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Myagmardorj R, Fortuni F, Galloo X, Nabeta T, Meucci MC, Butcher SC, van der Kley F, Bax JJ, Ajmone Marsan N. Changes in Global Longitudinal Strain after TAVI: Additional Prognostic Value over Cardiac Damage in Patients with Severe Aortic Stenosis. J Clin Med 2024; 13:3945. [PMID: 38999514 PMCID: PMC11242647 DOI: 10.3390/jcm13133945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Previous studies demonstrated the prognostic value of baseline cardiac damage staging as well as left ventricular global longitudinal strain (LVGLS) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the present study was to evaluate the changes in cardiac damage stage and LVGLS after TAVI and to investigate their prognostic values when integrated into the follow-up assessment. Methods: Patients with severe aortic stenosis undergoing TAVI were hierarchically classified into cardiac damage stages based on echocardiographic criteria before TAVI and at a 6-month follow-up. At the same time, LVGLS was measured. The staging system included stage 0 = no signs of cardiac damage; stage 1 = LV damage; stage 2 = mitral or left atrial damage; stage 3 = pulmonary vasculature or tricuspid damage; and stage 4 = right ventricular damage. The primary endpoint was all-cause mortality. Results: A total of 620 patients were included. At follow-up, LVGLS significantly improved, and the improvement was similar among each baseline cardiac damage stage. Follow-up LVGLS values were divided into quintiles, and each quintile was integrated into the cardiac damage staging, leading to a reclassification of 308 (50%) patients. At the time of a median follow-up at 48 (IQR 31-71) months starting from the 6-month follow-up after TAVI, 262 (38%) patients had died. A multivariable Cox regression model showed that LVGLS-integrated cardiac damage staging at follow-up had an incremental prognostic value over the baseline assessment (HR per 1-stage increase 1.384; 95% CI 1.152-1.663; p < 0.001). Conclusions: The integration of LVGLS with conventional echocardiographic parameters of cardiac damage at a 6-month follow-up after TAVI can improve patient risk-stratification.
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Affiliation(s)
- Rinchyenkhand Myagmardorj
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Federico Fortuni
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
| | - Xavier Galloo
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Takeru Nabeta
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Steele C. Butcher
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Frank van der Kley
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Jeroen J. Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
- Heart Center, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
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Meredith T, Roy D, Hayward C, Feneley M, Kovacic J, Muller D, Namasivayam M. Strain Assessment in Aortic Stenosis: Pathophysiology and Clinical Utility. J Am Soc Echocardiogr 2024; 37:64-76. [PMID: 37805144 DOI: 10.1016/j.echo.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
Contemporary echocardiographic criteria for grading aortic stenosis severity have remained relatively unchanged, despite significant advances in noninvasive imaging techniques over the last 2 decades. More recently, attention has shifted to the ventricular response to aortic stenosis and how this might be quantified. Global longitudinal strain, semiautomatically calculated from standard two-dimensional echocardiographic images, has been the focus of extensive research. Global longitudinal strain is a sensitive marker of subtle hypertrophy-related impairment in left ventricular function and has shown promise as a relatively robust prognostic marker, both independently and when added to severity classification systems. Herein we review the pathophysiological basis underpinning the potential utility of global longitudinal strain in the assessment of aortic stenosis, as well as its potential role in quantifying myocardial recovery and prognostic discrimination following aortic valve replacement.
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Affiliation(s)
- Thomas Meredith
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Roy
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Hayward
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Feneley
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Kovacic
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Muller
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mayooran Namasivayam
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
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3
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Hjertaas JJ, Einarsen E, Gerdts E, Kokorina M, Moen CA, Urheim S, Saeed S, Matre K. Impact of aortic valve stenosis on myocardial deformation in different left ventricular levels: A three-dimensional speckle tracking echocardiography study. Echocardiography 2023; 40:1028-1039. [PMID: 37543718 DOI: 10.1111/echo.15668] [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: 12/29/2022] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Global systolic left ventricular (LV) myocardial function progressively declines as degenerative aortic valve stenosis (AS) progresses. Whether this results in uniformly distributed deformation changes from base to apex has not been investigated. METHODS Eighty-five AS patients underwent three-dimensional (3D) echocardiography in this cross-sectional study. Patients were grouped by peak jet velocity into mild (n = 32), moderate (n = 31), and severe (n = 22) AS. 3D speckle tracking derived strain, rotation, twist, and torsion were obtained to assess global LV function and myocardial function at the apical, mid, and basal levels. RESULTS Global longitudinal strain (GLS) was lower in patients with severe AS (-16.1 ± 2.4% in mild, -15.5 ± 2.5% in moderate, and -13.5 ± 3.0% in severe AS [all p < .01]). Peak basal and mid longitudinal strain (LS), basal rotation and twist from apical to basal level followed the same pattern, while peak apical LS was higher in moderate AS compared to severe AS (all p < .05). In multivariate analyses, lower GLS was particularly associated with male sex, higher body mass index and peak aortic jet velocity, lower basal LS with higher filling pressure (E/e') and LV mass, lower mid LS with higher RWT and presence of AS symptoms, and lower apical LS with male sex and higher systolic blood pressure, respectively (all p < .05). CONCLUSION Using 3D speckle tracking echocardiography reveals regional and global changes in LV mechanics in AS related to the severity of AS, LV remodeling and presence of cardiovascular risk factors.
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Affiliation(s)
| | - Eigir Einarsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marina Kokorina
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Stig Urheim
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review. Life (Basel) 2023; 13:1079. [PMID: 37240724 PMCID: PMC10221682 DOI: 10.3390/life13051079] [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: 03/06/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Kim HM, Hwang I, Yoon YE, Park J, Lee S, Kim H, Kim Y, Lim Y, Cho G. Prediction of Deterioration of Left Ventricular Function Using 3-Dimensional Speckle-Tracking Echocardiography in Patients With Left Bundle-Branch Block. J Am Heart Assoc 2022; 12:e026194. [PMID: 36583438 PMCID: PMC9973573 DOI: 10.1161/jaha.122.026194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Previous studies have demonstrated that 2-dimensional (2D) global longitudinal strain (GLS) is associated with cardiovascular outcomes in patients with left bundle-branch block. However, the predictive value of 3-dimensional (3D) speckle-tracking echocardiography has not yet been investigated in these patients. Methods and Results The authors retrospectively identified 290 patients with left bundle-branch block who underwent echocardiography more than twice. Using speckle-tracking echocardiography, 2D-GLS, 3D-GLS, 3D-global circumferential strain, 3D global radial strain, and 3D global area strain were acquired. The association between 2D and 3D strains and the follow-up left ventricular (LV) ejection fraction (LVEF) was analyzed. The study population was divided into 2 sets: a group with preserved LVEF (baseline LVEF ≥40%) and a group with reduced LVEF (baseline LVEF <40%). After a median follow-up of 29.1 months (interquartile range, 13.1-53.0 months), 14.9% of patients progressed to LV dysfunction in the group with preserved LVEF, and 51.0% of patients showed improved LV function in the group with reduced LVEF. Multivariable analysis of 2D and 3D strains revealed that higher 2D-GLS (odds ratio [OR], 0.65 [95% CI, 0.54-0.78], P<0.001) was highly associated with maintaining LVEF in patients with preserved LVEF. However, a lower 3D-global circumferential strain (OR, 0.61 [95% CI, 0.47-0.78], P<0.001) showed a strong association with persistently reduced LVEF in patients with reduced LVEF. Conclusions Although 2D-GLS showed a powerful predictive value for the deterioration of LV function in the preserved LVEF group, 3D strain, especially 3D-global circumferential strain, can be helpful to predict consistent LV dysfunction in patients with left bundle-branch block who have reduced LVEF.
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Affiliation(s)
- Hyue Mee Kim
- Division of CardiologyDepartment of Internal MedicineChung‐Ang University HospitalChung‐Ang University College of MedicineSeoulSouth Korea
| | - In‐Chang Hwang
- Cardiovascular Center & Department of Internal MedicineCollege of MedicineSeoul National UniversitySeoul National University Bundang HospitalSeongnamGyeonggiSouth Korea
| | - Yeonyee Elizabeth Yoon
- Cardiovascular Center & Department of Internal MedicineCollege of MedicineSeoul National UniversitySeoul National University Bundang HospitalSeongnamGyeonggiSouth Korea
| | - Jun‐Bean Park
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Seung‐Pyo Lee
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Hyung‐Kwan Kim
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Yong‐Jin Kim
- Cardiovascular Center, Department of Internal MedicineCollege of Medicine, Seoul National UniversitySeoul National University HospitalSeoulSouth Korea
| | - Yaeji Lim
- Department of Applied StatisticsChung‐Ang UniversitySeoulSouth Korea
| | - Goo‐Yeong Cho
- Cardiovascular Center & Department of Internal MedicineCollege of MedicineSeoul National UniversitySeoul National University Bundang HospitalSeongnamGyeonggiSouth Korea
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Shamekhi J, Hasse C, Veulemans V, Al-Kassou B, Piayda K, Maier O, Zeus T, Weber M, Sedaghat A, Zimmer S, Kelm M, Nickenig G, Sinning JM. A simplified cardiac damage staging predicts the outcome of patients undergoing TAVR-A multicenter analysis. Catheter Cardiovasc Interv 2022; 100:850-859. [PMID: 35989489 DOI: 10.1002/ccd.30368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/24/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND A significant number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) suffer from extra-aortic cardiac damage. Few studies have investigated strategies to quantify cardiac damage and stratify patients accordingly in different risk groups. The aim of this retrospective multicenter study was to provide a user-friendly simplified staging system based on the proposed classification system of Généreux et al. as a tool to evaluate the prognosis of patients undergoing TAVR more easily. Moreover, we analyzed changes in cardiac damage after TAVR. METHODS We assessed cardiac damage in patients, who underwent TAVR at the Heart Center Bonn or Düsseldorf, using pre- and postprocedural transthoracic echocardiography. Patients were assigned to the staging system proposed by Généreux et al. according to the severity of their baseline cardiac damage. Based on the established system, we created a simplified staging system to facilitate improved applicability. Finally, we compared clinical outcomes between the groups and evaluated changes in cardiac damage after TAVR. RESULTS A total of 933 TAVR patients were included in the study. We found a significant association between cardiac damage and 1-year all-cause mortality (stage 0: 0% vs. stage 1: 3% vs. stage 2: 6.6%; p < 0.009). In multivariate analysis, cardiac damage was an independent predictor of 1-year all-cause mortality (hazard ratio: 2.0, 95% confidence interval: 1.1-3.8; p = 0.03). CONCLUSIONS In patients undergoing TAVR, cardiac damage is associated with enhanced mortality. A simplified staging system can help identify patients at high risk for an adverse outcome.
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Affiliation(s)
- Jasmin Shamekhi
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Caroline Hasse
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Kerstin Piayda
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
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Naeim HA, Abuelatta R, Alatawi FO, Khedr L. Assessment of Left Ventricular Mechanics in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation: 2-D Speckle Tracking Imaging Study. J Saudi Heart Assoc 2020; 32:248-255. [PMID: 33154925 PMCID: PMC7640549 DOI: 10.37616/2212-5043.1065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chronic pressure overload secondary to severe aortic stenosis causes impairment of left ventricular myocardial deformation and associated with adverse outcome. The present study aimed to assess the response of myocardial mechanics after transcatheter aortic valve implantation (TAVI). Methods Assessment of myocardial mechanics by quantification of LV longitudinal, circumferential strain and rotational deformation (apical, basal rotation and twist) by 2-D Speckle-tracking echocardiography at baseline and at midterm follow-up post-TAVI. The patients were divided into 2 groups based on baseline left ventricular ejection fraction. 46 patients had preserved LV EF ≥50% preserved ejection fraction (PEF) and 34 patients had reduced left ventricular ejection (REF) < 50%. Results 80 patients with severe AS and high surgical risk were evaluated. At a mean follow-up of 8 ± 3 months after TAVI, left ventricular longitudinal strain (LS) significantly improved in reduced ejection fraction (REF) group from -9.88 ± 3.93% to 11.89 ± 3.15% (P = 0.001). In preserved ejection fraction (PEF) group, longitudinal strain improved from -13.8 ± 3.1% to -15.2 ± 3.3% (P < 0.001). Longitudinal strain rate (LSR) improved significantly in REFgroup, -0.48 ± 0.20sec−1 to -0.62 ± 0.16 sec−1 (P < 0.001) and in PEF group,-0.73 ± 0.19 sec−1 to-0.77 ± 0.16 sec −1 (P < 0.005). In PEF group, LV twist angle was supra-physiological at baseline and decreased after TAVI towards normal values (P = 0.006). In REF group LV twist angle was reduced at baseline with significant increase towards normal value after transcatheter aortic valve implantation (TAVI),P = 0.005. That was attributed to severe LV dysfunction associated with reduction of left ventricular twist at baseline which improved in response to TAVI alongside with improvement of left ventricular systolic function. In reduced ejection fraction (REF) group circumferential strain and strain rate improved significantly after TAVI. Conclusions Myocardial mechanics of the left ventricle including strain, strain rate and twist are deformed in severe aortic stenosis. TAVI restores myocardial mechanics towards physiological values in patients with preserved and reduced ejection fraction.
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Affiliation(s)
- Hesham A Naeim
- Madinah Cardiac Center, Madinah, Saudi Arabia.,Hesham A. Naeim is affiliated with Cardiology Department, AlAzhar University, Egypt
| | | | - Faisal O Alatawi
- Madinah Cardiac Center, Madinah, Saudi Arabia.,Department of Medicine, Taiba University, Saudi Arabia
| | - Lamiaa Khedr
- Madinah Cardiac Center, Madinah, Saudi Arabia.,Lamiaa Khedr is affiliated with Cardiology Department, Tanta University Hospitals, Egypt
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Nabeshima Y, Seo Y, Takeuchi M. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovasc Ultrasound 2020; 18:23. [PMID: 32591001 PMCID: PMC7320541 DOI: 10.1186/s12947-020-00204-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) left ventricular (LV) myocardial strain measurements using transthoracic 3D echocardiography speckle tracking analysis have several advantages over two-dimensional (2D) LV strain measurements, because 3D strain values are derived from the entire LV myocardium, yielding more accurate estimates of global and regional LV function. In this review article, we summarize the current status of 3D LV myocardial strain. Specifically, we describe how 3D LV strain analysis is performed. Next, we compare characteristics of 2D and 3D strain, and we explain validation of 3D strain measurements, feasibility and measurement differences between 2D and 3D strain, reference values of 3D strain, and its applications in several clinical scenarios. In some parts of this review, we used a meta-analysis to draw reliable conclusions. We also describe the added value of 3D over 2D strain in several specific pathologies and prognoses. Finally, we discuss novel techniques using 3D strain and suggest its future directions.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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Koifman E, Medvedofsky D, Didier R, Torguson R, Jerusalem Z, Kiramijyan S, Ben-Dor I, Wang Z, Goldstein SA, Xu L, Pichard AD, Satler LF, Waksman R, Asch FM. Impact of Baseline Left Ventricular Diastolic Dysfunction in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:258-263. [PMID: 31735329 DOI: 10.1016/j.amjcard.2019.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
We sought to assess the impact of diastolic dysfunction (DD) grade, as per the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines, on survival of patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). We included consecutive patients with severe AS who underwent TAVI in our institution. DD grading was determined retrospectively according to the 2016 ASE DD guidelines and categorized to grade I-III and indeterminate grade I-II DD. Comparison of 1-year survival according to DD grade was performed by Kaplan-Meier analysis, and evaluation of DD at 1 year was performed in a subset of patients. Among 606 TAVI patients, 394 (65%) had sufficient data for DD grading. Seventy-seven (20%) had grade I DD, 191 (48%) had grade II, 60 (15%) had grade III, and 66 (17%) had an indeterminate grade between I and II. Baseline characteristics indicate higher rates of atrial fibrillation, brain natriuretic peptide level, pulmonary artery systolic pressure, and indexed left ventricular mass as DD grade increases (all p ≤0.01). In conclusion, comparison of 1-year survival revealed a higher rate of mortality in patients with grade III DD that remained statistically significant following adjustment in a multivariate Cox proportional hazard model. DD grade after TAVI improved in patients with grades II and III. Severe AS patients with grade III DD have higher risk for 1-year mortality after TAVI compared with milder degrees of DD. Further research is warranted to explore a potential benefit for aortic valve therapy at an earlier stage of the disease process.
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Affiliation(s)
- Edward Koifman
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of The Negev, Be'er Sheva, Israel
| | - Diego Medvedofsky
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Romain Didier
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rebecca Torguson
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Zack Jerusalem
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sarkis Kiramijyan
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Itsik Ben-Dor
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Zuyue Wang
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Steven A Goldstein
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Linzhi Xu
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Augusto D Pichard
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Federico M Asch
- Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia.
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10
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Dogdus M, Kucukosmanoglu M, Kilic S. Assessment of the impact of isolated coronary artery ectasia on left ventricular functions with 3D speckle-tracking echocardiography. Echocardiography 2019; 36:2209-2215. [PMID: 31742786 DOI: 10.1111/echo.14533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D-STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D-STE in the present study. METHODS Ninety-one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D-STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography. RESULTS The mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >-16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >-20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE. CONCLUSION Isolated CAE has a considerable negative effect on LV functions as evaluated by 3D-strain parameters, and 3D-STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Usak University, Training and Research Hospital, Usak, Turkey
| | - Mehmet Kucukosmanoglu
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, Adana, Turkey
| | - Salih Kilic
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, Adana, Turkey
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11
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Hulshof HG, van Oorschot F, van Dijk AP, Hopman MTE, George KP, Oxborough DL, Thijssen DHJ. Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement. J Appl Physiol (1985) 2019; 127:415-422. [DOI: 10.1152/japplphysiol.00190.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.
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Affiliation(s)
- Hugo G. Hulshof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederieke van Oorschot
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P. van Dijk
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T. E. Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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12
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Nara Y, Kataoka A, Watanabe Y, Makoto N, Hioki H, Kawashima H, Fukuko N, Kozuma K, Shirai S, Tada N, Araki M, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Higashimori A, Takagi K, Yamamoto M, Hayashida K. Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis. Open Heart 2019; 6:e000988. [PMID: 31218001 PMCID: PMC6546191 DOI: 10.1136/openhrt-2018-000988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022] Open
Abstract
Objective The effect of postoperative blood flow status on the prognosis of patients with low-gradient severe aortic stenosis (AS) has not been examined. Severe AS is associated with a higher mortality rate after transcatheter aortic valve implantation (TAVI). We examined the prognostic value of low-flow status by comparing stroke volume indices (SVi) before and after TAVI in patients with symptomatic, low-gradient severe AS. Methods A total of 1613 patients with severe symptomatic AS who underwent TAVI in 14 Japanese institutes for low-gradient severe AS (418 patients, median age 84 years, 32.5% men) were prospectively enrolled. The primary endpoint was cardiovascular mortality during follow-up after TAVI, and independent predictors were evaluated. Receiver operating characteristic curves were generated to determine the optimal cut-off value of post-TAVI SVi for predicting cardiovascular mortality, and the receiver operating characteristic curves of pre-TAVI and post-TAVI SVi were compared. Results The cardiovascular mortality rate was 4.1% (17 patients) during follow-up (median 9.2 months). Multivariate analysis revealed post-TAVI SVi to be an independent predictor of cardiovascular mortality (per 10 mL/m2 decrease; HR, 2.0; 95% CI 1.28 to 3.12). The optimal cut-off value of post-TAVI SVi was 41.4 mL/m2. Post-TAVI SVi showed significantly larger area under the curve than pre-TAVI SVi (0.74 (95% CI 0.69 to 0.79) vs 0.61 (95% CI 0.56 to 0.65), p<0.05). Conclusions Post-TAVI SVi is a better predictor of cardiovascular mortality than pre-TAVI SVi in patients with symptomatic low-gradient severe AS. Low-flow and low-normal-flow status (35≤ SVi <40 mL/m2) require careful management after TAVI.
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Affiliation(s)
- Yugo Nara
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Nakashima Makoto
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Nagura Fukuko
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Norio Tada
- Department of Cardiovascular Centre, Sendai Kousei Hospital, Miyagi, Japan
| | - Motoharu Araki
- Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Centre, Chiba, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan.,Division of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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13
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Petitto M, Esposito R, Sorrentino R, Lembo M, Luciano F, De Roberto AM, La Mura L, Pezzullo E, Maffei S, Galderisi M, Lancellotti P. Sex-specific echocardiographic reference values: the women's point of view. J Cardiovasc Med (Hagerstown) 2019; 19:527-535. [PMID: 30015781 DOI: 10.2459/jcm.0000000000000696] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
: Clinical presentation, diagnosis and outcomes of cardiac diseases are influenced by the activity of sex steroid hormones. These hormonal differences explain the later development of heart diseases in women in comparison with men and the different clinical picture, management and prognosis. Echocardiography is a noninvasive and easily available technique for the analysis of cardiac structure and function. The aim of the present review is to underline the most important echocardiographic differences between sexes. Several echocardiographic studies have found differences in healthy populations between women and men. Sex-specific difference of some of these parameters, such as left ventricular (LV) linear dimensions and left atrial volume, can be explained on the grounds of smaller body size of women, but other parameters (LV volumes, stroke volume and ejection fraction, right ventricular size and systolic function) are specifically lower in women, even after adjusting for body size and age. Sex-specific differences of standard Doppler and Tissue Doppler diastolic indices remain controversial, but it is likely for aging to affect LV diastolic function more in women than in men. Global longitudinal strain appears to be higher in women during the childbearing age - a finding that also highlights a possible hormonal influence in women. All these findings have practical implications, and sex-specific reference values are necessary for the majority of echocardiographic parameters in order to distinguish normalcy from disease. Careful attention on specific cut-off points in women could avoid misinterpretation, inappropriate management and delayed treatment of cardiac diseases such as valvular disease and heart failure.
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Affiliation(s)
- Marta Petitto
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Roberta Esposito
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Regina Sorrentino
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Maria Lembo
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Federica Luciano
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Anna Maria De Roberto
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Lucia La Mura
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Enrica Pezzullo
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Silvia Maffei
- Cardiovascular and Gynecological Endocrinology, Fondazione Toscana 'G. Monasterio' for Clinical Research and Public Health, CNR-Regione Toscana, Pisa, Italy
| | - Maurizio Galderisi
- Interdepartmental Laboratory of Cardiac Imaging, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples
| | - Patrizio Lancellotti
- Department of Cardiology and Cardiovascular Surgery, Heart Valve Clinic, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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14
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Deng MD, Wei X, Zhang XL, Li XD, Liu GY, Zhu D, Guo YQ, Tang H. Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2018; 35:99-105. [PMID: 30264363 DOI: 10.1007/s10554-018-1445-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 ± 4.3 years) were enrolled. Conventional echocardiography was performed on all patients before and 12 months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 ± 7.3 to 52.0 ± 6.8 mm, p < 0.001), LV end-diastolic volume (from 199.4 ± 55.0 to 130.1 ± 48.9 mL, p < 0.001), and LV mass index (179.8 ± 52.2-134.4 ± 42.5 g/m2, p = 0.001) decreased 12 months after TAVI. Interestingly, GLS (from - 17.2 ± 3.2 to - 18.9 ± 3.7, p = 0.007) and GCS (from - 23.9 ± 4.9 to - 25.7 ± 5.0, p = 0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 ± 4.0 to 5.5 ± 3.9, p = 0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12 months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.
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Affiliation(s)
- Ming-Dan Deng
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Ling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Dong Li
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gu-Yue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China.
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15
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Corrigan FE, Zhou X, Lisko JC, Hayek SS, Parastatidis I, Keegan P, Howell S, Thourani V, Babaliaros VC, Lerakis S. Mean Aortic pressure gradient and global longitudinal strain recovery after transcatheter aortic valve replacement – A retrospective analysis. Hellenic J Cardiol 2018; 59:268-271. [DOI: 10.1016/j.hjc.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 01/05/2018] [Accepted: 01/12/2018] [Indexed: 10/18/2022] Open
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16
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Yu HK, Xia B, Liu X, Han C, Chen W, Li Z. Initial application of three-dimensional speckle-tracking echocardiography to detect subclinical left ventricular dysfunction and stratify cardiomyopathy associated with Duchenne muscular dystrophy in children. Int J Cardiovasc Imaging 2018; 35:67-76. [PMID: 30105418 DOI: 10.1007/s10554-018-1436-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 08/04/2018] [Indexed: 01/16/2023]
Abstract
Three-dimensional (3D) speckle-tracking echocardiography (STE) is a new imaging modality used for quantitative analysis of left ventricular (LV) function. The aim of this study is to assess the value of 3D STE in early detection of subclinical myocardial involvement in children with Duchenne muscular dystrophy (DMD). Fifty-six children with DMD (mean age, 8.8 ± 1.9 years) and 31 age-matched control subjects were studied. Patients were subdivided into two groups by age: ≤ 8 or > 8 years. Standard echocardiography examinations were performed to measure LV size and ejection fraction (EF). 3D STE was performed to assess LV 3D global strain and LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF. Standard and 3D echocardiography measures were compared between children with DMD and those in the control group as well as between different patient groups. The areas under the receiver-operating characteristic (ROC) curve were calculated to determine the capability of 3D global strain indices to discriminate between patients and control subjects. No significant difference was detected in either LVEF derived from M-mode or 3D echocardiography between the two groups, and they were both within the normal range. Compared with control subjects, children with DMD had significantly reduced LV 3D global longitudinal strain (GLS; - 16.6 ± 4.7 vs. - 19.5 ± 3.7, p = 0.003), global circumferential strain (GCS; - 13.7 ± 2.9 vs. - 15.8 ± 2.6, p = 0.001), global radial strain (GRS; 42.5 ± 9.7 vs. 50.3 ± 10.4, p = 0.001), and global area strain (GAS; - 25.3 ± 4.9 vs. - 30.7 ± 4.1, p = 0.000). The older DMD children (age > 8 years) had lower GLS (- 15.1 ± 4.43 vs. - 18.6 ± 4.35, p < 0.05), GCS (- 12.8 ± 3.48 vs. - 14.8 ± 2.83, p < 0.001), GAS (- 23.8 ± 4.7 vs. - 29.0 ± 5.4, p < 0.001), and GRS (40.7 ± 8.8 vs. 47.3 ± 11.5, p < 0.05) than younger patients (age ≤ 8 years). The AUC of GAS was 0.80, and the cutoff value of - 29.5 had a sensitivity of 85.7% and a specificity of 71.0% for differentiating DMD patients from control. 3D speckle-tracking echocardiography is useful for detecting subclinical myocardial dysfunction and stratifying cardiomyopathy in children with DMD.
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Affiliation(s)
- Hong-Kui Yu
- Department of Ultrasonography, Shenzhen Children's Hospital, 7019, Yitian Road, Shenzhen, Guangdong, China
| | - Bei Xia
- Department of Ultrasonography, Shenzhen Children's Hospital, 7019, Yitian Road, Shenzhen, Guangdong, China.
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Children's Hospital, 7019, Yitian Road, Shenzhen, Guangdong, China
| | - Chunxi Han
- Laboratory of Neuromuscular Disease, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Weiling Chen
- Department of Ultrasonography, Shenzhen Children's Hospital, 7019, Yitian Road, Shenzhen, Guangdong, China
| | - Zhihui Li
- Department of Ultrasonography, Shenzhen Children's Hospital, 7019, Yitian Road, Shenzhen, Guangdong, China
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17
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Dimitriadis Z, Scholtz S, Scholtz W, Wiemer M, Piper C, Ensminger S, Fox H, Horstkotte D, Faber L. Impact of procedure-related conduction disturbances after transcatheter aortic valve implantation on myocardial performance and survival evaluated by conventional and speckle tracking echocardiography. Echocardiography 2018; 35:621-631. [PMID: 29437242 DOI: 10.1111/echo.13823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Although procedure-related new cardiac conduction disturbances (CCDs) remain an important issue in transcatheter aortic valve implantation (TAVI), their effect on myocardial function and overall patient outcome remains unclear. The goal of this study was to analyze the influence of procedure-related CCDs on systolic and diastolic LV performance and on patient survival after TAVI. METHODS AND RESULTS Ninety-five patients who underwent TAVI for severe symptomatic aortic stenosis (AS) and had a complete follow-up were evaluated with respect to procedure-related CCDs. Left ventricular (LV) performance was measured using standard echocardiographic parameters and speckle tracking analysis. Survival was assessed during longer-term follow-up (mean: 29.1 ± 16.9 months). After TAVI, the improvement of global LV function expressed as ejection fraction (LVEF; from 45.5 ± 10.0 to 47.8 ± 13.9%, P = .13) was not significant. New CCDs were found in 35.7% of TAVI recipients. A comparison between patients with and without new CCDs showed that LV systolic function improved in those without CCDs, while it tended to deteriorate in patients with CCDs (change in LVEF: 5.5 ± 12.3% vs -4.9% ± 11.5%, P = .001; change in global longitudinal strain (GLS): -1.1 ± 4.6% vs 1.2 ± 4.5%, P = .01). Changes in diastolic function did not differ significantly between the groups (changes in transmitral E/A-ratio: -0.3 ± 0.6 vs -0.5 ± 0.5, P = .1). Kaplan-Meier survival analysis revealed no significant differences between the two cohorts (P = .795). CONCLUSION Procedure-related conduction abnormalities after TAVI lead to an LBBB-related dyssynchrony with impairment of LV performance but not of overall survival.
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Affiliation(s)
- Zisis Dimitriadis
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Smita Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Werner Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marcus Wiemer
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cornelia Piper
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Lothar Faber
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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18
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Muraru D, Niero A, Rodriguez-Zanella H, Cherata D, Badano L. Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc Diagn Ther 2018. [PMID: 29541615 DOI: 10.21037/cdt.2017.06.01] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is an advanced imaging technique designed for left ventricular (LV) myocardial deformation analysis based on 3D data sets. 3DSTE has the potential to overcome some of the intrinsic limitations of two-dimensional STE (2DSTE) in the assessment of complex LV myocardial mechanics, offering additional deformation parameters (such as area strain) and a comprehensive quantitation of LV geometry and function from a single 3D acquisition. Albeit being a relatively young technique still undergoing technological developments, several experimental studies and clinical investigations have already demonstrated the reliability and feasibility of 3DSTE, as well as several advantages of 3DSTE over 2DSTE. This technique has provided new insights into LV mechanics in several clinical fields, such as the objective assessment of global and regional LV function in ischemic and non-ischemic heart diseases, the evaluation of LV mechanical dyssynchrony, as well as the detection of subclinical cardiac dysfunction in cardiovascular conditions at risk of progression to overt heart failure. However, 3DSTE generally requires patient's breathhold and regular rhythm for enabling an ECG-gated multi-beat 3D acquisition. In addition, the measurements, normal limits and cut-off values pertaining to 3D strain parameters are currently vendor-specific and highly dependent on the 3D ultrasound equipment used. Technological advances with improvement in spatial and temporal resolution and a standardized methodology for obtaining vendor-independent 3D strain measurements are expected in the future for a widespread application of 3DSTE in both clinical and research arenas. The purpose of this review is to summarize currently available data on 3DSTE methodology (feasibility, accuracy and reproducibility), strengths and weaknesses with respect to 2DSTE, as well as the main clinical applications and future research priorities of this emerging technology.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alice Niero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Hugo Rodriguez-Zanella
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.,Echocardiography Laboratory, National Institute of Cardiology, "Ignacio Chávez", Mexico City, Mexico
| | - Diana Cherata
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.,Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania
| | - Luigi Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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19
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Sato K, Kumar A, Jones BM, Mick SL, Krishnaswamy A, Grimm RA, Desai MY, Griffin BP, Rodriguez LL, Kapadia SR, Obuchowski NA, Popović ZB. Reversibility of Cardiac Function Predicts Outcome After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis. J Am Heart Assoc 2017; 6:JAHA.117.005798. [PMID: 28698259 PMCID: PMC5586298 DOI: 10.1161/jaha.117.005798] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Reversibility of left ventricular (LV) dysfunction in high‐risk aortic stenosis patient and its impact on survival after transcatheter aortic valve replacement (TAVR) are unclear. We aimed to evaluate longitudinal changes of LV structure and function after TAVR and their impact on survival. Methods and Results We studied 209 patients with aortic stenosis who underwent TAVR from May 2006 to December 2012. Echocardiograms were used to calculate LV end‐diastolic volume index (LVEDVi), LV ejection fraction, LV mass index (LVMi), and global longitudinal strain before, immediately (<10 days), late (1–3 months), and yearly after TAVR. During a median follow‐up of 1345 days, 118 patients died, with 26 dying within 1 year. Global longitudinal strain, LVEDVi, LV ejection fraction, and LVMi improved during follow‐up. In patients who died during the first year, death was preceded by LVEDVi and LVMi increase. Multivariable longitudinal data analysis showed that aortic regurgitation at baseline, aortic regurgitation at 30 days, and initial LVEDVi were independent predictors of subsequent LVEDVi. In a joint analysis of longitudinal and survival data, baseline Society of Thoracic Surgeons score was predictive of survival, with no additive effect of longitudinal changes in LVEDVi, LVMi, global longitudinal strain, or LV ejection fraction. Presence of aortic regurgitation at 1 month after TAVR was the only predictor of 1‐year survival. Conclusions LV reverse remodeling was observed after TAVR, whereas lack of LVEDVi and LVMi improvement was observed in patients who died during the first year after TAVR. Post‐TAVR, aortic regurgitation blocks reverse remodeling and is associated with poor 1‐year survival after TAVR.
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Affiliation(s)
- Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brandon M Jones
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Richard A Grimm
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popović
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Tadic M, Zlatanovic M, Cuspidi C, Ivanovic B, Stevanovic A, Damjanov N, Kocijancic V, Celic V. The relationship between left ventricular deformation and heart rate variability in patients with systemic sclerosis: Two- and three-dimensional strain analysis. Int J Cardiol 2017; 236:145-150. [DOI: 10.1016/j.ijcard.2017.02.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/26/2017] [Accepted: 02/10/2017] [Indexed: 12/11/2022]
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21
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Garg V, Ho JK, Vorobiof G. Changes in myocardial deformation after transcatheter and surgical aortic valve replacement. Echocardiography 2017; 34:603-613. [DOI: 10.1111/echo.13485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Vinisha Garg
- Department of Medicine; Division of Cardiology; David Geffen School of Medicine at UCLA; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
| | - Jonathan K. Ho
- Department of Anesthesiology & Perioperative Medicine; David Geffen School of Medicine at UCLA; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
| | - Gabriel Vorobiof
- Department of Medicine; Division of Cardiology; David Geffen School of Medicine at UCLA; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
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Howard-Quijano K, Salem A, Barkulis C, Mazor E, Scovotti JC, Ho JK, Shemin RJ, Grogan T, Elashoff D, Mahajan A. Preoperative Three-Dimensional Strain Imaging Identifies Reduction in Left Ventricular Function and Predicts Outcomes After Cardiac Surgery. Anesth Analg 2017; 124:419-428. [DOI: 10.1213/ane.0000000000001440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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Dimitriadis Z, Scholtz S, Ensminger S, Wiemer M, Fischbach T, Scholtz W, Piper C, Börgermann J, Bitter T, Horstkotte D, Faber L. Left ventricular adaptation after TAVI evaluated by conventional and speckle-tracking echocardiography. Int J Cardiol 2017; 228:633-637. [DOI: 10.1016/j.ijcard.2016.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/16/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
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Kemaloğlu Öz T, Eren M, Atasoy I, Gürol T, Soylu Ö, Dağdeviren B. Are biventricular systolic functions impaired in patient with coronoray slow flow? A prospective study with three dimensional speckle tracking. Int J Cardiovasc Imaging 2017; 33:675-681. [DOI: 10.1007/s10554-016-1054-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
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25
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Stöhr EJ, Shave RE, Baggish AL, Weiner RB. Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 2016; 311:H633-44. [DOI: 10.1152/ajpheart.00104.2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022]
Abstract
The anatomy of the adult human left ventricle (LV) is the result of its complex interaction with its environment. From the fetal to the neonatal to the adult form, the human LV undergoes an anatomical transformation that finally results in the most complex of the four cardiac chambers. In its adult form, the human LV consists of two muscular helixes that surround the midventricular circumferential layer of muscle fibers. Contraction of these endocardial and epicardial helixes results in a twisting motion that is thought to minimize the transmural stress of the LV muscle. In the healthy myocardium, the LV twist response to stimuli that alter preload, afterload, or contractility has been described and is deemed relatively consistent and predictable. Conversely, the LV twist response in patient populations appears to be a little more variable and less predictable, yet it has revealed important insight into the effect of cardiovascular disease on LV mechanical function. This review discusses important methodological aspects of assessing LV twist and evaluates the LV twist responses to the main physiological and pathophysiological states. It is concluded that correct assessment of LV twist mechanics holds significant potential to advance our understanding of LV function in human health and cardiovascular disease.
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Affiliation(s)
- Eric J. Stöhr
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Rob E. Shave
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B. Weiner
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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Shin SH, Suh YJ, Baek YS, Lee MJ, Park SD, Kwon SW, Woo SI, Kim DH, Park KS, Kwan J. Impact of area strain by 3D speckle tracking on clinical outcome in patients after acute myocardial infarction. Echocardiography 2016; 33:1854-1859. [DOI: 10.1111/echo.13354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Young Ju Suh
- Institute of Clinical Research; Inha University College of Medicine; Incheon South Korea
| | - Yong-Soo Baek
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Man-Jong Lee
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Sang-Don Park
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Sung-Woo Kwon
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Seong-Ill Woo
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Dae-Hyeok Kim
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Keum-Soo Park
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Jun Kwan
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
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Calcific Aortic Valve Disease: Part 1--Molecular Pathogenetic Aspects, Hemodynamics, and Adaptive Feedbacks. J Cardiovasc Transl Res 2016; 9:102-18. [PMID: 26891845 DOI: 10.1007/s12265-016-9679-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/27/2016] [Indexed: 01/01/2023]
Abstract
Aortic valvular stenosis (AVS), produced by calcific aortic valve disease (CAVD) causing reduced cusp opening, afflicts mostly older persons eventually requiring valve replacement. CAVD had been considered "degenerative," but newer investigations implicate active mechanisms similar to atherogenesis--genetic predisposition and signaling pathways, lipoprotein deposits, chronic inflammation, and calcification/osteogenesis. Consequently, CAVD may eventually be controlled/reversed by lifestyle and pharmacogenomics remedies. Its management should be comprehensive, embracing not only the valve but also the left ventricle and the arterial system with their interdependent morphomechanics/hemodynamics, which underlie the ensuing diastolic and systolic LV dysfunction. Compared to even a couple of decades ago, we now have an increased appreciation of genomic and cytomolecular pathogenetic mechanisms underlying CAVD. Future pluridisciplinary studies will characterize better and more completely its pathobiology, evolution, and overall dynamics, encompassing intricate feedback processes involving specific signaling molecules and gene network cascades. They will herald more effective, personalized medicine treatments of CAVD/AVS.
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Poulin F, Yingchoncharoen T, Wilson WM, Horlick EM, Généreux P, Tuzcu EM, Stewart W, Osten MD, Woo A, Thavendiranathan P. Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2016; 5:JAHA.115.002866. [PMID: 26857069 PMCID: PMC4802434 DOI: 10.1161/jaha.115.002866] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis‐patient mismatch (PPM). Methods and Results In a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid‐term follow‐up post‐TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P=0.01), GLSR (−0.61±0.20 to −0.73±0.25 second−1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second−1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre‐TAVR ejection fraction and post‐TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM. Conclusions TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.
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Affiliation(s)
- Frédéric Poulin
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada
| | | | - William M Wilson
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Eric M Horlick
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Philippe Généreux
- Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada
| | | | | | - Mark D Osten
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Anna Woo
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
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Assessment of Biventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Secondary Mitral Regurgitation after Repair with the MitraClip System. J Am Soc Echocardiogr 2015; 28:1070-82. [DOI: 10.1016/j.echo.2015.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/22/2022]
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30
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Echocardiographic evaluation of myocardial strain in patients after transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:95-9. [PMID: 26161100 PMCID: PMC4495124 DOI: 10.5114/pwki.2015.52281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/22/2015] [Accepted: 03/26/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Echocardiographic evaluation of regional myocardial function helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. Aim To assess whether myocardial strain can be useful in estimation of left ventricle (LV) function in patients who have undergone transcatheter aortic valve implantation (TAVI). Material and methods Twenty-six patients with severe aortic stenosis, who successfully underwent TAVI, were enrolled in the study. Left ventricular peak systolic longitudinal strain (LV PSLS) was obtained before and 1 year after the procedure. Analysis included the potent influence of factors such as sex, LV ejection fraction (LVEF), type of prosthesis implanted or the type of the approach on LV PSLS values. Results We observed a significant improvement in LV PSLS values after TAVI (–10.9 ±5.7 vs. –13.4 ±4.7, p < 0.05). Men had better improvement in LV PSLS after TAVI, but their starting values were considerably lower (M: –10.7 ±4.5 before vs. –13.3 ±4.9 after, p < 0.05; W: –11.8 ±6.8 before vs. –11.9 ±5.6 after, p = NS). Patients with starting LVEF ≤ 40% benefited from the procedure (LV PSLS: –10.3 ±6.4 before vs. –13.7 ±2.9 after, p < 0.05), but in the group of patients with the higher starting LVEF no significant changes in LV PSLS were observed. We also did not note any differences in LV PSLS depending on type of the prosthesis implemented (Edwards Sapiens/CoreValve). Patients in whom the prostheses were implemented via the femoral approach only presented significant increase in LV PSLS values (before: –10.4 ±6.7 vs. after: –13.6 ±3.7, p < 0.05). Conclusions The TAVI results in improvement of LV systolic function according to LV PSLS values. Some factors, especially lower baseline LVEF, are related to increased benefit in LV PSLS after TAVI.
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Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR. Clin Res Cardiol 2015; 104:964-74. [DOI: 10.1007/s00392-015-0865-9] [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: 07/28/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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32
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Recovery of Left Ventricular Mechanics after Transcatheter Aortic Valve Implantation: Effects of Baseline Ventricular Function and Postprocedural Aortic Regurgitation. J Am Soc Echocardiogr 2014; 27:1133-42. [DOI: 10.1016/j.echo.2014.07.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Indexed: 11/15/2022]
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33
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Kleijn SA, Pandian NG, Thomas JD, Perez de Isla L, Kamp O, Zuber M, Nihoyannopoulos P, Forster T, Nesser HJ, Geibel A, Gorissen W, Zamorano JL. Normal reference values of left ventricular strain using three-dimensional speckle tracking echocardiography: results from a multicentre study. Eur Heart J Cardiovasc Imaging 2014; 16:410-6. [DOI: 10.1093/ehjci/jeu213] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Muraru D, Cucchini U, Mihăilă S, Miglioranza MH, Aruta P, Cavalli G, Cecchetto A, Padayattil-Josè S, Peluso D, Iliceto S, Badano LP. Left Ventricular Myocardial Strain by Three-Dimensional Speckle-Tracking Echocardiography in Healthy Subjects: Reference Values and Analysis of Their Physiologic and Technical Determinants. J Am Soc Echocardiogr 2014; 27:858-871.e1. [DOI: 10.1016/j.echo.2014.05.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 01/05/2023]
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Kamperidis V, Joyce E, Debonnaire P, Katsanos S, van Rosendael PJ, van der Kley F, Sianos G, Bax JJ, Ajmone Marsan N, Delgado V. Left ventricular functional recovery and remodeling in low-flow low-gradient severe aortic stenosis after transcatheter aortic valve implantation. J Am Soc Echocardiogr 2014; 27:817-25. [PMID: 24906801 DOI: 10.1016/j.echo.2014.04.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Speckle-tracking-derived global longitudinal strain (GLS) is a more sensitive method of detecting left ventricular (LV) functional recovery after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. However, it remains unknown whether LV function improves in patients with low-flow, low-gradient severe aortic stenosis (LFLGSAS) after TAVI. The aim of the present was to evaluate LV functional recovery and remodeling after TAVI in patients with LFLGSAS. METHODS Sixty-eight patients (57% men; mean age, 79.1 ± 7.1 years) with LFLGSAS treated with TAVI were evaluated. LV function and remodeling were investigated before TAVI and at 6 and 12 months after TAVI. All echocardiographic data were prospectively collected, and GLS was retrospectively analyzed. RESULTS Among patients with LFLGSAS, 35 (52%) had low LV ejection fraction (LVEF) (<50%), and 33 (48%) had preserved LVEF (≥50%). The low-LVEF group had significantly more impaired GLS than the group with preserved LVEF (-8.3 ± 2.6% vs -13.3 ± 3.5%, P < .001). LV systolic function improved after TAVI in both groups. Although in the group of patients with low LVEF, all functional parameters improved, in the group of patients with preserved LVEF, only strain-derived parameters significantly improved. There were significant decreases in absolute LV wall thickness and relative wall thickness and a trend toward decreased LV mass index in both LVEF groups. LV volumes decreased significantly in those with low LVEF but not in those with preserved LVEF. Baseline GLS but not LVEF group was independently associated to GLS improvement at 12 months after TAVI. CONCLUSIONS Patients with LFLGSAS with low and preserved LVEF had a significant improvement in LV function after TAVI, as assessed by GLS. Absolute and relative LV wall thickness decreased in both groups of patients, but only those with low LVEF had reductions in LV volumes.
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Affiliation(s)
- Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Emer Joyce
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippe Debonnaire
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Spyridon Katsanos
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Georgios Sianos
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. Functional status and quality of life after transcatheter aortic valve replacement: a systematic review. Ann Intern Med 2014; 160:243-54. [PMID: 24727842 PMCID: PMC4039034 DOI: 10.7326/m13-1316] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. PURPOSE To evaluate the changes in functional status and quality of life after TAVR. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. STUDY SELECTION Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. DATA EXTRACTION Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range of mean change was summarized. DATA SYNTHESIS We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. LIMITATIONS Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. CONCLUSION Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making.
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Affiliation(s)
- Caroline A. Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Suraj P. Rasania
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jonathan Afilalo
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey J. Popma
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Lewis A. Lipsitz
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Dae Hyun Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
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Luo XX, Fang F, Lee APW, Sun JP, Li S, Zhang ZH, Sanderson JE, Kwong JSW, Zhang Q, Wang J, Yu CM. What can three-dimensional speckle-tracking echocardiography contribute to evaluate global left ventricular systolic performance in patients with heart failure? Int J Cardiol 2014; 172:132-7. [PMID: 24485606 DOI: 10.1016/j.ijcard.2013.12.314] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/11/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Three-dimensional speckle-tracking echocardiography (3D-STE) is a newly developed technique to evaluate left ventricular (LV) deformation by measuring the area strain (AS) of endocardial surface that combines information from both longitudinal (LS) and circumferential strain (CS). We performed a study to examine myocardial deformation in patients with heart failure (HF) using 3D-STE. METHOD A total of 149 subjects including 58 patients with HF and preserved ejection fraction (HFPEF), 45 patients with HF and reduced ejection fraction (HFREF), and 46 normal subjects were prospectively studied by 3D-STE. RESULT After adjusting for age, gender and BSA, global CS, LS, radial strain (RS) and AS derived from 3D-STE in patients with HFPEF were significantly higher than their counterparts in patients with HFREF (all p<0.001), but lower than that in normal subjects (all p<0.05). In addition, among all the strain parameters, global AS exhibited the highest correlation with LV ejection fraction (y=1.243x+6.332, r=0.982, p<0.001) and the best intra- (ICCs: 0.986, p<0.001) and inter-observer variability (ICCs: 0.978, p<0.001) than other parameters of 3D strain (CS: 0.981 and 0.974; LS: 0.908 and 0.841; RS: 0.946 and 0.915; all p<0.001). CONCLUSIONS Measurement of endocardial surface AS based on 3D-STE technique is reproducible and proves to be accurate and comprehensive in assessing the global LV performance and multidirectional deformation of the LV myocardium in HF patients.
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Affiliation(s)
- Xiu-Xia Luo
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Fang Fang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jing-Ping Sun
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shuang Li
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Zhi-Hua Zhang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - John E Sanderson
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joey S W Kwong
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Qing Zhang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jing Wang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong.
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Costa SP, Beaver TA, Rollor JL, Vanichakarn P, Magnus PC, Palac RT. Quantification of the Variability Associated with Repeat Measurements of Left Ventricular Two-Dimensional Global Longitudinal Strain in a Real-World Setting. J Am Soc Echocardiogr 2014; 27:50-4. [DOI: 10.1016/j.echo.2013.08.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Indexed: 10/26/2022]
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Seo Y, Ishizu T, Atsumi A, Kawamura R, Aonuma K. Three-Dimensional Speckle Tracking Echocardiography. Circ J 2014; 78:1290-301. [DOI: 10.1253/circj.cj-14-0360] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Akiko Atsumi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Ryo Kawamura
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Xia JZ, Xia JY, Li G, Ma WY, Wang QQ. Left ventricular strain examination of different aged adults with 3D speckle tracking echocardiography. Echocardiography 2013; 31:335-9. [PMID: 24028413 DOI: 10.1111/echo.12367] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to identify traits of the left ventricular (LV) global longitudinal strain (GLS), global radial strain (GRS), global circular strain (GCS), and global area tracking (GAT) with three-dimensional speckle tracking echocardiography (3DSTE), and to determine the relationship between strain and age in healthy adults of different ages. A total of 153 volunteers were divided into young adult, middle-aged, and elderly groups, and examined with echocardiography to obtain general data and live two-dimensional (2D) images of the apical four-chamber view, which were assembled to obtain the full volume view of the LV. The images were then analyzed with 3DSTE software. Compared with the young adult and middle-aged groups, elderly adults demonstrated lower GLS, GRS, GCS, and GAT. Significant differences were not noted in GLS, GRS, and GCS between the young adult and middle-aged groups; however, the GAT of the middle-aged group was lower than that of the young adult group. The longitudinal strain (LS), radial strain (RS), and area tracking (AT) of 16 LV segments of the young adult group decreased gradually in level from the mitral valve to the apex, and increased in circular strain (CS). The LS, RS, CS, and AT of the middle-aged group also decreased gradually. The LS, RS, CS, and AT of the elderly people were highest from the mitral valve to the apex level and lowest at the papillary muscle. The results of this study demonstrated that LV GLS, GRS, GCS, and GAT decrease with age.
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Affiliation(s)
- Ji-zhu Xia
- Department of Ultrasound, Affiliated Hospital of Luzhou Medical College, Luzhou, China
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Value of three-dimensional speckle-tracking in detecting left ventricular dysfunction in patients with aortic valvular diseases. J Am Soc Echocardiogr 2013; 26:1245-52. [PMID: 23993696 DOI: 10.1016/j.echo.2013.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to investigate the value of three-dimensional speckle-tracking echocardiography for the detection of subclinical left ventricular dysfunction in patients with aortic valvular disease (AVD). METHODS Fifty-nine patients with AVD in New York Heart Association functional class I or II as well as 48 controls were recruited. Patients with AVD were divided further into those with aortic stenosis (AS; n = 34) and those with aortic regurgitation (AR; n = 25). All patients underwent conventional echocardiography and three-dimensional speckle-tracking echocardiography. RESULTS Analysis of variance showed global longitudinal strain to be compromised in the AR group (-16.9% vs -19.3%, P = .015) and more dramatically decreased in the AS group (-14.3% vs -19.3%, P < .001) compared with healthy controls. Impairment of global circumferential strain was observed in patients with AR (-15.9% vs -18.5%, P = .009) but not in those with AS (-18.2% vs -18.5%, P = .768). Global area strain and global radial strain were decreased in patients with AS and those with AR compared with controls, but the difference between the two subgroups was not significant. CONCLUSIONS Strains measured by three-dimensional speckle-tracking echocardiography are useful indices of early-stage heart dysfunction caused by AVD. Longitudinal strain is more vulnerable to pressure overload caused by AS, whereas circumferential strain is more sensitive to volume overload due to AR.
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Biswas M, Sudhakar S, Nanda NC, Buckberg G, Pradhan M, Roomi AU, Gorissen W, Houle H. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography 2013; 30:88-105. [PMID: 23297852 DOI: 10.1111/echo.12079] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two-dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two-dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three-dimensional STE may further extend its clinical usefulness.
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Affiliation(s)
- Monodeep Biswas
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama 35249, USA
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Sinning JM, Vasa-Nicotera M, Chin D, Hammerstingl C, Ghanem A, Bence J, Kovac J, Grube E, Nickenig G, Werner N. Evaluation and Management of Paravalvular Aortic Regurgitation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2013; 62:11-20. [DOI: 10.1016/j.jacc.2013.02.088] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 01/23/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022]
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Løgstrup BB, Andersen HR, Thuesen L, Christiansen EH, Terp K, Klaaborg KE, Poulsen SH. Left ventricular global systolic longitudinal deformation and prognosis 1 year after femoral and apical transcatheter aortic valve implantation. J Am Soc Echocardiogr 2013; 26:246-54. [PMID: 23306032 DOI: 10.1016/j.echo.2012.12.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aortic valve replacement is the recommended therapy for patients with severe aortic stenosis who have symptoms or decreased left ventricular (LV) function. Transcatheter aortic valve implantation (TAVI) is a treatment alternative in surgically high-risk or inoperable patients with severe aortic stenosis. The objective of this study was to analyze LV function assessed by global LV longitudinal systolic strain (GLS) and relation to prognosis in patients with severe aortic stenosis treated with femoral or apical TAVI. METHODS Two-dimensional echocardiography was performed before and 1 year after TAVI. Ejection fraction (EF) was retrospectively measured using the biplane Simpson's method, and GLS was obtained as an average of 16 segments in the three standard apical views by speckle-tracking. GE Vivid 7 and Vivid 9 machines were used for echocardiography, and speckle-tracking analysis was performed using EchoPAC PC '08 version 7.0.1. RESULTS The total population consisted of 100 TAVI patients. Eighty-one patients survived to 1-year follow-up, with a mean age of 81 ± 7 years (range, 64-93 years) and a mean European System for Cardiac Operative Risk Evaluation score of 9.6 ± 2.7. Nineteen patients died before 1-year follow-up (12 women), with a mean age of 82 ± 7 years (range, 66-92 years) and a mean European System for Cardiac Operative Risk Evaluation score of 10.5 ± 2.8. No differences were found between the 19 patients who died before follow-up and the 81 patients who survived to 1-year follow-up. GLS was increased significantly 1 year after TAVI. In 34 patients with EFs > 50%, GLS increased from -15.3 ± 3.4 to -17.1 ± 3.6 (P = .04). In these patients, the mean EF increased numerically from 57.9 ± 5.3% to 60 ± 7.7% (P = .19). In 74 patients with EFs ≤ 50%, mean GLS and EF improved significantly from -10 ± 2.8 to -13.8 ± 3.8 (P < .0001) and 39 ± 9.4% to 52 ± 12.5% (P < .0001), respectively. The 1-year gain in EF was the same after femoral TAVI (9.7 ± 10.1%) and after apical TAVI (8 ± 10.8%) (P = .52). Furthermore, GLS did not differ significantly after femoral and apical TAVI (-3.8 ± 3.3 and -2.6 ± 3.7, respectively, P = .21). There was no difference in causes of death according to approach. In the total population (n = 100), 35 deaths occurred, 19 before 1-year follow-up and 16 afterward. The median follow-up time was 30 months. Twenty-five patients (71%) died from cardiac causes. Overall 1-year mortality was 19%, and overall 2-year mortality was 28%. In the patients who died, the median survival time in the apical group was 28.5 ± 15.4 months, compared with 31.6 ± 19 months in the femoral group (P = .47). There was no impact on prognosis according to high (≥47.5%) versus low (<47.5%) baseline EF or high (≥11.95%) versus low (<11.95%) baseline GLS. However, the magnitude of changes in GLS seemed to have a prognostic impact. CONCLUSIONS LV EF and longitudinal systolic deformation were improved in TAVI independent of technical approach using the Edwards SAPIEN valve prosthesis during 1-year follow-up. The mortality rate was comparable between technical approaches and independent of baseline LV function. However, patients with the greatest improvement in LV systolic longitudinal deformation after TAVI had a lower mortality rate.
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Jasaityte R, Heyde B, D'hooge J. Current state of three-dimensional myocardial strain estimation using echocardiography. J Am Soc Echocardiogr 2012; 26:15-28. [PMID: 23149303 DOI: 10.1016/j.echo.2012.10.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Indexed: 11/25/2022]
Abstract
With the developments in ultrasound transducer technology and both hardware and software computing, real-time volumetric imaging has become widely available, accompanied by various methods of assessing three-dimensional (3D) myocardial strain, often referred to as 3D speckle-tracking echocardiographic methods. Indeed, these methods should provide cardiologists with a better view of regional myocardial mechanics, which might be important for diagnosis, prognosis, and therapy. However, currently available 3D speckle-tracking echocardiographic methods are based on different algorithms, which introduce substantial differences between them and make them not interchangeable with each other. Therefore, it is critical that each 3D speckle-tracking echocardiographic method is validated individually before being introduced into clinical practice. In this review, the authors discuss differences and similarities of the currently available 3D strain estimation approaches and provide an overview of the current status of their validation.
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Affiliation(s)
- Ruta Jasaityte
- Department Cardiovascular Sciences, Laboratory of Cardiovascular Imaging and Dynamics, Catholic University of Leuven, Leuven, Belgium.
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Nemes A, Kalapos A, Domsik P, Forster T. Three-dimensional speckle-tracking echocardiography – a further step in the non-invasive three-dimensional cardiac imaging. Orv Hetil 2012; 153:1570-7. [DOI: 10.1556/oh.2012.29466] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Three-dimensional speckle-tracking echocardiography is a new cardiac imaging methodology, which allows three-dimensional non-invasive evaluation of the myocardial mechanics. The aim of this review is to present this new tool emphasizing its diagnostic potentials and demonstrating its limitations, as well. Orv. Hetil., 2012, 153, 1570–1577.
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Affiliation(s)
- Attila Nemes
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ Szeged Korányi fasor 6. 6720
| | - Anita Kalapos
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ Szeged Korányi fasor 6. 6720
| | - Péter Domsik
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ Szeged Korányi fasor 6. 6720
| | - Tamás Forster
- Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ Szeged Korányi fasor 6. 6720
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