, p = 0.0007). Both low EF and low EFa were associated with a high HF readmission risk. However, in the cohort with a normal EF (EF ≥ 50%), models using EFa were significantly more associative with HF readmissions within 3 years, where the leave one out cross validation ROC analysis showed a 18.6% reduction in errors, and Net Classification Index (NRI) analysis showed that risk increment classification of events increased by 12.2%, while risk decrement classification of non-events decreased by 16.6%. Conclusion EFa is associated with HF readmission in patients with a normal EF.
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Affiliation(s)
- Wei Xuan Chan
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Amit Kaura
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Abdulrahim Mulla
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dimitri Papadimitriou
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Benjamin Glampson
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Erik Mayer
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Anoop S. V. Shah
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jamil Mayet
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Vasileiadis K, Antza C, Kotsis V. The Depiction of Hypertension in Heart Imaging Examinations: An Up-to-Date Review of the Evidence. Vasc Health Risk Manag 2023; 19:789-796. [PMID: 38045022 PMCID: PMC10693270 DOI: 10.2147/vhrm.s436133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023] Open
Abstract
Hypertension is one of the main preventable cardiovascular (CV) risk factors all over the years, closely related to CV morbidity and mortality. One of the most common hypertensive target organ damages is hypertensive heart disease (HHD), including left ventricular hypertrophy, which progresses gradually and leads to systolic or diastolic dysfunction of the left ventricular, and finally to end-stage heart failure. Regarding its prevalence and the need for early diagnosis, assessment of heart imaging examination is of major importance. Echocardiography has been used as the standard imaging technique to evaluate HHD for years, providing an accurate evaluation of the left ventricular geometry, along with the systolic and diastolic function. However, nowadays there is a growing interest in cardiovascular magnetic resonance (CMR). Despite the importance of the use of echocardiography in everyday clinical practice, numerous studies have shown the superiority of CMR as an imaging technique for clinical and research purposes, mainly due to its strength to provide an unlimited area of view, as well as the identification and quantification of the type and extent of myocardial fibrosis. Hence, this review aims to analyze the importance of heart imaging in the hypertensive population, with a special interest in CMR imaging.
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Affiliation(s)
- Konstantinos Vasileiadis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zheng Y, Chan WX, Charles CJ, Richards AM, Sampath S, Abu Bakar Ali A, Leo HL, Yap CH. Effects of Hypertrophic and Dilated Cardiac Geometric Remodeling on Ejection Fraction. Front Physiol 2022; 13:898775. [PMID: 35711303 PMCID: PMC9193973 DOI: 10.3389/fphys.2022.898775] [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: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Both heart failure (HF) with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) can present a wide variety of cardiac morphologies consequent to cardiac remodeling. We sought to study if geometric changes to the heart during such remodeling will adversely affect the ejection fraction (EF) parameter’s ability to serve as an indicator of heart function, and to identify the mechanism for it. Methods and Results: A numerical model that simulated the conversion of myocardial strain to stroke volume was developed from two porcine animal models of heart failure. Hypertrophic wall thickening was found to elevate EF, while left ventricle (LV) dilation was found to depress EF when myocardial strain was kept constant, causing EF to inaccurately represent the overall strain function. This was caused by EF being calculated using the endocardial boundary rather than the mid-wall layer. Radial displacement of the endocardial boundary resulted in endocardial strain deviating from the overall LV strain, and this deviation varied with LV geometric changes. This suggested that using the epi- or endo-boundaries to calculate functional parameters was not effective, and explained why EF could be adversely affected by geometric changes. Further, when EF was modified by calculating it at the mid-wall layer instead of at the endocardium, this shortcoming was resolved, and the mid-wall EF could differentiate between healthy and HFpEF subjects in our animal models, while the traditional EF could not. Conclusion: We presented the mechanism to explain why EF can no longer effectively indicate cardiac function during cardiac geometric changes relevant to HF remodeling, losing the ability to distinguish between hypertrophic diseased hearts from healthy hearts. Measuring EF at the mid-wall location rather than endocardium can avoid the shortcoming and better represent the cardiac strain function.
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Affiliation(s)
- Yu Zheng
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Wei Xuan Chan
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Christopher J Charles
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore.,Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore.,Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Smita Sampath
- Translational Biomarkers, Merck Sharp & Dohme, Singapore, Singapore
| | | | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 2016; 28:727-54. [PMID: 26140936 DOI: 10.1016/j.echo.2015.05.002] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Roxy Senior
- Biomedical Research Unit, Imperial College, London, UK; Royal Brompton Hospital, London, UK
| | | | - Jose L Zamorano
- University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
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Kobayashi Y, Ariyama M, Kobayashi Y, Giraldeau G, Fleischman D, Kozelj M, Vrtovec B, Ashley E, Kuznetsova T, Schnittger I, Liang D, Haddad F. Comparison of left ventricular manual versus automated derived longitudinal strain: implications for clinical practice and research. Int J Cardiovasc Imaging 2015; 32:429-37. [DOI: 10.1007/s10554-015-0804-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
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Lee JH, Park JH. Role of echocardiography in clinical hypertension. Clin Hypertens 2015; 21:9. [PMID: 26893921 PMCID: PMC4750785 DOI: 10.1186/s40885-015-0015-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/13/2015] [Indexed: 12/17/2022] Open
Abstract
Hypertension is a major and correctable cardiovascular risk factor. The correct diagnosis of hypertension and precise assessment of cardiovascular risk are essential to give proper treatment in patients with hypertension. Although echocardiography is the second-line study in the evaluation of hypertensive patients, it gives many clues suggesting bad prognosis associated with hypertension, including increased left ventricular (LV) mass, decreased LV systolic function, impaired LV diastolic function, and increased left atrial size and decreased function. Along with conventional echocardiographic methods, tissue Doppler imaging, three-dimensional echocardiography, and strain echocardiography are newer echocardiographic modalities in the evaluation of hypertensive patients in the current echocardiographic laboratories. Understanding conventional and newer echocardiographic parameters is important in the diagnosis and assessment of cardiovascular risk in hypertensive patients.
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Affiliation(s)
- Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea
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Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K. Midwall ejection fraction for assessing systolic performance of the hypertrophic left ventricle. Cardiovasc Ultrasound 2012; 10:45. [PMID: 23167789 PMCID: PMC3552820 DOI: 10.1186/1476-7120-10-45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/04/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In patients with left ventricular hypertrophy (LVH), LV midwall fractional shortening (FS) is used as a measure of LV systolic performance that is more physiologically appropriate than conventional FS. For evaluation of LV volume and ejection fraction (EF), 2-dimensional (2D) echocardiography is more accurate than M-mode echocardiography. The purpose of this study was to assess systolic performance by midwall EF using 2D speckle tracking echocardiography (STE). METHODS Sixty patients were enrolled in the study. Patients were divided into two groups with LVH (n = 30) and without LVH (control group, n = 30). LV systolic function was compared between the two groups and the relationships of left ventricular mass index (LVMI) with LV systolic parameters, including midwall EF, were investigated. RESULTS Midwall EF in the LVH group was significantly lower than that in the control group (42.8±4.4% vs. 48.1±4.1%, p <0.0001). Midwall FS was also significantly lower in the LVH group (13.4±2.8% vs. 16.1±1.5%, p <0.0001), but EF did not differ significantly between the two groups. There were significant correlations between midwall EF and LVMI (r=0.731, p <0.0001) and between midwall FS and LVMI (r=0.693, p <0.0001), with midwall EF having the higher correlation. CONCLUSIONS These results show that midwall EF can be determined using 2D STE. Midwall EF can be used to monitor LV systolic dysfunction, which is not possible with conventional EF. Evaluation of midwall EF may allow assessment of new parameters of LV systolic function in patients with LV geometric variability.
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Affiliation(s)
- Hisao Yoshikawa
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, Japan.
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Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ. Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure. J Am Coll Cardiol 2009; 54:618-24. [PMID: 19660692 DOI: 10.1016/j.jacc.2009.04.061] [Citation(s) in RCA: 368] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 04/06/2009] [Accepted: 04/14/2009] [Indexed: 01/12/2023]
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Determination of left ventricular mass on cardiac computed tomographic angiography. Acad Radiol 2009; 16:726-32. [PMID: 19427981 DOI: 10.1016/j.acra.2008.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 12/06/2008] [Accepted: 12/31/2008] [Indexed: 01/19/2023]
Abstract
RATIONALE AND OBJECTIVES Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiac death. The present study evaluates whether using computed tomographic (CT)-derived criteria for normal myocardial mass can improve detection of LVH on CT angiography (CTA). MATERIALS AND METHODS A total of 2238 subjects (63 +/- 9 years, 27% female) who underwent CTA were studied. To identify normal limits for CT-derived myocardial mass, we studied normal subjects (those without diabetes, hypertension, congestive heart failure, or coronary artery disease). Left ventricular mass (LVM) was measured manually using two different workstations. The CT criteria of LVH was defined as LVM above the 97th percentile per gender and compared to echocardiographic criteria (110 g/m(2) in women; 124 g/m(2) in men), and specificity and sensitivity of both models to detect LVH were calculated. RESULTS The LVM was higher in men than women in normal cohorts (75.5 +/- 14.0 vs. 63.1 +/- 12.8 g/m(2), P = .001 with electron beam CTA and 78.5 +/- 11.9 vs. 65.0 +/- 9.2 g/m(2), P = .001 with 64 multidetector [MD] CT, respectively). The coefficient of variation between electron beam CTA and 64 MDCT for measuring LVM was 3.1%. Comparing the new CTA/64 MDCT criteria of LVH (103.0 g/m(2) in men; 89.0 g/m(2) in women) to the previous echocardiographic criteria of LVH, the specificity in women and men decreased from 100% in both genders by echocardiography to 91.8% and 92.6%, respectively, but the sensitivity increased from 42.0% to 100% and from 41.1% to 100%. CONCLUSION This study suggests that CT-measured LVM has low variability and normal values based on CT criteria will potentially increase the early detection of LVH.
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