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Lisi M, Luisi GA, Pastore MC, Mandoli GE, Benfari G, Ilardi F, Malagoli A, Sperlongano S, Henein MY, Cameli M, D'Andrea A. New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure. Heart Fail Rev 2024; 29:799-809. [PMID: 38507022 PMCID: PMC11189326 DOI: 10.1007/s10741-024-10398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
International Guidelines consider left ventricular ejection fraction (LVEF) as an important parameter to categorize patients with heart failure (HF) and to define recommended treatments in clinical practice. However, LVEF has some technical and clinical limitations, being derived from geometric assumptions and is unable to evaluate intrinsic myocardial function and LV filling pressure (LVFP). Moreover, it has been shown to fail to predict clinical outcome in patients with end-stage HF. The analysis of LV antegrade flow derived from pulsed-wave Doppler (stroke volume index, stroke distance, cardiac output, and cardiac index) and non-invasive evaluation of LVFP have demonstrated some advantages and prognostic implications in HF patients. Speckle tracking echocardiography (STE) is able to unmask intrinsic myocardial systolic dysfunction in HF patients, particularly in those with LV preserved EF, hence allowing analysis of LV, right ventricular and left atrial (LA) intrinsic myocardial function (global peak atrial LS, (PALS)). Global PALS has been proven a reliable index of LVFP which could fill the gaps "gray zone" in the previous Guidelines algorithm for the assessment of LV diastolic dysfunction and LVFP, being added to the latest European Association of Cardiovascular Imaging Consensus document for the use of multimodality imaging in evaluating HFpEF. The aim of this review is to highlight the importance of the hemodynamics multiparametric approach of assessing myocardial function (from LVFP to stroke volume) in patients with HF, thus overcoming the limitations of LVEF.
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Affiliation(s)
- Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
| | - Giovanni Andrea Luisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
- Mediterranea Cardiocentro, 80122, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Baggiovara, Italy
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Matteo Cameli
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014, Nocera Inferiore, SA, Italy
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Russo I, Dun W, Mehta S, Ahmed S, Tzimas C, Fukuma N, Tsai EJ. Extracellular Matrix Instability and Chronic Inflammation Underlie Maladaptive Right Ventricular Pressure Overload Remodeling and Failure in Male Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.03.588013. [PMID: 38617374 PMCID: PMC11014567 DOI: 10.1101/2024.04.03.588013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background Right ventricular dysfunction (RVD) portends increased death risk for heart failure (HF) and pulmonary arterial hypertension (PAH) patients, regardless of left ventricular function or etiology. In both, RVD arises from the chronic RV pressure overload, and represents advanced cardiopulmonary disease. RV remodeling responses and survival rates of HF and PAH patients, however, differ by sex. Men develop more severe RVD and die at younger ages than do women. Mechanistic details of this sexual dimorphism in RV remodeling are incompletely understood. We sought to elucidate the cardiac pathophysiology underlying the sex-specific RV remodeling phenotypes, RV failure (RVF) versus compensated RVD. Methods We subjected male (M-) and female (F-) adult mice to moderate pulmonary artery banding (PAB) for 9wks. Mice underwent serial echocardiography, cardiac MRI, RV pressure-volume loop recordings, histologic and molecular analyses. Results M-PAB developed severe RVD with RVF, increased RV collagen deposition and degradation, extracellular matrix (ECM) instability, and activation and recruitment of macrophages. Despite the same severity and chronicity of RV pressure overload, F-PAB had more stable ECM, lacked chronic inflammation, and developed mild RVD without RVF. Conclusions ECM destabilization and chronic activation of recruited macrophages are associated with maladaptive RV remodeling and RVF in male PAB mice. Adaptive RV remodeling of female PAB mice lacked these histopathologic changes. Our findings suggest that these two pathophysiologic processes likely contribute to the sexual dimorphism of RV pressure overload remodeling. Further mechanistic studies are needed to assess their pathogenic roles and potential as targets for RVD therapy and RVF prevention. CLINICAL PERSPECTIVE What is new?: In a mouse model of pure PH, males but not females showed an association between ECM instability, chronic inflammation with activation of recruited macrophages, and severe RV dysfunction and failure.What are the clinical implications?: In male HF and PH patients, enhancing ECM stability and countering the recruitment and activation of macrophages may help preserve RV function such that RVF can be prevented or delayed. Further preclinical mechanistic studies are needed to assess the therapeutic potential of such approaches. RESEARCH PERSPECTIVE What new question does this study raise? What question should be addressed next?: What mechanisms regulate RV ECM stability and macrophage recruitment and activation in response to chronic RV pressure overload? Are these regulatory mechanisms dependent upon or independent of sex hormone signaling?
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Ali AA, Habib SA, AbdElaziz OH, Mohammad SA. Right ventricular systolic function and mechanical dyssynchrony in ischemic or non-ischemic dilated cardiomyopathy: A speckle-tracking study. Echocardiography 2023; 40:1166-1176. [PMID: 37676474 DOI: 10.1111/echo.15676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/17/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
AIM This study assessed RV dyssynchrony (irrespective to QRS duration) and RV systolic function in non-ischemic dilated cardiomyopathy (NIDCM) versus ischemic dilated cardiomyopathy (IDCM) patients by using different echo-Doppler modalities. METHODS Eighty-five cases (48 patients with DCM [whether ischemic or non-ischemic] and 37 age-matched healthy controls) were studied. Conventional echo-Doppler study, tissue Doppler (TDI), and speckle tracking (STE) were carried out to measure LV and RV systolic function. Time-to-peak negative longitudinal strain at the four RV sites were assessed by TDI derived strain and 2D speckle tracking. RESULTS Patients with DCM (whether ischemic or non-ischemic) had significantly lower fractional area change, RV tricuspid annular systolic velocity (p < .001 for both), tricuspid annular plane systolic excursion (p = .01), RV-GLS whether TDI or 2D derived (p < .001). Twenty-nine patients (60%) showed right intraventricular delay (RV4SD > 60 ms). The RV-dyssynchrony index was negatively correlated to %FAC (r = -.362, p = .01), RV Sm (r = -.312, p = .04), and 2D-RV GLS (r = -.305, p = .05). Insignificant higher RV-dysynchrony index was detected in NIDCM compared to IDCM group; however, the basal septal segment was significantly delayed in dilated group. More impaired RV systolic function was detected in ischemic group. 2D STE and TDI showed a significant correlation in the assessment of the right-intraventricular delay (p = .001). CONCLUSION Right-intraventricular dyssynchrony are detectable in patients with dilated cardiomyopathy (whether ischemic or non-ischemic) with a higher statistically insignificant value in non-ischemic group by using tissue Doppler imaging and 2D speckle tracking. More impairment of the RV systolic function was noticed in the ischemic group. Impaired RV systolic function was associated with right intraventricular delay.
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Affiliation(s)
- Asmaa Ahmed Ali
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Shaimaa Ahmed Habib
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Ola Hassan AbdElaziz
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
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Gregor Z, Kiss AR, Grebur K, Dohy Z, Kovács A, Merkely B, Vágó H, Szűcs A. Characteristics of the right ventricle in left ventricular noncompaction with reduced ejection fraction in the light of dilated cardiomyopathy. PLoS One 2023; 18:e0290981. [PMID: 37747903 PMCID: PMC10519585 DOI: 10.1371/journal.pone.0290981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/20/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Reports of left ventricular noncompaction (LVNC) rarely include descriptions of the right ventricle (RV). This study aimed to describe the characteristics of the RV in LVNC patients with reduced LV function (LVNC-R) compared with patients with dilated cardiomyopathy (DCM) and subjects with LVNC with normal left ventricular ejection fraction (LV-EF) (LVNC-N). METHODS Forty-four LVNC-R patients, 44 LVNC-N participants, and 31 DCM patients were included in this retrospective study (LV-EF: LVNC-R: 33.4±10.2%; LVNC-N: 65.0±5.9%; DCM: 34.6±7.9%). Each group was divided into two subgroups by the amount of RV trabeculation. RESULTS There was no difference in the RV-EF between the groups, and the RV trabecular mass correlated positively with the RV volume and negatively with the RV-EF in all the groups. All the measured parameters were comparable between the groups with decreased LV function. The hypertrabeculated RV subgroups showed significantly higher RV volumes and lower RV-EF only in the decreased-LV-function groups. The correlation of LV and RV trabeculation was observed only in the LVNC-N group, while LV trabeculation correlated with RV volumes in both noncompacted groups. Both decreased-LV-function groups had worse RV strain values than the LVNC-N group; however, RV strain values correlated with RV trabeculation predominantly in the LVNC-R group. CONCLUSIONS The presence and characteristics of RV hypertrabeculation and the correlations between LV trabeculation and RV parameters raise the possibility of RV involvement in noncompaction; moreover, RV strain values might be helpful in the early detection of RV function deterioration.
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Affiliation(s)
- Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
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Winkler NE, Anwer S, Reeve KA, Michel JM, Kasel AM, Tanner FC. Right vs. left ventricular longitudinal strain for mortality prediction after transcatheter aortic valve implantation. Front Cardiovasc Med 2023; 10:1252872. [PMID: 37745112 PMCID: PMC10513390 DOI: 10.3389/fcvm.2023.1252872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction This study aims at exploring biventricular remodelling and its implications for outcome in a representative patient cohort with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods and results Pre-interventional echocardiographic examinations of 100 patients with severe AS undergoing TAVI were assessed by speckle tracking echocardiography of both ventricles. Association with mortality was determined for right ventricular global longitudinal strain (RVGLS), RV free wall strain (RVFWS) and left ventricular global longitudinal strain (LVGLS). During a median follow-up of 1,367 [959-2,123] days, 33 patients (33%) died. RVGLS was lower in non-survivors [-13.9% (-16.4 to -12.9)] than survivors [-17.1% (-20.2 to -15.2); P = 0.001]. In contrast, LVGLS as well as the conventional parameters LV ejection fraction (LVEF) and RV fractional area change (RVFAC) did not differ (P = ns). Kaplan-Meier analyses indicated a reduced survival probability when RVGLS was below the -14.6% cutpoint (P < 0.001). Lower RVGLS was associated with higher mortality [HR 1.13 (95% CI 1.04-1.23); P = 0.003] independent of LVGLS, LVEF, RVFAC, and EuroSCORE II. Addition of RVGLS clearly improved the fitness of bivariable and multivariable models including LVGLS, LVEF, RVFAC, and EuroSCORE II with potential incremental value for mortality prediction. In contrast, LVGLS, LVEF, and RVFAC were not associated with mortality. Discussion In patients with severe AS undergoing TAVI, RVGLS but not LVGLS was reduced in non-survivors compared to survivors, differentiated non-survivors from survivors, was independently associated with mortality, and exhibited potential incremental value for outcome prediction. RVGLS appears to be more suitable than LVGLS for risk stratification in AS and timely valve replacement.
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Affiliation(s)
- Neria E. Winkler
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kelly A. Reeve
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jonathan M. Michel
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Albert M. Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Felix C. Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Bonios MJ, Armenis I, Kogerakis N, Thodou A, Fragoulis S, Georgiadou P, Leontiadis E, Chamogeorgakis T, Drakos SG, Adamopoulos S. Prospective Phenotyping of Right Ventricle Function Following Intra-Aortic Balloon Pump Counterpulsation in Left Ventricular Assist Device Candidates: Outcomes and Predictors of Response. ASAIO J 2023; 69:e215-e222. [PMID: 37000672 DOI: 10.1097/mat.0000000000001927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Intra-aortic balloon pump (IABP) may be applied to optimize advanced heart failure (AHF) patients and improve right ventricular (RV) function before left ventricular assist device (LVAD) implantation. We aimed to evaluate the outcome of this intervention and define RV response predictors. Decompensated AHF patients, not eligible for LVAD because of poor RV function, who required IABP for stabilization were enrolled. Echocardiography and invasive hemodynamics were serially applied to determine fulfillment of prespecified "LVAD eligibility RV function" criteria (right atrium pressure [RA] <12 mm Hg, pulmonary artery pulsatility index [PAPi] >2.00, RA/pulmonary capillary wedge pressure [PCWP] <0.67, RV strain <-14.0%). Right ventricular-free wall tissue was harvested to assess interstitial fibrosis. Eighteen patients (12 male), aged 38 ± 14 years were supported with IABP for 55 ± 51 (3-180) days. In 11 (61.1%), RV improved and fulfilled the prespecified criteria, while seven (38.9%) showed no substantial improvement. Histopathology revealed an inverse correlation between RV interstitial fibrosis and functional benefit following IABP: interstitial fibrosis correlated with post-IABP RA ( r = 0.63, p = 0.037), RA/PCWP ( r = 0.87, p = 0.001), PAPi ( r = -0.83, p = 0.003). Conclusively, IABP improves RV function in certain AHF patients facilitating successful LVAD implantation. Right ventricular interstitial fibrosis quantification may be applied to predict response and guide preoperative patient selection and optimization. http://links.lww.com/ASAIO/A995.
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Affiliation(s)
- Michael J Bonios
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
- Division of Cardiovascular Medicine and Nora Eccles Treadwell Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Iakovos Armenis
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aspasia Thodou
- Division of Cardiovascular Medicine and Nora Eccles Treadwell Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Socrates Fragoulis
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Panagiota Georgiadou
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | - Evangelos Leontiadis
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Stavros G Drakos
- Division of Cardiovascular Medicine and Nora Eccles Treadwell Cardiovascular Research and Training Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stamatis Adamopoulos
- From the Heart Failure and Transplant Units, Onassis Cardiac Surgery Center, Athens, Greece
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Bech-Hanssen O, Smith JG, Astengo M, Bollano E, Bobbio E, Polte CL, Bergh N, Karason K. Pulmonary Hypertension Phenotype Can Be Identified in Heart Failure With Reduced Ejection Fraction Using Echocardiographic Assessment of Pulmonary Artery Pressure With Supportive Use of Pressure Reflection Variables. J Am Soc Echocardiogr 2023:S0894-7317(23)00021-4. [PMID: 36681129 DOI: 10.1016/j.echo.2023.01.011] [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: 04/26/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) is frequent in patients with heart failure and reduced ejection fraction (HFrEF) with 2 different phenotypes: isolated postcapillary PH (IpcPH) and, with the worst prognosis, combined pre- and postcapillary PH (CpcPH). The aims of the present echocardiography study were to investigate (1) the ability to identify PH phenotype in patients with HFrEF using the newly adopted definition of PH (mean pulmonary artery pressure >20 mm Hg) and (2) the relationship between PH phenotype and right ventricular (RV) function. METHODS One hundred twenty-four patients with HFrEF consecutively referred for heart transplant or heart failure workup were included with echocardiography and right heart catheterization within 48 hours. We estimated systolic pulmonary artery pressure (sPAPDoppler) and used a method to detect increased pulmonary vascular resistance (>3 Wood units) based on predefined thresholds of 3 pressure reflection (PRefl) variables (the acceleration time in the RV outflow tract [RVOT], the interval between peak RVOT and peak tricuspid regurgitant velocity, and the RV pressure augmentation following peak RVOT velocity). RESULTS Using receiver operator characteristic analysis in a derivation group (n = 62), we identified sPAPDoppler ≥35 mm Hg as a cutoff that in a test group (n = 62) increased the likelihood of PH 6.6-fold. The presence of sPAPDoppler >40 mm Hg and 2 or 3 positive PRefl variables increased the probability of CpcPH 6- to 8-fold. A 2-step approach with primarily assessment of sPAPDoppler and the supportive use of PRefl variables in patients with mild/moderate PH (sPAPDoppler 41-59 mm Hg) showed 76% observer agreement and a weighted kappa of 0.63. The steady-state (pulmonary vascular resistance) and pulsatile (compliance, elastance) vascular loading are increased in both IpcPH and CpcPH with a comparable degree of RV dysfunction. CONCLUSIONS The PH phenotype can be identified in HFrEF using standard echocardiographic assessment of pulmonary artery pressure with supportive use of PRefl variables in patients with mild to moderate PH.
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Affiliation(s)
- Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden.
| | - J Gustav Smith
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory and Department of Molecular and Clinical Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden; Department of Cardiology, Clinical Sciences and Lund University and Skåne University Hospital, Lund, Sweden; Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University and Skåne University Hospital, Lund, Sweden
| | - Marco Astengo
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
| | - Christian Lars Polte
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
| | - Niklas Bergh
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
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Clinical Utility of Strain Imaging in Assessment of Myocardial Fibrosis. J Clin Med 2023; 12:jcm12030743. [PMID: 36769393 PMCID: PMC9917743 DOI: 10.3390/jcm12030743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/26/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Myocardial fibrosis (MF) is a non-reversible process that occurs following acute or chronic myocardial damage. MF worsens myocardial deformation, remodels the heart and raises myocardial stiffness, and is a crucial pathological manifestation in patients with end-stage cardiovascular diseases and closely related to cardiac adverse events. Therefore, early quantitative analysis of MF plays an important role in risk stratification, clinical decision, and improvement in prognosis. With the advent and development of strain imaging modalities in recent years, MF may be detected early in cardiovascular diseases. This review summarizes the clinical usefulness of strain imaging techniques in the non-invasive assessment of MF.
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Mustapic I, Bakovic D, Susilovic Grabovac Z, Borovac JA. Impact of SGLT2 Inhibitor Therapy on Right Ventricular Function in Patients with Heart Failure and Reduced Ejection Fraction. J Clin Med 2022; 12:jcm12010042. [PMID: 36614843 PMCID: PMC9820989 DOI: 10.3390/jcm12010042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in addition to optimal medical therapy (OMT) on the right ventricular (RV) systolic function using advanced echocardiographic analysis among outpatients with heart failure and a reduced ejection fraction (HFrEF) has thus far been poorly investigated. Methods: This was a single-center, prospective, single-blinded study in which an echocardiographic expert was blinded to the allocation of the treatment. A total of 36 outpatients with HFrEF were randomized to either OMT or OMT+SGLT2i. Both groups underwent an echocardiographic examination of the RV systolic function at the baseline and at the 3-month follow-up (3mFU). Results: The patients in both groups did not significantly differ with respect to the relevant baseline comorbidities, therapy, and clinical characteristics. The patients receiving OMT+SGLT2i showed a significant improvement from the baseline to the 3mFU in all the measured RV echocardiographic parameters, while for the OMT group, a significant improvement after the 3mFU was observed for TAPSE and s'. The mean percent change from the baseline to the 3mFU was significant when comparing OMT+SGLT2i to the OMT group concerning RV FWS (+91% vs. +28%, p = 0.039), TR maxPG (-27% vs. +19%, p = 0.005), and TR Vmax (-17% vs. +13%, p = 0.008), respectively. Conclusions: Adding SGLT2i to OMT in patients with HFrEF resulted in a greater improvement in the RV systolic function from the baseline to the 3mFU compared to the OMT alone.
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Affiliation(s)
- Ivona Mustapic
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-95-2276-970
| | - Darija Bakovic
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Physiology, University of Split School of Medicine, 21000 Split, Croatia
| | | | - Josip A Borovac
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Sun W, Yuan Y, Shen X, Zhang Y, Dong N, Wang G, Li Y, Liang B, Lv Q, Zhang L, Xie M. Prognostic value of feature-tracking right ventricular longitudinal strain in heart transplant recipients. Eur Radiol 2022; 33:3878-3888. [PMID: 36538069 DOI: 10.1007/s00330-022-09327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The prognostic value of cardiac magnetic resonance feature tracking (CMR-FT)-derived right ventricular longitudinal strain (RVLS) post-heart transplantation has not been studied. This study aimed to evaluate the prognostic significance of CMR-FT-derived RVLS, in patients post- heart transplantation and to directly compare its value with that of conventional RV ejection fraction (RVEF). METHODS In a cohort of consecutive heart transplantation recipients who underwent CMR for surveillance, RVLS from the free wall was measured by CMR-FT. The composite endpoint was all-cause death or major adverse cardiac events. The Cox regression model was used to examine the independent association between RVLS and the endpoint. RESULTS A total of 96 heart transplantation recipients were retrospectively included. Over a median follow-up of 41 months, 20 recipients reached the composite endpoint. The multivariate Cox analysis showed that the model with RVLS (hazard ratio [HR]:1.334; 95% confidence interval [CI]:1.148 to 1.549; p < 0.001; Akaike information criterion [AIC] = 140, C-index = 0.831) was better in predicting adverse events than the model with RVEF (HR:0.928; 95% CI: 0.868 to 0.993; p = 0.030; AIC = 149, C-index = 0.751). Furthermore, receiver operating characteristic curves revealed that the accuracy for predicting adverse events was greater for RVLS than RVEF (area under the curve: 0.85 vs 0.76, p = 0.03). CONCLUSIONS CMR-FT-derived RVLS is an independent predictor of adverse events in post-heart transplantation, and its predictive value was better than RVEF. Therefore, our study highlighted the importance of evaluating RVLS for risk stratification after heart transplantation. KEY POINTS • CMR-RVLS is an independent predictor of adverse events post-heart transplantation and provides greater predictive value. • CMR-RVLS may help clinicians to risk stratification in heart transplantation recipients.
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Affiliation(s)
- Wei Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yating Yuan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuehua Shen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Yiwei Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China.
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China.
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430022, China.
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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11
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Association of Whole-Heart Myocardial Mechanics by Transthoracic Echocardiography with Presence of Late Gadolinium Enhancement by CMR in Non-Ischemic Dilated Cardiomyopathy. J Clin Med 2022; 11:jcm11226607. [PMID: 36431084 PMCID: PMC9697251 DOI: 10.3390/jcm11226607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Background: In patients with non-ischemic dilated cardiomyopathy (NIDCM), myocardial fibrosis (MF) is related to adverse cardiovascular outcomes. The purpose of this study was to evaluate the potential relationship between the myocardial mechanics of different chambers of the heart and the presence of MF and to determine the accuracy of the whole-heart myocardial strain parameters to predict MF in patients with NIDCM. Methods: We studied 101 patients (64% male; 50 ± 11 years) with a first-time diagnosis of NIDCM who were referred for a clinical cardiovascular magnetic resonance (CMR) and speckle tracking 2D echocardiography examination. We analyzed MF by late gadolinium enhancement (LGE), and the whole-heart myocardial mechanics were assessed by speckle tracking. The presence of MF was related to worse strain parameters in both ventricles and atria. The strongest correlations were found between MF and left ventricle (LV) global longitudinal strain (GLS) (r = −0.586, p < 0.001), global circumferential strain (GCS) (r = −0.609, p < 0.001), LV ejection fraction (LVEF) (r = 0.662, p < 0.001), and left atrial strain during the reservoir phase (LASr) (r = 0.588, p < 0.001). However, the binary logistic regression analysis revealed that only LV GLS, GCS, and LASr were independently associated with the presence of MF (area under the curves of 0.84, 0.85, and 0.64, respectively). None of the echocardiographic parameters correlated with fibrosis localization. Conclusions: In NIDCM patients, MF is correlated with reduced mechanical parameters in both ventricles and atria. LV GLS, LASr, and LV GCS are the most accurate 2D echocardiography predictive factors for the presence of MF.
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12
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Harrison NE, Favot MJ, Gowland L, Lenning J, Henry S, Gupta S, Abidov A, Levy P, Ehrman R. Point-of-care echocardiography of the right heart improves acute heart failure risk stratification for low-risk patients: The REED-AHF prospective study. Acad Emerg Med 2022; 29:1306-1319. [PMID: 36047646 PMCID: PMC9671834 DOI: 10.1111/acem.14589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Validated acute heart failure (AHF) clinical decision instruments (CDI) insufficiently identify low-risk patients meriting consideration of outpatient treatment. While pilot data show that tricuspid annulus plane systolic excursion (TAPSE) is associated with adverse events, no AHF CDI currently incorporates point-of-care echocardiography (POCecho). We evaluated whether TAPSE adds incremental risk stratification value to an existing CDI. METHODS Prospectively enrolled patients at two urban-academic EDs had POCechos obtained before or <1 h after first intravenous diuresis, positive pressure ventilation, and/or nitroglycerin. STEMI and cardiogenic shock were excluded. AHF diagnosis was adjudicated by double-blind expert review. TAPSE, with an a priori cutoff of ≥17 mm, was our primary measure. Secondary measures included eight additional right heart and six left heart POCecho parameters. STRATIFY is a validated CDI predicting 30-day death/cardiopulmonary resuscitation, mechanical cardiac support, intubation, new/emergent dialysis, and acute myocardial infarction or coronary revascularization in ED AHF patients. Full (STRATIFY + POCecho variable) and reduced (STRATIFY alone) logistic regression models were fit to calculate adjusted odds ratios (aOR), category-free net reclassification index (NRIcont ), ΔSensitivity (NRIevents ), and ΔSpecificity (NRInonevents ). Random forest assessed variable importance. To benchmark risk prediction to standard of care, ΔSensitivity and ΔSpecificity were evaluated at risk thresholds more conservative/lower than the actual outcome rate in discharged patients. RESULTS A total of 84/120 enrolled patients met inclusion and diagnostic adjudication criteria. Nineteen percent experiencing the primary outcome had higher STRATIFY scores compared to those event free (233 vs. 212, p = 0.009). Five right heart (TAPSE, TAPSE/PASP, TAPSE/RVDD, RV-FAC, fwRVLS) and no left heart measures improved prediction (p < 0.05) adjusted for STRATIFY. Right heart measures also had higher variable importance. TAPSE ≥ 17 mm plus STRATIFY improved prediction versus STRATIFY alone (aOR 0.24, 95% confidence interval [CI] 0.06-0.91; NRIcont 0.71, 95% CI 0.22-1.19), and specificity improved by 6%-32% (p < 0.05) at risk thresholds more conservative than the standard-of-care benchmark without missing any additional events. CONCLUSIONS TAPSE increased detection of low-risk AHF patients, after use of a validated CDI, at risk thresholds more conservative than standard of care.
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Affiliation(s)
- Nicholas E. Harrison
- Indiana University School of MedicineIndianapolisIndianaUSA,Wayne State UniversityDetroitMichiganUSA
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13
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Gao L, Lin Y, Ji M, Wu W, Li H, Qian M, Zhang L, Xie M, Li Y. Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure. J Clin Med 2022; 11:6307. [DOI: 10.3390/jcm11216307] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Heart failure (HF) is an extremely major health problem with gradually increasing incidence in developed and developing countries. HF may lead to cardiac remodeling; thus, advanced imaging techniques are required to comprehensively evaluate cardiac mechanics. Recently, three-dimensional speckle-tracking echocardiography (3D-STE) has been developed as a novel imaging technology that is based on the three-dimensional speckle-tracking on the full volume three-dimensional datasets. Three-dimensional speckle-tracking echocardiography allows a more accurate evaluation of global and regional myocardial performance, assessment of cardiac mechanics, detection of subclinical cardiac dysfunction, and prediction of adverse clinical events in a variety of cardiovascular diseases. Therefore, this review summarizes the clinical usefulness of 3D-STE in patients with HF.
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14
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Gheorghe LL, Hegeman R, Vrijkorte M, Wunderlich N, Cavalcante J, Wang DD, Rana B, Vannan M, Timmers L, Swaans M. The evolving role of multi-modality imaging in transcatheter tricuspid valve interventions. Front Cardiovasc Med 2022; 9:793267. [DOI: 10.3389/fcvm.2022.793267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Tricuspid valve pathophysiology is not well-understood. Emergence of novel transcatheter tricuspid therapies has fueled the requirements for improved imaging visualization techniques and interventional imaging physician skillsets in guiding these complex transcatheter procedures. There is growing understanding on the clinical significance of tricuspid regurgitation which expanded the interest for percutaneous tricuspid valve interventions. The present review concentrates on three essential aspects of tricuspid valve pathophysiology: anatomical considerations for tricuspid interventions, optimal timing of tricuspid interventions by imaging guidance, and the role of interventional imaging physicians’ skillset and knowledge in this field.
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15
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Molecular Approaches and Echocardiographic Deformation Imaging in Detecting Myocardial Fibrosis. Int J Mol Sci 2022; 23:ijms231810944. [PMID: 36142856 PMCID: PMC9501415 DOI: 10.3390/ijms231810944] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/25/2022] Open
Abstract
The pathological remodeling of myocardial tissue is the main cause of heart diseases. Several processes are involved in the onset of heart failure, and the comprehension of the mechanisms underlying the pathological phenotype deserves special attention to find novel procedures to identify the site of injury and develop novel strategies, as well as molecular druggable pathways, to counteract the high degree of morbidity associated with it. Myocardial fibrosis (MF) is recognized as a critical trigger for disruption of heart functionality due to the excessive accumulation of extracellular matrix proteins, in response to an injury. Its diagnosis remains focalized on invasive techniques, such as endomyocardial biopsy (EMB), or may be noninvasively detected by cardiac magnetic resonance imaging (CMRI). The detection of MF by non-canonical markers remains a challenge in clinical practice. During the last two decades, two-dimensional (2D) speckle tracking echocardiography (STE) has emerged as a new non-invasive imaging modality, able to detect myocardial tissue abnormalities without specifying the causes of the underlying histopathological changes. In this review, we highlighted the clinical utility of 2D-STE deformation imaging for tissue characterization, and its main technical limitations and criticisms. Moreover, we focalized on the importance of coupling 2D-STE examination with the molecular approaches in the clinical decision-making processes, in particular when the 2D-STE does not reflect myocardial dysfunction directly. We also attempted to examine the roles of epigenetic markers of MF and hypothesized microRNA-based mechanisms aiming to understand how they match with the clinical utility of echocardiographic deformation imaging for tissue characterization and MF assessment.
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16
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Wu J, Huang X, Huang K, Gao Q, Tian Y, Lin B, Tang Y, Chen X, Su M. Correlations among noninvasive right ventricular myocardial work indices and the main parameters of systolic and diastolic functions. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:873-884. [PMID: 36069462 PMCID: PMC9540218 DOI: 10.1002/jcu.23284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Right ventricular (RV) myocardial work (RVMW) is the latest method used to assess RV function. To date, correlations among RVMW indices and RV systolic and diastolic functions have not been studied. METHODS A total of 106 healthy volunteers (median age, 34 years; 46% male) were prospectively enrolled. RVMW indices were measured using the RV pressure-strain loop using specific software. The correlations among RVMW indices and other RV functions were analyzed. RESULTS During the multivariate analysis, the RV global work index (RVGWI) was significantly correlated with RV global longitudinal strain (RV GLS) (p < .0001), pulmonary systolic artery pressure (PASP) (p < .0001), and tricuspid annular (TA) plane systolic excursion (TAPSE) (p = .036). RV global constructive work (RVGCW) was correlated with RV GLS (p < .0001) and PASP (p < .0001). RV global wasted work (RVGWW) was correlated with RV GLS (p = .008) and TA isovolumetric acceleration (TA IVA) (p = .008). RV global work efficiency (RVGWE) was correlated with RV GLS (p < .0001) and tissue Doppler (TD) RV myocardial performance index (TD RMPI) (p = .043). CONCLUSION RVMW indices showed good correlations with RV myocardial systolic function.
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Affiliation(s)
- Jian Wu
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Xinyi Huang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Kunhui Huang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Qiumei Gao
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Yuan Tian
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Biqin Lin
- Department of Ultrasonography, Xiamen Humanity HospitalFujian Medical UniversityXiamenChina
| | - Yiruo Tang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Xu Chen
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
| | - Maolong Su
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Precision Medicine for Cardiovascular DiseaseXiamenChina
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17
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Bech-Hanssen O, Fredholm M, Astengo M, Bartfay SE, Bollano E, Dellgren G, Karason K, Ricksten SE. A novel echocardiographic right ventricular dysfunction score can identify hemodynamic severity profiles in left ventricular dysfunction. Cardiovasc Ultrasound 2022; 20:20. [PMID: 35915497 PMCID: PMC9344733 DOI: 10.1186/s12947-022-00290-5] [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] [Received: 03/02/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Recognition of congestion and hypoperfusion in patients with chronic left ventricular dysfunction (LVD) has therapeutic and prognostic implications. In the present study we hypothesized that a multiparameter echocardiographic grading of right ventricular dysfunction (RVD) can facilitate the characterization of hemodynamic profiles. Methods Consecutive patients (n = 105, age 53 ± 14 years, males 77%, LV ejection fraction 28 ± 11%) referred for heart transplant or heart failure work-up, with catheterization and echocardiography within 48 h, were reviewed retrospectively. Three hemodynamic profiles were defined: compensated LVD (cLVD, normal pulmonary capillary wedge pressure (PCWP < 15 mmHg) and normal mixed venous saturation (SvO2 ≥ 60%)); decompensated LVD (dLVD, with increased PCWP) and LV failure (LVF, increased PCWP and reduced SvO2). We established a 5-point RVD score including pulmonary hypertension, reduced tricuspid annular plane systolic excursion, RV dilatation, ≥ moderate tricuspid regurgitation and increased right atrial pressure. Results The RVD score [median (IQR 25%;75%)] showed significant in-between the three groups differences with 1 (0;1), 1 (0.5;2) and 3.0 (2;3.5) in patients with cLVD, dLVD and LVF, respectively. The finding of RVD score ≥ 2 or ≥ 4 increased the likelihood of decompensation or LVF 5.2-fold and 6.7-fold, respectively. On the contrary, RVD score < 1 and < 2 reduced the likelihood 11.1-fold and 25-fold, respectively. The RVD score was more helpful than standard echocardiography regarding identification of hemodynamic profiles. Conclusions In this proof of concept study an echocardiographic RVD score identified different hemodynamic severity profiles in patients with chronic LVD and reduced ejection fraction. Further studies are needed to validate its general applicability. Graphical abstract ![]()
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Affiliation(s)
- Odd Bech-Hanssen
- Department of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden. .,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Martin Fredholm
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Marco Astengo
- Department of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Bartfay
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Gothenburg, Sweden
| | - Entela Bollano
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Gothenburg, Sweden
| | - Göran Dellgren
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Göteborg, Sweden
| | - Kristjan Karason
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Gothenburg, Sweden.,Department of Cardiothoracic Surgery at, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
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18
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Heidari A, Elkhodary KI, Pop C, Badran M, Vali H, Abdel-Raouf YMA, Torbati S, Asgharian M, Steele RJ, Mahmoudzadeh Kani I, Sheibani S, Pouraliakbar H, Sadeghian H, Cecere R, Friedrich MGW, Tafti HA. Patient-specific finite element analysis of heart failure and the impact of surgical intervention in pulmonary hypertension secondary to mitral valve disease. Med Biol Eng Comput 2022; 60:1723-1744. [PMID: 35442004 DOI: 10.1007/s11517-022-02556-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/12/2022] [Indexed: 12/31/2022]
Abstract
Pulmonary hypertension (PH), a chronic and complex medical condition affecting 1% of the global population, requires clinical evaluation of right ventricular maladaptation patterns under various conditions. A particular challenge for clinicians is a proper quantitative assessment of the right ventricle (RV) owing to its intimate coupling to the left ventricle (LV). We, thus, proposed a patient-specific computational approach to simulate PH caused by left heart disease and its main adverse functional and structural effects on the whole heart. Information obtained from both prospective and retrospective studies of two patients with severe PH, a 72-year-old female and a 61-year-old male, is used to present patient-specific versions of the Living Heart Human Model (LHHM) for the pre-operative and post-operative cardiac surgery. Our findings suggest that before mitral and tricuspid valve repair, the patients were at risk of right ventricular dilatation which may progress to right ventricular failure secondary to their mitral valve disease and left ventricular dysfunction. Our analysis provides detailed evidence that mitral valve replacement and subsequent chamber pressure unloading are associated with a significant decrease in failure risk post-operatively in the context of pulmonary hypertension. In particular, right-sided strain markers, such as tricuspid annular plane systolic excursion (TAPSE) and circumferential and longitudinal strains, indicate a transition from a range representative of disease to within typical values after surgery. Furthermore, the wall stresses across the RV and the interventricular septum showed a notable decrease during the systolic phase after surgery, lessening the drive for further RV maladaptation and significantly reducing the risk of RV failure.
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Affiliation(s)
- Alireza Heidari
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, QC, H3A 0C3, Canada. .,Department of Anatomy & Cell Biology, McGill University, Montreal, QC, Canada.
| | - Khalil I Elkhodary
- Department of Mechanical Engineering, American University in Cairo, New Cairo, 11835, Egypt
| | - Cristina Pop
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Mohamed Badran
- Department of Mechanical Engineering, Future University in Egypt, New Cairo, Egypt
| | - Hojatollah Vali
- Department of Anatomy & Cell Biology, McGill University, Montreal, QC, Canada
| | - Yousof M A Abdel-Raouf
- Department of Mechanical Engineering, American University in Cairo, New Cairo, 11835, Egypt
| | - Saeed Torbati
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Masoud Asgharian
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | | | - Sara Sheibani
- Department of Anatomy & Cell Biology, McGill University, Montreal, QC, Canada
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hakimeh Sadeghian
- Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran.,Department of Surgery, Tehran Heart Center, Tehran, Iran
| | - Renzo Cecere
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, QC, H3A 0C3, Canada.,Department of Surgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Matthias G W Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, QC, Canada
| | - Hossein Ahmadi Tafti
- Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran.,Department of Surgery, Tehran Heart Center, Tehran, Iran
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19
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Tian F, Gu Y, Zhang Y, Zhang B, Xie Y, Yu S, Zhu S, Sun W, Cheng S, Qian M, Lin Y, Wu W, Yang Y, Lv Q, Wang J, Zhang L, Li Y, Xie M. Evaluation of Right Ventricular Myocardial Mechanics by 2- and 3-Dimensional Speckle-Tracking Echocardiography in Patients With an Ischemic or Non-ischemic Etiology of End-Stage Heart Failure. Front Cardiovasc Med 2022; 9:765191. [PMID: 35694662 PMCID: PMC9174453 DOI: 10.3389/fcvm.2022.765191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background The aims of our study were (1) to assess the right ventricular (RV) myocardial mechanics by two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) in patients with an ischemic or non-ischemic etiology of end-stage heart failure (HF) and (2) to explore which RV index evaluated by 2D- and 3D-STE was the most powerful indicator for identifying the ischemic and non-ischemic etiologies of end-stage HF. Methods A total of 96 patients with left ventricular ejection fraction (LVEF) < 30% were enrolled in our study: 42 patients (mean age, 52 ± 10 years; 9.5% female) with ischemic cardiomyopathy and 54 patients (mean age, 46 ± 14 years; 16.7% female) with non-ischemic cardiomyopathy. A total of 45 healthy subjects (mean age, 46 ± 13 years; 24.4% female) served as controls. The longitudinal strain of the RV free wall (RVFWLS) was determined by both 2D- and 3D-STE. Results Compared to controls, patients with an ischemic or non-ischemic etiology of end-stage HF had lower 2D-RVFWLS, 3D-RVFWLS and RV ejection fraction (RVEF) values (P < 0.05). Patients with non-ischemic cardiomyopathies (NICMs) had significantly lower 3D-RVFWLS and RVEF values than in those with ischemic cardiomyopathies (ICMs), whereas 2D-RVFWLS and conventional RV function parameters did not differ between the two subgroups. RVEF was highly related to 3D-RVFWLS (r = 0.72, P < 0.001), modestly related to 2D-RVFWLS (r = 0.51, P < 0.001), and weakly related to conventional RV function indices (r = –0.26 to 0.46, P < 0.05). Receiver operating characteristic curve analysis revealed that the optimal 3D-RVFWLS cut-off value to distinguish NICM from ICM patients was –14.78% (area under the curve: 0.73, P < 0.001), while 2D-RVFWLS and conventional RV echocardiographic parameters did not. Conclusion Our study demonstrated the superiority of 3D-RVFWLS over 2D-RVFWLS and conventional RV function indices in identifying the ischemic and non-ischemic etiologies of end-stage HF. These findings support the idea that 3D-RVFWLS may be a promising non-invasive imaging marker for distinguishing NICM from ICM.
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Affiliation(s)
- Fangyan Tian
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ying Gu
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yanting Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bei Zhang
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Shaomei Yu
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Shan Cheng
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mingzu Qian
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yixia Lin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenqian Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Li Zhang,
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Yuman Li,
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Mingxing Xie,
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20
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Applying global longitudinal strain in assessing cardiac dysfunction after radiotherapy among breast cancer patients: a systemic review and meta-analysis. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, Li Y. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12020445. [PMID: 35204536 PMCID: PMC8871506 DOI: 10.3390/diagnostics12020445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingzhu Qian
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
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22
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Lisi M, Cameli M, Mandoli GE, Pastore MC, Righini FM, D'Ascenzi F, Focardi M, Rubboli A, Mondillo S, Henein MY. Detection of myocardial fibrosis by speckle-tracking echocardiography: from prediction to clinical applications. Heart Fail Rev 2022; 27:1857-1867. [PMID: 35043264 DOI: 10.1007/s10741-022-10214-0] [Citation(s) in RCA: 3] [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] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
Myocardial fibrosis (MF) represents the underlying pathologic condition of many cardiac disease, leading to cardiac dysfunction and heart failure (HF). Biopsy studies have shown the presence of MF in patients with decompensating HF despite apparently normal cardiac function. In fact, basic indices of left ventricular (LV) function, such as LV ejection fraction (EF), fail to recognize subtle LV dysfunction caused by MF. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) is currently recognized as the gold standard imaging investigation for the detection of focal and diffuse cardiac chambers MF; however, its use is limited by its availability and the use of contrast agents, while echocardiography remains the first level cardiac imaging technique due to its low cost, portability and high accessibility. Advanced echocardiographic techniques, above all speckle-tracking echocardiography (STE), have demonstrated reliability for early detection of structural myocardial abnormalities and for the prediction of prognosis in acute and chronic HF. Myocardial strain of both ventricles and also left atrium has been shown to correlate with the degree of MF, providing useful prognostic information in several diseases, such as HF, cardiomyopathies and valvular heart disease. This paper aims to provide an overview of the pathophysiology of MF and the clinical application of STE for the prediction of left and right heart chambers MF in HF patients.
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Affiliation(s)
- Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Andrea Rubboli
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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23
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Vértes V, Porpáczy A, Nógrádi Á, Tőkés-Füzesi M, Hajdu M, Czirják L, Komócsi A, Faludi R. Galectin-3 and sST2: associations to the echocardiographic markers of the myocardial mechanics in systemic sclerosis - a pilot study. Cardiovasc Ultrasound 2022; 20:1. [PMID: 35042522 PMCID: PMC8764793 DOI: 10.1186/s12947-022-00272-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/05/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Progressive cardiac fibrosis is the central aspect of the myocardial involvement in systemic sclerosis (SSc). We hypothesized that circulating biomarkers of the cardiac fibrosis may be useful in the early diagnosis of the cardiac manifestation in this disease. Thus, we investigated the potential correlations between the levels of galectin-3, soluble suppression of tumorigenicity-2 (sST2) and the echocardiographic markers of the myocardial mechanics in SSc patients. METHODS Forty patients (57.3 ± 13.7 years, 36 female) were investigated. In addition to the conventional echocardiography, tissue Doppler and speckle tracking-derived strain techniques were used to assess the function of both ventricles and atria. To estimate the correlations between galectin-3 and sST2 levels and the echocardiographic variables, partial correlation method was used with age as correcting factor. RESULTS In age adjusted analysis galectin-3 level showed significant correlation with left ventricular global longitudinal strain (r = 0.460, p = 0.005); grade of left ventricular diastolic dysfunction (r = 0.394, p = 0.013); septal e' (r = - 0.369, p = 0.021); septal E/e' (r = 0.380, p = 0.017) and with the grade of mitral regurgitation (r = 0.323, p = 0.048). No significant correlation was found between sST2 levels and the echocardiographic variables. CONCLUSIONS Galectin-3 levels, but not sST2 levels show significant correlation with the parameters of the left ventricular systolic and diastolic function. Galectin-3 may be a useful biomarker for the screening and early diagnosis of SSc patients with cardiac involvement.
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Affiliation(s)
- Vivien Vértes
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Adél Porpáczy
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Ágnes Nógrádi
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Margit Tőkés-Füzesi
- grid.9679.10000 0001 0663 9479Department of Laboratory Medicine, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Máté Hajdu
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - László Czirják
- grid.9679.10000 0001 0663 9479Department of Rheumatology and Immunology, Medical School, University of Pécs, Akác u. 1, H-7632 Pécs, Hungary
| | - András Komócsi
- grid.9679.10000 0001 0663 9479 Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, Ifjúság út 13, H-7624, Pécs, Hungary.
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25
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Sun W, Shen X, Wang J, Zhu S, Zhang Y, Wu C, Xie Y, Yang Y, Dong N, Wang G, Li Y, Lv Q, Liang B, Zhang L, Xie M. Association Between 2D- and 3D-Speckle-Tracking Longitudinal Strain and Cardiovascular Magnetic Resonance Evidence of Diffuse Myocardial Fibrosis in Heart Transplant Recipients. Front Cardiovasc Med 2021; 8:727745. [PMID: 34917656 PMCID: PMC8669344 DOI: 10.3389/fcvm.2021.727745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to: (1) evaluate the association between myocardial fibrosis (MF) quantified by extracellular volume fraction (ECV) and myocardial strain measured by two-dimensional (2D)- and three-dimensional speckle-tracking echocardiography (3D-STE) and (2) further investigate which strain parameter measured by 2D- and 3D-STE is the more robust predictor of MF in heart transplant (HT) recipients. Methods: A total of 40 patients with HT and 20 healthy controls were prospectively enrolled. Left ventricular (LV)-global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were measured by 2D- and 3D-STE. LV diffuse MF was defined by cardiovascular magnetic resonance (CMR)-ECV. Results: The HT recipients had a significantly higher native T1 and ECV than healthy controls (1043.8 ± 34.0 vs. 999.7 ± 19.7 ms, p < 0.001; 26.6 ± 2.7 vs. 24.3 ± 1.8%, p = 0.02). The 3D- and 2D-STE-LVGLS and LVGCS were lower (p < 0.005) in the HT recipients than in healthy controls. ECV showed a moderate correlation with 2D-LVGLS (r = 0.53, p = 0.002) and 3D-LVGLS (r = 0.60, p < 0.001), but it was not correlated with 2D or 3D-LVGCS, or LVGRS. Furthermore, 3D-LVGLS and 2D-LVGLS had a similar correlation with CMR-ECV (r = 0.60 vs. 0.53, p = 0.670). A separate stepwise multivariate linear analysis showed that both the 2D-LVGLS (β = 0.39, p = 0.019) and 3D-LVGLS (β = 0.54, p < 0.001) were independently associated with CMR-ECV. Conclusion: CMR marker of diffuse MF was present in asymptomatic patients with HT and appeared to be associated with decreased myocardial strain by echocardiography. Both the 2D- and 3D-LVGLS were independently correlated with diffuse LVMF, which may provide an alternative non-invasive tool for monitoring the development of adverse fibrotic remodeling during the follow-up of HT recipients.
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Affiliation(s)
- Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xuehua Shen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanting Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yun Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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26
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Yuchi Y, Suzuki R, Kanno H, Teshima T, Matsumoto H, Koyama H. Right Ventricular Myocardial Adaptation Assessed by Two-Dimensional Speckle Tracking Echocardiography in Canine Models of Chronic Pulmonary Hypertension. Front Vet Sci 2021; 8:727155. [PMID: 34485446 PMCID: PMC8415444 DOI: 10.3389/fvets.2021.727155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is a life-threatening disease in dogs characterized by an increase in pulmonary arterial pressure (PAP) and/or pulmonary vascular resistance. Right ventricle adapts to its pressure overload through various right ventricular (RV) compensative mechanisms: adaptive and maladaptive remodeling. The former is characterized by concentric hypertrophy and increased compensatory myocardial contractility, whereas the latter is distinguished by eccentric hypertrophy associated with impaired myocardial function. Objectives: To evaluate the RV adaptation associated with the increase of PAP using two-dimensional speckle tracking echocardiography. Animals: Seven experimentally induced PH models. Methods: Dogs were anesthetized and then a pulmonary artery catheter was placed via the right jugular vein. Canine models of PH were induced by the repeated injection of microspheres through the catheter and monitored pulmonary artery pressure. Dogs were performed echocardiography and hemodynamic measurements in a conscious state when baseline and systolic PAP (sPAP) rose to 30, 40, 50 mmHg, and chronic phase. The chronic phase was defined that the sPAP was maintained at 50 mmHg or more for 4 weeks without injection of microspheres. Results: Pulmonary artery to aortic diameter ratio, RV area, end-diastolic RV wall thickness, and RV myocardial performance index were significantly increased in the chronic phase compared with that in the baseline. Tricuspid annular plane systolic excursion was significantly decreased in the chronic phase compared with that in the baseline. The RV longitudinal strain was significantly decreased in the sPAP30 phase, increased in the sPAP40 and sPAP50 phases, and decreased in the chronic phase. Conclusions: Changes in two-dimensional speckle tracking echocardiography-derived RV longitudinal strain might reflect the intrinsic RV myocardial contractility during the PH progression, which could not be detected by conventional echocardiographic parameters.
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Affiliation(s)
- Yunosuke Yuchi
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Haruka Kanno
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, Faculty of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Japan
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27
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Sanna GD, Canonico ME, Santoro C, Esposito R, Masia SL, Galderisi M, Parodi G, Nihoyannopoulos P. Echocardiographic Longitudinal Strain Analysis in Heart Failure: Real Usefulness for Clinical Management Beyond Diagnostic Value and Prognostic Correlations? A Comprehensive Review. Curr Heart Fail Rep 2021; 18:290-303. [PMID: 34398411 DOI: 10.1007/s11897-021-00530-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a highly prevalent clinical syndrome characterized by considerable phenotypic heterogeneity. The traditional classification based on left ventricular ejection fraction (LVEF) is widely accepted by the guidelines and represents the grounds for patient enrollment in clinical trials, even though it shows several limitations. Ejection fraction (EF) is affected by preload, afterload, and contractility, it being problematic to express LV function in several conditions, such as HF with preserved EF (HFpEF), valvular heart disease, and subclinical HF, and in athletes. Over the last two decades, developments in diagnostic techniques have provided useful tools to overcome EF limitations. Strain imaging analysis (particularly global longitudinal strain (GLS)) has emerged as a useful echocardiographic technique in patients with HF, as it is able to simultaneously supply information on both systolic and diastolic functions, depending on cardiac anatomy and physiology/pathophysiology. The use of GLS has proved helpful in terms of diagnostic performance and prognostic value in several HF studies. Universally accepted cutoff values and variability across vendors remain an area to be fully explored, hence limiting routine application of this technique in clinical practice. In the present review, the current role of GLS in the diagnosis and management of patients with HF will be discussed. We describe, by critical analysis of the pros and cons, various clinical settings in HF, and how the appropriate use and interpretation of GLS can provide important clues.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.
| | - Mario E Canonico
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Stefano L Masia
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Petros Nihoyannopoulos
- Imperial College London (National Heart and Lung Institute), Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
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Gavazzoni M, Badano LP, Vizzardi E, Raddino R, Genovese D, Taramasso M, Sciatti E, Palermo C, Metra M, Muraru D. Prognostic value of right ventricular free wall longitudinal strain in a large cohort of outpatients with left-side heart disease. Eur Heart J Cardiovasc Imaging 2021; 21:1013-1021. [PMID: 31596464 DOI: 10.1093/ehjci/jez246] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS Right ventricular free wall longitudinal strain (RVFWLS) has been proposed as an accurate and sensitive measure of right ventricular function that could integrate other conventional parameters such as tricuspid annulus plane systolic excursion (TAPSE) and fractional area change (FAC%). The aim of the present study was to evaluate the relationship between RVFWLS and outcomes in stable asymptomatic outpatients with left-sided structural heart disease. METHODS AND RESULTS We enrolled 458 asymptomatic patients with left-side heart diseases and any ejection fraction who were referred for echocardiography to two Italian centres. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome of this analysis. After a mean follow-up of 5.4 ± 1.2 years, 145 patients (31%) reached the combined endpoint. Most of echocardiographic parameters were related to outcomes, including right ventricular functional parameters. Mean value of RVFWLS in our cohort was -21 ± 8% and it was significantly related to the combined endpoint and in multivariable Cox-regression model; when tested with other echocardiographic parameters that were significantly related to outcome at univariate analysis, RVFWLS maintained its independent association with outcome (hazard ratio 0.963, 95% confidence interval 0.948-0.978; P = 0.0001). The best cut-off value of RVFWLS to predict outcome was -22% (area under the curve 0.677; P < 0.001; sensitivity 70%; 65% specificity). CONCLUSION RVFWLS may help clinicians to identify patients with left-sided structural heart disease at higher risk for first heart failure hospitalization and death for any cause.
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Affiliation(s)
- Mara Gavazzoni
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy.,Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Luigi P Badano
- IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, P.zza Brescia n 20, 20149, Milan, Italy
| | - Enrico Vizzardi
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Riccardo Raddino
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Davide Genovese
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova School of Medicine, Nicolo Giustiniani Street, n 2, 35128, Padova, Italy
| | - Maurizio Taramasso
- Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Edoardo Sciatti
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Chiara Palermo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova School of Medicine, Nicolo Giustiniani Street, n 2, 35128, Padova, Italy
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Denisa Muraru
- Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.,IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, P.zza Brescia n 20, 20149, Milan, Italy
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Tadic M, Nita N, Schneider L, Kersten J, Buckert D, Gonska B, Scharnbeck D, Reichart C, Belyavskiy E, Cuspidi C, Rottbauer W. The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases. Front Cardiovasc Med 2021; 8:698158. [PMID: 34222387 PMCID: PMC8247437 DOI: 10.3389/fcvm.2021.698158] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
Right ventricular (RV) systolic function has an important role in the prediction of adverse outcomes, including mortality, in a wide range of cardiovascular (CV) conditions. Because of complex RV geometry and load dependency of the RV functional parameters, conventional echocardiographic parameters such as RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), have limited prognostic power in a large number of patients. RV longitudinal strain overcame the majority of these limitations, as it is angle-independent, less load-dependent, highly reproducible, and measure regional myocardial deformation. It has a high predictive value in patients with pulmonary hypertension, heart failure, congenital heart disease, ischemic heart disease, pulmonary embolism, cardiomyopathies, and valvular disease. It enables detection of subclinical RV damage even when conventional parameters of RV systolic function are in the normal range. Even though cardiac magnetic resonance-derived RV longitudinal strain showed excellent predictive value, echocardiography-derived RV strain remains the method of choice for evaluation of RV mechanics primarily due to high availability. Despite a constantly growing body of evidence that support RV longitudinal strain evaluation in the majority of CV patients, its assessment has not become the part of the routine echocardiographic examination in the majority of echocardiographic laboratories. The aim of this clinical review was to summarize the current data about the predictive value of RV longitudinal strain in patients with pulmonary hypertension, heart failure and valvular heart diseases.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Nicoleta Nita
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | | | - Johannes Kersten
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Dominik Buckert
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Birgid Gonska
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Evgeny Belyavskiy
- Department of Cardiology, Charité-University-Medicine (Campus Virchow - Klinikum), Berlin, Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Wolfang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
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30
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Lisi M, Mandoli GE, Cameli M, Pastore MC, Righini FM, Benfari G, Rubboli A, D'Ascenzi F, Focardi M, Tsioulpas C, Bernazzali S, Maccherini M, Lisi E, Lindqvist P, Valente S, Mondillo S, Henein MY. Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation. Eur Heart J Cardiovasc Imaging 2021; 23:829-835. [PMID: 34118154 DOI: 10.1093/ehjci/jeab106] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS In patients with heart failure (HF), chronically raised left ventricular (LV) filling pressures lead to progressive left atrial (LA) dysfunction and fibrosis. We aimed to assess the correlation of LA reservoir strain (peak atrial longitudinal strain, PALS) by speckle tracking echocardiography (STE) and LA fibrosis assessed by myocardial biopsy in patients undergoing heart transplantation (HTx). METHODS AND RESULTS Forty-eight patients with advanced HF [mean age 51.2 ± 8.1 years, 29% females; LV ejection fraction ≤25% and New York Heart Association (NYHA) class III-IV] referred for HTx were enrolled and underwent pre-operative echocardiographic evaluation, right heart catheterization, and cardiopulmonary exercise testing. Exclusion criteria were non-sinus rhythm, mechanical ventilation, severe mitral/tricuspid regurgitation, or other valvular disease and poor acoustic window. After HTx, LA bioptic samples were collected and analysed to determine the extent of myocardial fibrosis (%). LA fibrosis showed correlation with PALS (R = -0.88, P < 0.0001), VO2max (R = -0.68, P < 0.0001), NYHA class (R = 0.66, P < 0.0001), LA stiffness (R = 0.58, P = 0.0002), and E/e' (R = 0.44, P = 0.005), while poorly correlated with E/A ratio (R = 0.23, P = 0.21). PALS had a good correlation with NYHA class (R = -0.64, P < 0.0001), PAoP (R = -0.61, P = 0.03) and VO2max (R = 0.57, P = 0.0001). Multivariate regression analysis identified PALS (beta = -0.91, P < 0.001) and LA Volume (beta = -0.19, P = 0.03) as predictors of LA Fibrosis, while E/e' was not a significant predictor (beta = 0.15, P = 0.08). CONCLUSION Emerging as a possible index of myocardial fibrosis in patients with advanced HF, PALS could help to optimize the management and the selection of those patients with irreversible LA structural damage for advanced therapeutic strategies.
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Affiliation(s)
- Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Francesca Maria Righini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | | | - Andrea Rubboli
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | | | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | | | - Edoardo Lisi
- Department of Mathematics, Imperial College London, London, UK
| | - Per Lindqvist
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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31
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Park J, Kim Y, Pereira J, Hennessey KC, Faridi KF, McNamara RL, Velazquez EJ, Hur DJ, Sugeng L, Agarwal V. Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19. ACTA ACUST UNITED AC 2021; 6:100018. [PMID: 34095889 PMCID: PMC8168299 DOI: 10.1016/j.ahjo.2021.100018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality. Methods We performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS. Results The optimal LV GLS cutoff to predict death was −13.8%, with a sensitivity of 85% (95% CI 55–98%) and specificity of 54% (95% CI 36–71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13–23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > −13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (−13.7 ± 5.9 vs. −19.6 ± 6.7, p = 0.003), but not associated with decreased survival. Conclusion Abnormal LV strain with a cutoff of >−13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.
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Key Words
- 2D, Two-dimensional
- ARDS, acute respiratory distress syndrome
- COVID-19
- COVID-19, Coronavirus Disease 2019
- EF, ejection fraction
- FAC, fractional area change
- FWS, free wall strain
- GLS, global longitudinal strain
- HFrEF, heart failure reduced ejection fraction
- Hs-TNT, high sensitivity troponin T
- ICC, intra-class correlation coefficient
- LV, left ventricle
- Left ventricular strain
- NT-proBNP, NT-pro-brain natriuretic peptide
- RV, right ventricle
- Speckle-tracking echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Jakob Park
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kerrilynn C Hennessey
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David J Hur
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vratika Agarwal
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Bech-Hanssen O, Astengo M, Fredholm M, Bergh N, Hjalmarsson C, Polte CL, Ricksten SE, Bollano E. Grading right ventricular dysfunction in left ventricular disease using echocardiography: a proof of concept using a novel multiparameter strategy. ESC Heart Fail 2021; 8:3223-3236. [PMID: 34034360 PMCID: PMC8318504 DOI: 10.1002/ehf2.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/19/2021] [Accepted: 05/16/2021] [Indexed: 01/18/2023] Open
Abstract
Aims Grading right ventricular dysfunction (RVD) in patients with left ventricular (LV) disease has earned little attention. In the present study, we established an echocardiographic RVD score and investigated how increments of the score correspond to RVD at right heart catheterization. Methods and results We included 95 patients with LV disease consecutively referred for heart transplant or heart failure work‐up with catheterization and echocardiography within 48 h. The RVD score (5 points) included well‐known characteristics of the development from compensated to decompensated right ventricular (RV) function: pulmonary hypertension, reduced RV strain, RV area dilatation, moderate/severe tricuspid regurgitation, and increased right atrial pressure (RAP) by echocardiography. Comparing three groups with increments of RVD score [1 (mild), 2–3 (moderate), and 4–5 (severe)] showed more advanced RVD with increasing RV end‐diastolic pressure (P < 0.001) and signs of uncoupling to load (reduced ratio between RV and pulmonary artery elastance, P < 0.001) and more spherical RV shape (RV area/length, P < 0.001). Receiver operating characteristic curve analysis for detection of severe RV (RAP ≥ 10 mmHg) showed for the RVD score an area under the curve of 0.88 compared with 0.69, 0.68, and 0.64 for RV strain, tricuspid annular plane systolic excursion, and fractional area change, respectively. A patient with RVD score ≥ 4 had a 6.7‐fold increase in likelihood of severe RVD, and no patient with RVD score ≤ 1 had severe RVD. Conclusions In this proof of concept study, a novel RVD score outperformed the widely used longitudinal parameters regarding grading of RVD severity, with a potential role for refined diagnosis, follow‐up, and prognosis assessment in heart failure patients.
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Affiliation(s)
- Odd Bech-Hanssen
- Departments of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Marco Astengo
- Departments of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Martin Fredholm
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Niklas Bergh
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clara Hjalmarsson
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Lars Polte
- Departments of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Entela Bollano
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Vijiiac A, Onciul S, Guzu C, Scarlatescu A, Petre I, Zamfir D, Onut R, Deaconu S, Dorobantu M. Forgotten No More-The Role of Right Ventricular Dysfunction in Heart Failure with Reduced Ejection Fraction: An Echocardiographic Perspective. Diagnostics (Basel) 2021; 11:diagnostics11030548. [PMID: 33808566 PMCID: PMC8003573 DOI: 10.3390/diagnostics11030548] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/28/2022] Open
Abstract
During the last decade, studies have raised awareness of the crucial role that the right ventricle plays in various clinical settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they show good correlation with the gold standard represented by cardiac magnetic resonance. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature.
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Affiliation(s)
- Aura Vijiiac
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
- Correspondence: ; Tel.: +40-(75)-2298-189
| | - Sebastian Onciul
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Claudia Guzu
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Alina Scarlatescu
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Ioana Petre
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Diana Zamfir
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Roxana Onut
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Silvia Deaconu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Maria Dorobantu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
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Tian F, Zhang L, Xie Y, Zhang Y, Zhu S, Wu C, Sun W, Li M, Gao Y, Wang B, Wang J, Yang Y, Lv Q, Dong N, Li Y, Xie M. 3-Dimensional Versus 2-Dimensional STE for Right Ventricular Myocardial Fibrosis in Patients With End-Stage Heart Failure. JACC Cardiovasc Imaging 2021; 14:1309-1320. [PMID: 33744147 DOI: 10.1016/j.jcmg.2021.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Longitudinal strain of the right ventricular (RV) free wall (RVFWLS) assessed by 2-dimensional (2D) speckle-tracking echocardiography (STE) has been recently demonstrated to correlate with the extent of RV myocardial fibrosis (MF). However, the value of 3-dimensional (3D) STE-derived strain parameters in predicting RV MF has not been investigated in patients with end-stage heart failure (HF). OBJECTIVES This study aimed to determine which RV strain parameter assessed by 2D-STE and 3D-STE was the most reliable parameter for predicting RV MF in patients with end-stage HF against histological confirmation of MF. METHODS A total of 105 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in our study. The conventional RV function parameters, 2D-RVFWLS, and 3D-RVFWLS were obtained in these patients. The degree of MF was quantified by Masson trichrome staining in RV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology. RESULTS Patients with severe MF had lower 3D-RVFWLS, 2D-RVFWLS, and conventional parameters of RV function compared with those with mild and moderate MF. RV MF strongly correlated with 3D-RVFWLS (r = -0.72; p < 0.001), modestly with 2D-RVFWLS (r = -0.53; p < 0.001), and weakly with conventional RV function parameters (r = -0.21 to -0.49; p < 0.01). 3D-RVFWLS correlated best with the degree of MF (r = -0.72 vs. -0.21 to -0.53; p < 0.05) compared with 2D-RVFWLS and conventional RV function parameters. 3D-RVFWLS had the highest accuracy for detecting severe MF (area under the receiver-operating characteristic curve: 0.90 vs. 0.24-0.80; p < 0.05) compared with 2D-RVFWLS and conventional RV parameters. The model with 3D-RVFWLS (R2 = 0.63; p < 0.001) was better in predicting the degree of RV MF than that with 2D-RVFWLS (R2 = 0.54; p < 0.001). CONCLUSIONS 3D-RVFWLS may be the most robust echocardiographic measure for predicting the extent of RV MF in patients with end-stage HF.
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Affiliation(s)
- Fangyan Tian
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanting Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Gao
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Abstract
Diffuse myocardial fibrosis resulting from the excessive deposition of collagen fibres through the entire myocardium is encountered in a number of chronic cardiac diseases. This lesion results from alterations in the regulation of fibrillary collagen turnover by fibroblasts, facilitating the excessive deposition of type I and type III collagen fibres within the myocardial interstitium and around intramyocardial vessels. The available evidence suggests that, beyond the extent of fibrous deposits, collagen composition and the physicochemical properties of the fibres are also relevant in the detrimental effects of diffuse myocardial fibrosis on cardiac function and clinical outcomes in patients with heart failure. In this regard, findings from the past 20 years suggest that various clinicopathological phenotypes of diffuse myocardial fibrosis exist in patients with heart failure. In this Review, we summarize the current knowledge on the mechanisms and detrimental consequences of diffuse myocardial fibrosis in heart failure. Furthermore, we discuss the validity and usefulness of available imaging techniques and circulating biomarkers to assess the clinicopathological variation in this lesion and to track its clinical evolution. Finally, we highlight the currently available and potential future therapeutic strategies aimed at personalizing the prevention and reversal of diffuse myocardial fibrosis in patients with heart failure.
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Echocardiography for left ventricular assist device implantation and evaluation: an indispensable tool. Heart Fail Rev 2021; 27:891-902. [PMID: 33428013 DOI: 10.1007/s10741-021-10073-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Echocardiography is an indispensable tool in the evaluation, placement, management and follow-up of patients with left ventricular assist devices (LVAD). While transoesophageal echocardiography is the ideal tool in guiding the implantation procedure, transthoracic echocardiography is essential during the initial evaluation, patient selection and in the post-operative follow-up. This review attempts to summarize which parameters the echocardiographic assessment should focused on during each step. In particular, during the pre-operative assessment, it is of paramount importance to assess the presence of aortic regurgitation and most importantly to evaluate right ventricular function, since it is one of the strongest predictor of post-implant right ventricular failure. During the procedure, through transoesophageal echocardiography, it is possible to confirm the correct placement of the inflow cannula, to assess right ventricular function and to guide the choice of the right pump speed. Transthoracic echocardiographic is an essential part in the patient's follow-up once the LVAD has been implanted, in order to attest the onset of possible complications.
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Gumus F, Sarıcaoglu C, Inan MB, Akar AR. Right Ventricular Strain to Assess Early Right Heart Failure in the Left Ventricular Assist Device Candidate. Curr Heart Fail Rep 2020; 16:212-219. [PMID: 31741233 DOI: 10.1007/s11897-019-00445-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Right heart failure (RHF) following left ventricular assist device implantation (LVAD) remains the primary cause of postoperative mortality and morbidity, and prediction of RHF is the main interest of the transplantation community. In this review, we outline the role and impact of right ventricular strain in the evaluation of the right ventricle function before LVAD implantation. RECENT FINDINGS Accumulating data suggest that measurement of right ventricular longitudinal strain (RVLS) has a critical role in predicting RHF preoperatively and may improve morbidity and mortality following LVAD implantation. However, the significant intraobserver, interobserver variability, the lack of multicenter, prospective studies, and the need for a learning curve remain the most critical limitations in the clinical practice at present. This review highlighted the importance of right ventricular strain in the diagnosis of RHF preoperatively and revealed that RVLS might have a crucial clinical measurement for the selection and management of LVAD patients in the future with the more extensive multicenter studies.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Cahit Sarıcaoglu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Mustafa Bahadir Inan
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey
| | - Ahmet Ruchan Akar
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Dikimevi, 06340, Ankara, Turkey.
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38
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Cameli M, Pastore MC, Henein MY, Mondillo S. The left atrium and the right ventricle: two supporting chambers to the failing left ventricle. Heart Fail Rev 2020; 24:661-669. [PMID: 31025236 DOI: 10.1007/s10741-019-09791-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) is mainly caused by left ventricular (LV) impairment of function, hence detailed assessment of its structure and function is a clinical priority. The frequent involvement of the left atrium (LA) and the right ventricle (RV) in the overall cardiac performance has recently gained significant interest with specific markers predicting exercise intolerance and prognosis being proposed. The LA and RV are not anatomically separated from the LV, while the LA controls the inlet the RV shares the interventricular septum with the LV. Likewise, the function of the two chambers is not entirely independent from that of the LV, with the LA enlarging to accommodate any rise in filling pressures, which could get transferred to the RV via the pulmonary circulation. In the absence of pulmonary disease, LA and RV function may become impaired in patients with moderate-severe LV disease and raised filling pressures. These changes can often occur irrespective of the severity of systolic dysfunction, thus highlighting the important need for critical assessment of the function of the two chambers. This review evaluates the pivotal role of the left atrium and right ventricle in the management of HF patients based on the available evidence.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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Habert P, Capron T, Hubert S, Bentatou Z, Bartoli A, Tradi F, Renard S, Rapacchi S, Guye M, Bernard M, Habib G, Jacquier A. Quantification of right ventricular extracellular volume in pulmonary hypertension using cardiac magnetic resonance imaging. Diagn Interv Imaging 2020; 101:311-320. [DOI: 10.1016/j.diii.2019.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/30/2022]
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40
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Zhu S, Li M, Tian F, Wang S, Li Y, Yin P, Zhang L, Xie M. Diagnostic value of myocardial strain using two-dimensional speckle-tracking echocardiography in acute cardiac allograft rejection: A systematic review and meta-analysis. Echocardiography 2020; 37:561-569. [PMID: 32200582 DOI: 10.1111/echo.14637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/06/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Two-dimensional speckle-tracking echocardiography (2D STE) has been demonstrated to have certain diagnostic utility in heart transplantation (HTX) patients with acute cardiac allograft rejection (ACAR). The aim of the systematic review and meta-analysis was to evaluate the diagnostic value of common strain parameters for ACAR in HTX patients. METHODS After conducting a database search, we selected studies evaluating left ventricular global longitudinal strain (GLS), circumferential strain (CS), radial strain (RS), and free wall right ventricular longitudinal strain (RV FW) in rejection group vs rejection-free group. RESULTS After reviewing 886 publications, seven studies were finally included in the meta-analysis, representing the data of 1173 pairs of endomyocardial biopsy and echocardiographic examination. Heart transplantation patients with rejection had significantly lower GLS than rejection-free subjects (weighted mean difference -2.32 (95% CI, -3.41 to -1.23; P < .001). Heart transplantation patients with rejection had significantly lower CS than rejection-free subjects (weighted mean difference -2.49 (95% CI, -4.05 to -0.91; P = .0019). In addition, HTX patients with rejection also had significantly lower RV FW (weighted mean difference -4.90 (95% CI, -6.15 to -3.65; P < .001). CONCLUSIONS The meta-analysis and systematic review demonstrate that myocardial strain parameters derived from 2D STE may be useful in detecting ACAR in HTX patients. The present results provide encouraging evidence to consider the routine use of GLS, CS, and RV FW as markers of graft function involvement during ACAR.
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Affiliation(s)
- Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Meng Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fangyan Tian
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Shuyuan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ping Yin
- Epidemiology and Health Statistics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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41
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Powers JC, Sabri A, Al-Bataineh D, Chotalia D, Guo X, Tsipenyuk F, Berretta R, Kavitha P, Gopi H, Houser SR, Khan M, Tsai EJ, Recchia FA. Differential microRNA-21 and microRNA-221 Upregulation in the Biventricular Failing Heart Reveals Distinct Stress Responses of Right Versus Left Ventricular Fibroblasts. Circ Heart Fail 2020; 13:e006426. [PMID: 31916447 DOI: 10.1161/circheartfailure.119.006426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The failing right ventricle (RV) does not respond like the left ventricle (LV) to guideline-directed medical therapy of heart failure, perhaps due to interventricular differences in their molecular pathophysiology. METHODS Using the canine tachypacing-induced biventricular heart failure (HF) model, we tested the hypothesis that interventricular differences in microRNAs (miRs) expression distinguish failing RV from failing LV. RESULTS Severe RV dysfunction was indicated by elevated end-diastolic pressure (11.3±2.5 versus 5.7±2.0 mm Hg; P<0.0001) and diminished fractional area change (24.9±7.1 versus 48.0±3.6%; P<0.0001) relative to prepacing baselines. Microarray analysis of ventricular tissue revealed that miR-21 and miR-221, 2 activators of profibrotic and proliferative processes, increased the most, at 4- and 2-fold, respectively, in RV-HF versus RV-Control. Neither miR-21 or miR-221 was statistically significantly different in LV-HF versus LV-Control. These changes were accompanied by more extensive fibrosis in RV-HF than LV-HF. To test whether miR-21 and miR-221 upregulation is specific to RV cellular response to mechanical and hormonal stimuli associated with HF, we subjected fibroblasts and cardiomyocytes isolated from normal canine RV and LV to cyclic overstretch and aldosterone. These 2 stressors markedly upregulated miR-21 and miR-221 in RV fibroblasts but not in LV fibroblasts nor cardiomyocytes of either ventricle. Furthermore, miR-21/221 knockdown significantly attenuated RV but not LV fibroblast proliferation. CONCLUSIONS We identified a novel, biological difference between RV and LV fibroblasts that might underlie distinctions in pathological remodeling of the RV in biventricular HF.
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Affiliation(s)
- Jeffery C Powers
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Abdelkarim Sabri
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Dalia Al-Bataineh
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Dhruv Chotalia
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Xinji Guo
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Florence Tsipenyuk
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Remus Berretta
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Pavithra Kavitha
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Heramba Gopi
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Steven R Houser
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Mohsin Khan
- the Center for Translational Medicine (M.K.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Emily J Tsai
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA.,Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York (E.J.T.)
| | - Fabio A Recchia
- From the Cardiovascular Research Center (J.C.P, A.S., D.A.-B., D.C., X.G., F.T., R.B., P.K., H.G., S.R.H., F.A.R.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa; and Fondazione Toscana Gabriele Monasterio, Pisa, Italy (F.A.R.)
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42
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Right ventricular free wall strain predicts functional capacity in patients with repaired Tetralogy of Fallot. Int J Cardiovasc Imaging 2020; 36:595-604. [DOI: 10.1007/s10554-019-01753-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
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43
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Espe EKS, Aronsen JM, Nordén ES, Zhang L, Sjaastad I. Regional right ventricular function in rats: a novel magnetic resonance imaging method for measurement of right ventricular strain. Am J Physiol Heart Circ Physiol 2020; 318:H143-H153. [DOI: 10.1152/ajpheart.00357.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The function of the right ventricle (RV) is linked to clinical outcome in many cardiovascular diseases, but its role in experimental heart failure remains largely unexplored due to difficulties in measuring RV function in vivo. We aimed to advance RV imaging by establishing phase-contrast MRI (PC-MRI) as a robust method for measuring RV function in rodents. A total of 46 Wistar-Hannover rats with left ventricular (LV) myocardial infarction and 10 control rats (sham) were examined 6 wk after surgery. Using a 9.4-T preclinical MRI system, we utilized PC-MRI to measure strain/strain rate in the RV free wall under isoflurane anesthesia. Cine MRI was used to measure RV volumes. LV end-diastolic pressure (LVEDP) was measured and used to identify pulmonary congestion. The infarct rats were divided into two groups: those with signs of pulmonary congestion (PC), with LVEDP ≥ 15 mmHg ( n = 26) and those without signs of pulmonary congestion (NPC), with LVEDP < 15 mmHg ( n = 20). The NPC rats exhibited preserved RV strains/strain rates, whereas the PC rats exhibited reduced strains/strain rates (26–48% lower than sham). Of the strain parameters, longitudinal strain and strain rate exhibited the highest correlations to LVEDP and lung weight (rho = 0.65–0.72, P < 0.001). Basal longitudinal strain was most closely associated with signs of pulmonary congestion and indexes of RV remodeling. Longitudinal RV strain had higher area under the curve than ejection fraction for detecting subtle RV dysfunction (area under the curve = 0.85 vs. 0.67). In conclusion, we show for the first time that global and regional RV myocardial strain can be measured robustly in rodents. Reduced RV strain was closely associated with indexes of pulmonary congestion and molecular markers of RV remodeling. NEW & NOTEWORTHY Global and regional right ventricular myocardial strain can be measured with high reproducibility and low interobserver variability in rodents using tissue phase mapping MRI. Reduced right ventricular strain was associated with indexes of pulmonary congestion and molecular markers of right ventricular remodeling. Regional strain in the basal myocardium was considerably higher than in the apical myocardium.
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Affiliation(s)
- Emil K. S. Espe
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Jan M. Aronsen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Bjørknes College, Oslo, Norway
| | - Einar S. Nordén
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
- Bjørknes College, Oslo, Norway
| | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
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44
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Cameli M, Pastore MC, De Carli G, Henein MY, Mandoli GE, Lisi E, Cameli P, Lunghetti S, D’Ascenzi F, Nannelli C, Rizzo L, Valente S, Mondillo S. ACUTE HF score, a multiparametric prognostic tool for acute heart failure: A real-life study. Int J Cardiol 2019; 296:103-108. [DOI: 10.1016/j.ijcard.2019.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022]
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45
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Swat SA, Cohen D, Shah SJ, Lloyd-Jones DM, Baldridge AS, Freed BH, Vorovich EE, Yancy CW, Jonnalagadda SR, Prenner S, Kim D, Wilcox JE. Baseline Longitudinal Strain Predicts Recovery of Left Ventricular Ejection Fraction in Hospitalized Patients With Nonischemic Cardiomyopathy. J Am Heart Assoc 2019; 7:e09841. [PMID: 30371257 PMCID: PMC6474980 DOI: 10.1161/jaha.118.009841] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Heart failure (HF) with “recovered” ejection fraction (HFrecEF) is an emerging phenotype, but no tools exist to predict ejection fraction (EF) recovery in acute HF. We hypothesized that indices of baseline cardiac structure and function predict HFrecEF in nonischemic cardiomyopathy and reduced EF. Methods and Results We identified a nonischemic cardiomyopathy cohort with EF<40% during the first HF hospitalization (n=166). We performed speckle‐tracking echocardiography to measure longitudinal, circumferential, and radial strain, and the average of these measures (myocardial systolic performance). HFrecEF was defined as follow‐up EF ≥40% and ≥10% improvement from baseline EF. Fifty‐nine patients (36%) achieved HFrecEF (baseline EF 26±7%; follow‐up EF 51±7%) within a median of 135 (interquartile range 58‐239) days after the first HF hospitalization. Baseline demographics, biomarker profiles, and comorbid conditions (except lower chronic kidney disease in HFrecEF) were similar between HFrecEF and persistent reduced‐EF groups. HFrecEF patients had smaller baseline left ventricular end‐systolic dimension (3.6 versus 4.8 cm; P<0.01), higher baseline myocardial systolic performance (9.2% versus 8.1%; P=0.02), and improved survival (adjusted hazard ratio 0.27, 95% confidence interval 0.11, 0.62). We found a significant interaction between baseline left ventricular end‐systolic dimension and absolute longitudinal strain. Among patients with left ventricular end‐systolic dimension >4.35 cm, higher absolute longitudinal strain (≥8%) was associated with HFrecEF (unadjusted odds ratio=3.9, 95% CI)confidence interval 1.2, 12.8). Incorporation of baseline indices of cardiac mechanics with clinical variables resulted in a predictive model for HFrecEF with c‐statistic=0.85. Conclusions Factors associated with achieving HFrecEF were specific to cardiac structure and indices of cardiac mechanics. Higher baseline absolute longitudinal strain is associated with HFrecEF among nonischemic cardiomyopathy patients with reduced EF and larger left ventricular dimensions.
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Affiliation(s)
- Stanley A Swat
- 1 Department of Medicine Northwestern University Chicago IL
| | - David Cohen
- 5 Division of Cardiology University of Michigan Ann Arbor MI
| | - Sanjiv J Shah
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Donald M Lloyd-Jones
- 2 Department of Preventative Medicine Northwestern University Chicago IL.,4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Benjamin H Freed
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Esther E Vorovich
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | - Clyde W Yancy
- 4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Stuart Prenner
- 6 Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Daniel Kim
- 3 Department of Radiology Northwestern University Chicago IL
| | - Jane E Wilcox
- 2 Department of Preventative Medicine Northwestern University Chicago IL.,4 Division of Cardiology Feinberg School of Medicine Northwestern University Chicago IL
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46
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Do reverse dippers have the highest risk of right ventricular remodeling? Hypertens Res 2019; 43:213-219. [DOI: 10.1038/s41440-019-0351-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/25/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
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47
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Park JH. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circ J 2019; 49:908-931. [PMID: 31456367 PMCID: PMC6753023 DOI: 10.4070/kcj.2019.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 01/14/2023] Open
Abstract
Echocardiography is the first and is the most-available imaging modality for many cardiovascular diseases, and echocardiographic parameters can give much important information for diagnosis, treatment, and prognostic evaluations. Left ventricular ejection fraction (LVEF) is the most commonly used echocardiographic parameter for left ventricular (LV) systolic function. Although LVEF is used routinely in daily practice, it is calculated from volumetric change without representing true myocardial properties. Recently, strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Although strain echocardiography has been applied to measure the right ventricle and left atrium, in addition to analyzing the LV, many cardiologists who are not imaging specialists are unaware of its clinical use and importance. Therefore, this review describes the measurement and clinical utility of 2-dimensional strain analysis in various cardiovascular diseases.
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Affiliation(s)
- Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
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48
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Prognosis and Risk Stratification of Patients With Advanced Heart Failure (from PROBE). Am J Cardiol 2019; 124:55-62. [PMID: 31047653 DOI: 10.1016/j.amjcard.2019.03.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/19/2022]
Abstract
In recent years, many prognostic scores have been developed for advanced chronic heart failure (CHF), but none of them is comprised of first- and second level echocardiographic indexes. The aim was to create a new prognostic echocardiographic score for patients with advanced CHF. Patients with advanced CHF were analyzed by standard, 3D, and speckle tracking echocardiography and followed prospectively for 2 ± 0.7 years recording major adverse cardiac events (MACE): cardiovascular death, hospitalization for HF, emergency heart transplantation, and left ventricular assist device or intra-aortic balloon pump implantation. A total of 110 patients were enrolled. The best predictors of MACE were selected on the basis of area under the curve by receiver operating characteristic analysis >0.70: left atrial volume index (no MACE vs MACE groups, 51.3 ± 20 ml/m2 vs 67 ± 20 ml/m2, p = 0.0003), right ventricular sphericity index (0.53 ± 0.09 vs 0.61 ± 0.10, p = 0.0002), right ventricular fractional area change (41 ± 9% vs 33 ± 9.5, p <0.0001), free-wall right ventricular longitudinal strain (-20 ± 4.5% vs -16 ± 6%, p = 0.0013). A prognostic score formula was calculated as: PROBE score = 1(if left atrial volume index >65 ml/m2) + 1(if right ventricular sphericity index >0.53) + 0.5(if right ventricular fractional area change <36.5%) + 1(if free-wall right ventricular longitudinal strain >-14%). It presented an area under the curve by receiver operating characteristic analysis of 0.90 and classified patients at low (PROBE ≤1), intermediate (PROBE = 1 to 2), or high (PROBE >2) risk of MACE. The Kaplan-Meier analysis revealed a strong correlation between the event-free survival rate and the 3 groups. In conclusion, the PROBE score, with first- and second level echocardiographic parameters, demonstrated a good predictive value for MACE. It represents a useful tool for a noninvasive, individualized, and accurate evaluation and stratification of prognosis in patients with advanced CHF.
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49
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Cherata DA, Donoiu I, Diaconu R, Glodeanu A, Cârstea D, Militaru C, Istrătoaie O. Longitudinal strain analysis allows the identification of subclinical deterioration of right ventricular function in patients with cancer therapy-related left ventricular dysfunction. Discoveries (Craiova) 2019; 7:e94. [PMID: 32309612 PMCID: PMC7093070 DOI: 10.15190/d.2019.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study was designed to assess right ventricular systolic function in cancer patients. METHODS AND RESULTS 68 consecutive patients receiving potentially cardiotoxic agents were followed for 6 months in a single-center, observational, cohort-study. Left ventricle and free-wall right ventricular longitudinal strain were analyzed prior and after 6 months of treatment, using a vendor-independent software, together with left ventricle ejection fraction, tricuspid annulus plane systolic excursion and right ventricular fractional area change. Cancer therapy-related cardiac dysfunction was defined as a left ventricle ejection fraction drop of >10% to <53%. Both left ventricle ejection fraction (59±7% vs. 55±8%, p<0.0001) and left ventricle longitudinal strain (-19.7±2.5% vs. -17.1±2.6%, p<0.0001) were reduced at follow up, along with free-wall right ventricular longitudinal strain (-24.9±4.5% vs. -21.6±4.9%, p<0.0001). Cancer therapy-related cardiac dysfunction was detected in 20 patients (29%). In 15 out of these 20 patients (75%), a concomitant relative reduction in free-wall right ventricular longitudinal strain magnitude by 17±7% was detected. Moreover, there was a significant correlation between left ventricle and free-wall right ventricular longitudinal strain at follow-up examinations (r=0.323, p<0.0001). A relative drop of right ventricular longitudinal strain >17% had a sensitivity of 55% and a specificity of 70% (AUC=0.75, 0.7-0.8, 95% CI) to identify patients with cancer treatment related cardiac dysfunction. Neither tricuspid annulus plane systolic excursion (24±5 vs. 23±4 mm, p=0.07), nor right ventricular fractional area change (45±8% vs. 44±7%, p=0.6) showed any significant change between examinations. CONCLUSIONS Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected.
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Affiliation(s)
| | - Ionuț Donoiu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Rodica Diaconu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Adina Glodeanu
- Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania.,Department of Medical Semiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Doina Cârstea
- Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania.,Department of Medical Semiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Constantin Militaru
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Octavian Istrătoaie
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
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50
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Sanz-de la Garza M, Giraldeau G, Marin J, Imre Sarvari S, Guasch E, Gabrielli L, Brambila C, Bijnens B, Sitges M. Should the septum be included in the assessment of right ventricular longitudinal strain? An ultrasound two-dimensional speckle-tracking stress study. Int J Cardiovasc Imaging 2019; 35:1853-1860. [PMID: 31129743 DOI: 10.1007/s10554-019-01633-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/18/2019] [Indexed: 12/01/2022]
Abstract
Right ventricular longitudinal strain (RVLS) by 2D speckle-tracking echocardiography (2D-STE) is a useful parameter for assessing systolic function. However, the exact method to perform it is not well defined as some authors evaluate only free wall (FW) segments while others include all six RV segments. To compare the assessment of RVLS at rest and during exercise by these two approaches. Echocardiography was performed on 80 healthy subjects at rest and during exercise. The analysis consisted of standard and 2D-STE assessment of RV global and segmental strain tracing only RVFW and also tracing all six RV segments. At rest, RVLS could be assessed in 78 (feasibility 97.5%) subjects by both methods. However, during exercise, RVLS by RVFW method was feasible in 67 (83.8%) as compared to 74 (92.5%) by RV6S approach. Both at rest and during exercise, RVLS values by the two methods showed excellent correlation (r = > 0.90). However, RVLS values assessed by RV6S were lower (absolute values) than those by RVFW approach (RV6S vs. RVFW; rest: - 27.0 ± 3.9 vs. - 9.5 ± 3.9, p < 0.001 and exercise: - 30.7 ± 5.2 vs. - 33.3 ± 5.1, p < 0.001). Furthermore, basal strain was higher and apical strain lower (absolute values) by RV6S approach. At rest, reproducibility for RVLS was excellent and similar for the two methods. However, during exercise, reproducibility for RVFW method was poorer, especially at the apex. The two currently described methods for RVLS assessment by 2D-STE demonstrated excellent agreement. However, the RV6S approach seemed to be more feasible and reproducible, particularly during exercise. Moreover, global and segmental strain values are different with both methods and should not be interchanged.
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Affiliation(s)
- Maria Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain.
| | - Geneviève Giraldeau
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
| | - Josefa Marin
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
| | - Sebastian Imre Sarvari
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
| | - Eduard Guasch
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
| | - Luigi Gabrielli
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
| | - Carlos Brambila
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
| | - Bart Bijnens
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Universitat Pompeu Fabra Barcelona, Carrer de Roc Boronat 138, 08018, Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Villarroel 170, 08036, Barcelona, Spain
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