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Meekers E, Dupont M. Role of Imaging and Biomarkers in Identifying, Monitoring, and Promoting Myocardial Recovery. Methodist Debakey Cardiovasc J 2024; 20:42-53. [PMID: 39193116 PMCID: PMC11348843 DOI: 10.14797/mdcvj.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/22/2024] [Indexed: 08/29/2024] Open
Abstract
Reverse remodeling, the overarching concept behind myocardial recovery, describes the process in which the maladaptive cardiac structural and functional alterations are reversed by removing the underlying etiology or by therapy. This review addresses different imaging modalities and biomarkers as possible predictors for reverse remodeling in patients with chronic heart failure. Although echocardiography remains the imaging modality of choice in daily practice, the presence and amount of fibrosis on cardiac magnetic resonance is a better predictor and inversely correlated with the likelihood for reverse remodeling. A decrease in NT-proBNP levels and serum soluble ST3 during follow-up is associated with better clinical and structural outcomes. The role of troponins and galectine-3 is less clear. There is a promising role for microRNAs in the future, although more research is necessary. Accurate predictors of reverse remodeling could help identify patients with an increased likelihood for reverse remodeling and, in turn, improve patient-tailored medicine.
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Affiliation(s)
- Evelyne Meekers
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium
- Hasselt University, Diepenbeek, Belgium
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2
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Anwar AM. Incremental diagnostic and prognostic utility of left atrial deformation in heart failure using speckle tracking echocardiography. Heart Fail Rev 2024; 29:713-727. [PMID: 38466374 DOI: 10.1007/s10741-024-10392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
Left atrium (LA) is a very important component of cardiovascular performance. The assessment of LA function has gathered the interest with expanding research supporting the utility as a biomarker for outcomes in heart failure (HF). Echocardiography is the main imaging modality which helps in a qualitative and quantitative assessment of the LA size and function. Recent advances in probe technology and software analysis have provided a better understanding of LA anatomy, physiology, pathology, and function. A variety of parameters have been defined as markers of LA function but there is no single parameter that best defines LA function. Speckle tracking echocardiography-derived analysis of LA deformation provides a window on all phases of LA function (reservoir, conduit, and booster pump). There is accumulative published data that supported the diagnostic and prognostic values of LA deformation integration during echo assessment of LA in HF. This review article summarized the clinical utility of LA deformation that may help in prediction, diagnosis, categorization, risk stratification, and guiding the proper selection of therapy in HF patients in daily practice.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, P.O. Box: 9862, Jeddah, 21159, Saudi Arabia.
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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O’Neill T, Kang P, Hagendorff A, Tayal B. The Clinical Applications of Left Atrial Strain: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:693. [PMID: 38792875 PMCID: PMC11123486 DOI: 10.3390/medicina60050693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Left atrial (LA) strain imaging, which measures the deformation of the LA using speckle-tracing echocardiography (STE), has emerged recently as an exciting tool to help provide diagnostic and prognostic information for patients with a broad range of cardiovascular (CV) pathologies. Perhaps due to the LA's relatively thin-walled architecture compared with the more muscular structure of the left ventricle (LV), functional changes in the left atrium often precede changes in the LV, making LA strain (LAS) an earlier marker for underlying pathology than many conventional echocardiographic parameters. LAS imaging is typically divided into three phases according to the stage of the cardiac cycle: reservoir strain, which is characterized by LA filling during systole; conduit strain, which describes LA deformation during passive LV filling; and booster strain, which provides information on the LA atrium during LA systole in late ventricular diastole. While additional large-population studies are still needed to further solidify the role of LAS in routine clinical practice, this review will discuss the current evidence of its use in different pathologies and explore the possibilities of its applications in the future.
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Affiliation(s)
- Thomas O’Neill
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Puneet Kang
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, 04103 Leipzig, Germany;
| | - Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
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4
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Buendía-Fuentes F, Lozano-Edo S, Jover-Pastor P, Sánchez-Martínez JC, Martínez-Sole J, Rodríguez-Serrano M, Aguero J, Arnau-Vives MA, Osa-Sáez A, Martínez-Dolz LV, Rueda J. Left atrial strain in adults after the arterial switch operation for transposition of the great arteries. Echocardiography 2024; 41:e15750. [PMID: 38284674 DOI: 10.1111/echo.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. METHODS A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. RESULTS LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13 ± 7.67 vs. 49.71 ± 8.38; LAS cd: -22.91 ± 5.69 vs. -34.55 ± 6.54; LASct: -8.14 ± 4.93 vs. -15.15 ± 6.07, p < .001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29 ± 2.68 vs. -21.98 ± 1.84, p < .001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38 ± 8.23 vs. 69.28 ± 5.92, p = .001) and 3D analysis (57.97% ± 4.16 vs. 60.67 ± 3.39, p = .011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. CONCLUSIONS LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.
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Affiliation(s)
- Francisco Buendía-Fuentes
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Silvia Lozano-Edo
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Pablo Jover-Pastor
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Julia Martínez-Sole
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel A Arnau-Vives
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luis V Martínez-Dolz
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Joaquín Rueda
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Pensa AV, Khan SS, Shah RV, Wilcox JE. Heart failure with improved ejection fraction: Beyond diagnosis to trajectory analysis. Prog Cardiovasc Dis 2024; 82:102-112. [PMID: 38244827 DOI: 10.1016/j.pcad.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
Left ventricular (LV) systolic dysfunction represents a highly treatable cause of heart failure (HF). A substantial proportion of patients with HF with reduced ejection fraction (EF;HFrEF) demonstrate improvement in LV systolic function (termed HF with improved EF [HFimpEF]), either spontaneously or when treated with guideline-directed medical therapy (GDMT). Although it is a relatively new HF classification, HFimpEF has emerged in recent years as an important and distinct clinical entity. Improvement in LVEF leads to decreased rates of mortality and adverse HF-related outcomes compared to patients with sustained LV systolic dysfunction (HFrEF). While numerous clinical and imaging factors have been associated with HFimpEF, identification of which patients do and do not improve requires further investigation. In addition, patients improve at different rates, and what determines the trajectory of HFimpEF patients after improvement is incompletely characterized. A proportion of patients maintain improvement in LV systolic function, while others experience a recrudescence of systolic dysfunction, especially with GDMT discontinuation. In this review we discuss the contemporary guideline-recommended classification definition of HFimpEF, the epidemiology of improvement in LV systolic function, and the clinical course of this unique patient population. We also offer evidence-based recommendations for the clinical management of HFimpEF and provide a roadmap for future directions in understanding and improving outcomes in the care of patients with HFimpEF.
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Affiliation(s)
- Anthony V Pensa
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ravi V Shah
- Department of Medicine, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
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Yoshimura R, Hayashi O, Horio T, Fujiwara R, Matsuoka Y, Yokouchi G, Sakamoto Y, Matsumoto N, Fukuda K, Shimizu M, Izumiya Y, Yoshiyama M, Fukuda D, Fujimoto K, Kasayuki N. The E/e' ratio on echocardiography as an independent predictor of the improvement of left ventricular contraction in patients with heart failure with reduced ejection fraction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1131-1138. [PMID: 37363957 DOI: 10.1002/jcu.23514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Clinical feature of heart failure with improved ejection fraction (HFimpEF) remains to be fully elucidated. The present study investigated the association of clinical and echocardiographic parameters with the subsequent improvement of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF). METHODS From outpatients with a history of hospitalized for heart failure, 128 subjects diagnosed as HFrEF (LVEF <40%) on heart failure hospitalization were enrolled and longitudinally surveyed. During follow-up periods more than 1 year, 58 and 42 patients were identified as HFimpEF (improved LVEF to ≥40% and its increase of ≥10 points) and persistent HFrEF, respectively. RESULTS There was no difference in age or sex between the two groups with HFimpEF and persistent HFrEF. The rate of ischemic heart disease was lower and that of tachyarrhythmia was higher in the HFimpEF group than in the persistent HFrEF group. At baseline (i.e., on heart failure hospitalization), LVEF did not differ between the two groups, but left ventricular systolic and diastolic diameters were already smaller and the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/e') was lower in the HFimpEF group. A multiple logistic regression analysis revealed that lower baseline E/e' was a significant determinant of HFimpEF, independently of confounding factors such as ischemic heart disease, tachyarrhythmia, and baseline left ventricular dimension. CONCLUSION Our findings indicate that the lower ratio of E/e' in the acute phase of heart failure onset is an independent predictor of the subsequent improvement of LVEF in HFrEF patients.
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Affiliation(s)
- Ryutaro Yoshimura
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Ou Hayashi
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Horio
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Ryosuke Fujiwara
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Yujiro Matsuoka
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Go Yokouchi
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Yuya Sakamoto
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Naoki Matsumoto
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Kohei Fukuda
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Masahiro Shimizu
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Internal Medicine, Daito Central Hospital, Daito, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kohei Fujimoto
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Noriaki Kasayuki
- Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
- Department of Cardiovascular Medicine, Kashibaseiki Hospital, Kashiba, Japan
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Dahl JS, Mogensen NSB. LAst Rain in Aortic Stenosis. J Am Soc Echocardiogr 2023; 36:38-40. [PMID: 36400637 DOI: 10.1016/j.echo.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
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Kewcharoen J, Trongtorsak A, Thangjui S, Kanitsoraphan C, Prasitlumkum N. Female Gender Is Associated with an Increased Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure with Reduced Ejection Fraction. Med Sci (Basel) 2022; 10:medsci10020021. [PMID: 35466229 PMCID: PMC9036235 DOI: 10.3390/medsci10020021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
We performed a systematic review and meta-analysis to evaluate the association whether the female gender was associated with an increased chance of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). We searched the databases of MEDLINE and EMBASE from inception to 18 January 2022. Included studies were published studies evaluating or reporting characteristics of patients with HF with recovered LVEF. Data from each study were combined using a random-effects model, the generic inverse variance method of DerSimonian and Laird, to calculate odd ratios (OR) and 95% confidence intervals (CI). Eighteen studies were included in the analysis with a total of 12,270 patients (28.2% female). Female gender was associated with an increased chance of LVEF recovery (pooled OR = 1.50, 95% CI = 1.21−1.86, p-value < 0.001, I2 = 74.5%). In our subgroup analysis, female gender was associated with an increased chance of LVEF recovery when defined as LVEF > 50% (pooled OR = 1.78, 95% CI = 1.45−2.18, p-value < 0.001, I2 = 0.0%), and LVEF > 40−45% (pooled OR = 1.45, 95% CI = 1.09−1.91, p-value = 0.009, I2 = 79.2%), but not in LVEF > 35 (OR = 2.18, 95% CI = 0.94−5.05, p-value = 0.06). Our meta-analysis demonstrated that the female gender is associated with an increased chance of LVEF recovery. This association was not statistically significant in the subgroup that defined LVEF recovery as LVEF > 35%.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Loma Linda University Health, Loma Linda, CA 92354, USA
- Correspondence: (J.K.); (N.P.)
| | | | - Sittinun Thangjui
- Internal Medicine Residency Program, Bassett Healthcare Network, New York, NY 13326, USA;
| | | | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, CA 92521, USA
- Correspondence: (J.K.); (N.P.)
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Abstract
Unlike the left ventricle (LV), the left atrium (LA) has a thin-walled structure and has been regarded as a simple conduit chamber. However, the unique function of the LA to modulate LV filling has recently drawn much attention. Because LA structure and function are directly influenced by the LV filling pressure, LA assessment is an essential step in the diagnosis of diastolic dysfunction that can help predict new-onset atrial fibrillation, assess the risk of further embolic events, and identify high-risk patients for adverse cardiovascular events. Even in the recent era of multimodality imaging, 2-dimensional (2D) echocardiography is the most common imaging method and the central modality for evaluation of LA function. LA strain derived from 2D echocardiography can help assess LA function objectively and demonstrates the 3 distinct phasic motions of the LA cycle. Further, LA strain provides invaluable pathophysiologic information and helps to predict clinical prognosis in various cardiovascular diseases. In this review article, we focus on LA strain: basic concepts, advantages over conventional parameters, and some unresolved issues. Additionally, we present a brief history of the clinical evidence for LA strain. Through this review, we suggest echocardiography for LA strain assessment in clinical practice.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital
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