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Sonaglioni A, Pusca I, Casieri F, Dell'Anna R, Luigi Nicolosi G, Bianchi S, Lombardo M. Echocardiographic assessment of left atrial mechanics in women with hypertensive disorders of pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 299:62-70. [PMID: 38838388 DOI: 10.1016/j.ejogrb.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/27/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE The influence of hypertensive disorders of pregnancy (HDP) on left atrial (LA) mechanics assessed by speckle tracking echocardiography (STE) has been poorly investigated. Accordingly, we performed a meta-analysis to summarize the main findings of STE studies who measured LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain in HDP women. STUDY DESIGN All echocardiographic studies assessing LA strain parameters in HDP women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LASr, LAScd and LASct) were pooled as standardized mean difference (SMD) comparing HDP group with healthy controls. The overall SMDs of LASr, LAScd and LASct were calculated using the random-effect model. RESULTS The full-texts of 8 studies with 566 HDP women and 420 healthy pregnant women were analyzed. Average LASr (34.3 ± 6.4 vs 42.7 ± 5.3 %, P = 0.01) and LAScd (23.4 ± 6.3 vs 32.5 ± 6.0 %, P < 0.001) were significantly lower in HDP women than controls, whereas LASct (-13.0 ± 5.4 vs -13.7 ± 4.5 %, P = 0.18) was similar in the two groups of women. Substantial heterogeneity was detected among the studies evaluating LASr (I2 = 94.3 %), LAScd (I2 = 64.9 %) and LASct (I2 = 86.4 %). SMDs were large and statistically significant for LASr (-1.70, 95 %CI -2.34,-1.06, P < 0.001) and LAScd (-1.35, 95 %CI -1.69,-1.00, P < 0.001), small and not statistically significant for LASct (-0.11, 95 %CI -0.60,0.39, P = 0.678) assessment. Egger's test gave P-values of 0.10, 0.34 and 0.75 for LASr, LAScd and LASct measurement respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LASr and its components (all P < 0.05). CONCLUSIONS HDPs are independently associated with LASr impairment in pregnancy. STE allows to identify, among HDP women, those who might benefit from a more aggressive antihypertensive treatment and/or a closer clinical follow-up, aimed at reducing the risk of adverse maternal outcome and cardiovascular complications later in life.
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Affiliation(s)
| | - Irene Pusca
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Federica Casieri
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Rebecca Dell'Anna
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | | | - Stefano Bianchi
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
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2
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Chávez CO, Centurión OA, Meza AJ, Del Pilar Falcón R, Scavenius KE, García LB, Sequeira OR, Torales JM, Galeano EJ. Left Atrial Peak Systolic Strain as an Indicator Pathway of Diastolic Dysfunction of the Left Ventricle. Crit Pathw Cardiol 2024; 23:111-118. [PMID: 38381698 DOI: 10.1097/hpc.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Left atrial peak systolic strain (LA-PSS) imaging is an emerging index of left atrial function, and it was shown to be decreased in heart failure with preserved ejection fraction (EF). We aimed to determine whether LA-PSS could be used as an additional diagnostic parameter to current existing guidelines for the presence of left ventricle diastolic dysfunction (LVDD). MATERIALS AND METHODS A total of 190 consecutive adult patients with cardiovascular risk factors and normal left ventricle EF with no prior history of heart failure were included in the study. Speckle tracking software was used to study ventricular parietal deformity, left ventricle global longitudinal systolic strain, and LA-PSS. RESULTS The median left ventricle global longitudinal systolic strain was -19%, with a significant difference ( P < 0.001) between patients with normal diastolic function versus those with LVDD. The median LA-PSS was 33% (30% to 38%) ( P < 0.001). Most patients (61%) had grade 1 atrial dysfunction based on PSS (range 24%-35%). The analysis of the area under the receiver operating characteristic curve of the LA-PSS as a potential indicator pathway of LVDD was 67% [95% confidence interval (CI), 62-72], and 75% (95% CI, 70-80), when the indeterminate pattern was included. The decreased LA-PSS made it possible to reclassify patients with an indeterminate pattern of diastolic function in 96% of cases. CONCLUSIONS These results support the potential role of LA-PSS as an additional parameter for the diagnosis of LVDD in patients with normal EF, and may be integrated into the guidelines for routine evaluation of patients.
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Affiliation(s)
- Christian Osmar Chávez
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Osmar Antonio Centurión
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Alfredo Javier Meza
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Rocío Del Pilar Falcón
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Karina E Scavenius
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Laura B García
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Orlando R Sequeira
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Judith M Torales
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
- Department of Health Sciences Research, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Erdulfo J Galeano
- From the Division of Cardiovascular Medicine, Clinical Hospital, Asunción National University (UNA), San Lorenzo, Paraguay
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3
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Shin SH. Mitral Annular Velocity in Primary MR: Unveiling the Prognostic Potential of an Oldie But Goodie. Korean Circ J 2024; 54:323-324. [PMID: 38863252 PMCID: PMC11169909 DOI: 10.4070/kcj.2024.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
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4
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Caminiti G, Volterrani M, Iellamo F, Marazzi G, Manzi V, D’Antoni V, Vadalà S, Di Biasio D, Catena M, Morsella V, Perrone MA. Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study. Front Cardiovasc Med 2024; 11:1377958. [PMID: 38774661 PMCID: PMC11106494 DOI: 10.3389/fcvm.2024.1377958] [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: 01/28/2024] [Accepted: 04/05/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose Left atrial dysfunction has shown to play a prognostic role in patients with ischemic cardiomyopathy (ICM) and is becoming a therapeutic target for pharmacological and non-pharmacological interventions. The effects of exercise training on the atrial function in patients with ICM have been poorly investigated. In the present study, we assessed the effects of a 12-week combined training (CT) program on the left atrial function in patients with ICM. Methods We enlisted a total of 45 clinically stable patients and randomly assigned them to one of the following three groups: 15 to a supervised CT with low-frequency sessions (twice per week) (CTLF); 15 to a supervised CT with high-frequency sessions (thrice per week) (CTHF); and 15 to a control group following contemporary preventive exercise guidelines at home. At baseline and 12 weeks, all patients underwent a symptom-limited exercise test and echocardiography. The training included aerobic continuous exercise and resistance exercise. The analysis of variance (ANOVA) was used to compare within- and inter-group changes. Results At 12 weeks, the CTLF and CTHF groups showed a similar increase in the duration of the ergometric test compared with the control (ANOVA p < 0.001). The peak atrial longitudinal strain significantly increased in the CTHF group, while it was unchanged in the CTLF and control groups (ANOVA p = 0.003). The peak atrial contraction strain presented a significant improvement in the CTHF group compared with the CTLF and control groups. The left ventricular global longitudinal strain significantly increased in both the CTHF and the CTLF groups compared with the control group (ANOVA p = 0.017). The systolic blood pressure decreased in the CTHF and CTLF groups, while it was unchanged in the control group. There were no side effects causing the discontinuation of the training. Conclusions We demonstrated that a CT program effectively improved atrial function in patients with ICM in a dose-effect manner. This result can help with programming exercise training in this population.
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Affiliation(s)
- Giuseppe Caminiti
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | - Maurizio Volterrani
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | - Ferdinando Iellamo
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Vincenzo Manzi
- Department of Wellbeing, Nutrition and Sport, Pegaso Open University, Naples, Italy
| | | | - Sara Vadalà
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | | | - Matteo Catena
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, Rome, Italy
| | | | - Marco Alfonso Perrone
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Nagueh SF. Left Atrial Conduit Volume Provides Insights Into Left Ventricular Diastolic Function. Circ Cardiovasc Imaging 2024; 17:e016896. [PMID: 38716666 DOI: 10.1161/circimaging.124.016896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Sherif F Nagueh
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, TX
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Anwar AM. Incremental diagnostic and prognostic utility of left atrial deformation in heart failure using speckle tracking echocardiography. Heart Fail Rev 2024; 29:713-727. [PMID: 38466374 DOI: 10.1007/s10741-024-10392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
Left atrium (LA) is a very important component of cardiovascular performance. The assessment of LA function has gathered the interest with expanding research supporting the utility as a biomarker for outcomes in heart failure (HF). Echocardiography is the main imaging modality which helps in a qualitative and quantitative assessment of the LA size and function. Recent advances in probe technology and software analysis have provided a better understanding of LA anatomy, physiology, pathology, and function. A variety of parameters have been defined as markers of LA function but there is no single parameter that best defines LA function. Speckle tracking echocardiography-derived analysis of LA deformation provides a window on all phases of LA function (reservoir, conduit, and booster pump). There is accumulative published data that supported the diagnostic and prognostic values of LA deformation integration during echo assessment of LA in HF. This review article summarized the clinical utility of LA deformation that may help in prediction, diagnosis, categorization, risk stratification, and guiding the proper selection of therapy in HF patients in daily practice.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, P.O. Box: 9862, Jeddah, 21159, Saudi Arabia.
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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Serafin A, Kosmala W, Marwick TH. Evolving Applications of Echocardiography in the Evaluation of Left Atrial and Right Ventricular Strain. Curr Cardiol Rep 2024:10.1007/s11886-024-02058-x. [PMID: 38647564 DOI: 10.1007/s11886-024-02058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Speckle-tracking echocardiography (STE) can assess myocardial motion in non-LV chambers-including assessment of left atrial (LA) and right ventricular (RV) strain. This review seeks to highlight the diagnostic, prognostic, and clinical significance of these parameters in heart failure, atrial fibrillation (AF), diastolic dysfunction, pulmonary hypertension (PH), tricuspid regurgitation, and heart transplant recipients. RECENT FINDINGS Impaired LA strain reflects worse LV diastolic function in individuals with and without HF, and this is associated with decreased exercise capacity. Initiating treatments targeting these functional aspects may enhance exercise capacity and potentially prevent heart failure (HF). Impaired LA strain also identifies patients with a high risk of AF, and this recognition may lead to preventive strategies. Impaired RV strain has significant clinical and prognostic implications across various clinical scenarios, including HF, PH, tricuspid regurgitation, or in heart transplant recipients. STE should not be limited to the assessment of deformation of the LV myocardium. The use of LA and RV strain is supported by a substantial evidence base, and these parameters should be used more widely.
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Affiliation(s)
| | - Wojciech Kosmala
- Wroclaw Medical University, Wroclaw, Poland
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Menzies Institute for Medical Research, Hobart, Australia
| | - Thomas H Marwick
- Wroclaw Medical University, Wroclaw, Poland.
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Menzies Institute for Medical Research, Hobart, Australia.
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8
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Cicetti M, Bagate F, Lapenta C, Gendreau S, Masi P, Mekontso Dessap A. Effect of volume infusion on left atrial strain in acute circulatory failure. Ann Intensive Care 2024; 14:53. [PMID: 38592568 PMCID: PMC11003961 DOI: 10.1186/s13613-024-01274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Left atrial strain (LAS) is a measure of atrial wall deformation during cardiac cycle and reflects atrial contribution to cardiovascular performance. Pathophysiological significance of LAS in critically ill patients with hemodynamic instability has never been explored. This study aimed at describing LAS and its variation during volume expansion and to assess the relationship between LAS components and fluid responsiveness. METHODS This prospective observational study was performed in a French ICU and included patients with acute circulatory failure, for whom the treating physician decided to proceed to volume expansion (rapid infusion of 500 mL of crystalloid solution). Trans-thoracic echocardiography was performed before and after the fluid infusion. LAS analysis was performed offline. Fluid responsiveness was defined as an increase in velocity-time integral (VTI) of left ventricular outflow tract ≥ 10%. RESULTS Thirty-eight patients were included in the final analysis. Seventeen (45%) patients were fluid responders. LAS analysis had a good feasibility and reproducibility. Overall, LAS was markedly reduced in all its components, with values of 19 [15 - 32], -9 [-19 - -7] and - 9 [-13 - -5] % for LAS reservoir (LASr), conduit (LAScd) and contraction (LASct), respectively. LASr, LAScd and LASct significantly increased during volume expansion in the entire population. Baseline value of LAS did not predict fluid responsiveness and the changes in LAS and VTI during volume expansion were not significantly correlated. CONCLUSIONS LAS is severely altered during acute circulatory failure. LAS components significantly increase during fluid administration, but cannot be used to predict or assess fluid responsiveness.
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Affiliation(s)
- Marta Cicetti
- Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - François Bagate
- Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France.
- Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France.
| | - Cristina Lapenta
- Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France
| | - Ségolène Gendreau
- Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France
- Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France
| | - Paul Masi
- Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France
- Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, AP-HP, Centre Hôpitaux Universitaires Henri Mondor, DHU A-TVB, 1 rue Gustave Eiffel, Créteil Cedex, F-94010, France
- Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, F- 94010, France
- INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, F-94010, France
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Palmiero P, Caretto P, Zito A, Ciccone MM, Pelliccia F, Maiello M. Left ventricular diastolic function in atrial fibrillation: Methodological implications and clinical considerations. Echocardiography 2024; 41:e15818. [PMID: 38654654 DOI: 10.1111/echo.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
The assessment of LVDD is routinely included in echocardiographic evaluation because it correlates with cardiac disease progression and its prognostic value. Classic parameters used for assessing LV diastolic function correlate well with invasive measurements which remains the gold standard. Nevertheless, no one echocardiographic parameter alone can completely evaluate LVDD. LV diastolic function evaluation in atrial fibrillation is still challenging, since the E/A ratio, one of the most used parameters in echocardiographic evaluation, cannot be feasible. This is not a good reason to give up measurement. In this review, we analyze the different methods for estimating LV diastolic function in atrial fibrillation, including measurement not dependent on atrial systole and some novel methods that are promising, but not ever available during clinical practice highlighting that this assessment is mandatory for a complete clinical evaluation of the patients.
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Affiliation(s)
- Pasquale Palmiero
- ASL Brindisi, Cardiology Equipe, District of Brindisi, Brindisi, Italy
- Medical School, University of Bari, Bari, Italy
| | - Pierpaolo Caretto
- University Cardiology Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, Bari, Italy
| | - Annapaola Zito
- ASL Brindisi, District of Francavilla Fontana, Brindisi, Italy
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, Bari, Italy
| | | | - Maria Maiello
- ASL Brindisi, Cardiology Equipe, District of Brindisi, Brindisi, Italy
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10
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Keramida K, Papadopoulos K. Discrimination of myocardial function changes: Evolution of chronic kidney disease or hemodialysis effect? Echocardiography 2024; 41:e15811. [PMID: 38591130 DOI: 10.1111/echo.15811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Kalliopi Keramida
- Cardiology Department, General Anti-Cancer, Oncological Hospital Agios Savvas, Athens, Greece
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11
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Assadi H, Sawh N, Bailey C, Matthews G, Li R, Grafton-Clarke C, Mehmood Z, Kasmai B, Swoboda PP, Swift AJ, van der Geest RJ, Garg P. Validation of Left Atrial Volume Correction for Single Plane Method on Four-Chamber Cine Cardiac MRI. Tomography 2024; 10:459-470. [PMID: 38668393 PMCID: PMC11054972 DOI: 10.3390/tomography10040035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Left atrial (LA) assessment is an important marker of adverse cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) accurately quantifies LA volume and function based on biplane long-axis imaging. We aimed to validate single-plane-derived LA indices against the biplane method to simplify the post-processing of cine CMR. METHODS In this study, 100 patients from Leeds Teaching Hospitals were used as the derivation cohort. Bias correction for the single plane method was applied and subsequently validated in 79 subjects. RESULTS There were significant differences between the biplane and single plane mean LA maximum and minimum volumes and LA ejection fraction (EF) (all p < 0.01). After correcting for biases in the validation cohort, significant correlations in all LA indices were observed (0.89 to 0.98). The area under the curve (AUC) for the single plane to predict biplane cutoffs of LA maximum volume ≥ 112 mL was 0.97, LA minimum volume ≥ 44 mL was 0.99, LA stroke volume (SV) ≤ 21 mL was 1, and LA EF ≤ 46% was 1, (all p < 0.001). CONCLUSIONS LA volumetric and functional assessment by the single plane method has a systematic bias compared to the biplane method. After bias correction, single plane LA volume and function are comparable to the biplane method.
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Affiliation(s)
- Hosamadin Assadi
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Nicholas Sawh
- Faculty of Medicine, Medical University of Sofia, Blvd Akademik Ivan Evstratiev Geshov 15, 1431 Sofia, Bulgaria
| | - Ciara Bailey
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Gareth Matthews
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Rui Li
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Ciaran Grafton-Clarke
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Zia Mehmood
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Bahman Kasmai
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Peter P. Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK
| | - Rob J. van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
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12
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Shinzato MH, Santos N, Nishida G, Moriya H, Assef J, Feres F, Hortegal RA. Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy. Cardiovasc Ultrasound 2024; 22:4. [PMID: 38433236 PMCID: PMC10910762 DOI: 10.1186/s12947-024-00323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. MAIN BODY This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans. CONCLUSION GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF.
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Affiliation(s)
- Mariane Higa Shinzato
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Natasha Santos
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Gustavo Nishida
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Henrique Moriya
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
- Biomedical Engineering Laboratory, University of Sao Paulo, São Paulo, Brazil
| | - Jorge Assef
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Fausto Feres
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909
| | - Renato A Hortegal
- Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909.
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13
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Cau R, Muscogiuri G, Pisu F, Mannelli L, Sironi S, Suri JS, Pontone G, Saba L. Effect of late gadolinium enhancement on left atrial impairment in myocarditis patients. Eur Radiol 2024; 34:1846-1853. [PMID: 37658889 PMCID: PMC10873434 DOI: 10.1007/s00330-023-10176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/13/2023] [Accepted: 07/04/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The aims of our study were to investigate the effect of the extent and location of late gadolinium enhancement (LGE) on the left atrium (LA) function in patients with acute myocarditis (AM) using cardiovascular magnetic resonance (CMR). METHOD This retrospective study performed CMR scans in 113 consecutive patients (89 males, 24 females; mean age 45.8 ± 17.3 years) with AM that met the updated Lake Louise criteria. Reservoir, conduit, and booster LA functions were analyzed by CMR feature tracking using dedicated software. Besides LA strain measurements, myocardial scar location and extent were assigned and quantified by LGE imaging. RESULTS AM patients with septal LGE had impaired reservoir, conduit, and conduit strain rate function in comparison with AM patients with non-septal LGE (p = 0.001, for all). In fully adjusted multivariable linear regression, reservoir and conduit were significantly associated with left ventricle (LV) LGE location (β coefficient = 8.205, p = 0.007; β coefficient = 5.185, p = 0.026; respectively). In addition, LA parameters decreased according to the increase in the extent of LV fibrosis (LGE ≤ 10%; LGE 11-19%; LGE ≥ 20%). After adjustment in multivariable linear regression, the association with LV LGE extent was no longer statistically significant. CONCLUSION In patients with acute myocarditis, LA function abnormalities are significantly associated with LV LGE location, but not with LGE extent. Septal LGE is paralleled by a deterioration of LA reservoir and conduit function. CLINICAL RELEVANCE STATEMENT Left atrium dysfunction is associated with the presence of late gadolinium enhancement in the left ventricle septum and can be useful in the clinical prognostication of patients with acute myocarditis, allowing individually tailored treatment. KEY POINTS • Myocardial fibrosis is related to atrial impairment. • The location of myocardial fibrosis is the main determinant of atrial dysfunction in myocarditis patients. • The quantification of atrial mechanisms may provide more in-depth insight into myocarditis pathophysiology.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, 09045, Cagliari, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, 09045, Cagliari, Italy
| | - Lorenzo Mannelli
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, 09045, Cagliari, Italy.
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14
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Beaver M, Jepson B, Binka E, Truong D, Crandall H, McFarland C, Williams R, Ou Z, Treemarcki E, Jensen D, Minich LL, Colquitt JL. Baseline Echocardiography and Laboratory Findings in MIS-C and Associations with Clinical Illness Severity. Pediatr Cardiol 2024; 45:560-569. [PMID: 38281215 DOI: 10.1007/s00246-023-03394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024]
Abstract
Children with COVID-associated multisystem inflammatory syndrome (MIS-C) may develop severe disease. We explored the association of admission echocardiographic and laboratory parameters with MIS-C disease severity. This retrospective, single center study of consecutive MIS-C patients (4/2020-12/2021) excluded those with preexisting cardiomyopathy, congenital heart disease, or prior cardiotoxic therapy. Our hypothesis was that worse admission echocardiographic and laboratory parameters were associated with more severe disease based on vasoactive medication use. Univariable and multivariable logistic regression models assessed the association between vasoactive medication use and baseline variables. Of 118 MIS-C patients, median age was 7.8 years (IQR 4.6, 11.8), 48% received vasoactive medication. Higher admission brain natriuretic peptide [OR 1.07 (95% CI 1.02,1.14), p = 0.019], C-reactive protein [OR 1.08 (1.03,1.14), p = 0.002], troponin [OR 1.05 (1.02,1.1), p = 0.015]; lower left ventricular ejection fraction [LVEF, OR 0.96 (0.92,1), p = 0.042], and worse left atrial reservoir strain [OR 0.96 (0.92,1), p = 0.04] were associated with vasoactive medication use. Only higher CRP [OR 1.07 (1.01, 1.11), p = 0.034] and lower LVEF [0.91 (0.84,0.98), p = 0.015] remained independently significant. Among those with normal admission LVEF (78%, 92/118), 43% received vasoactive medication and only higher BNP [OR 1.09 (1.02,1.19), p = 0.021 per 100 pg/mL] and higher CRP [OR 1.07 (1.02,1.14), p = 0.013] were associated with use of vasoactive medication. Nearly half of all children admitted for MIS-C subsequently received vasoactive medication, including those admitted with a normal LVEF. Similarly, admission strain parameters were not discriminatory. Laboratory markers of systemic inflammation and cardiac injury may better predict early MIS-C disease severity.
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Affiliation(s)
- Matthew Beaver
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
- Primary Children's Hospital Outpatient Services, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
| | - Bryan Jepson
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Edem Binka
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Dongngan Truong
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Hillary Crandall
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Carol McFarland
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Richard Williams
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Erin Treemarcki
- Department of Pediatrics, Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Devri Jensen
- Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - L LuAnn Minich
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - John L Colquitt
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
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15
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De Carli G, Mandoli GE, Salvatici C, Biagioni G, Marallo C, Turchini F, Ghionzoli N, Melani A, Pastore MC, Gozzetti A, D'Ascenzi F, Cavigli L, Giacomin E, Cameli M, Focardi M. Speckle tracking echocardiography in plasma cell disorders: The role of advanced imaging in the early diagnosis of AL systemic cardiac amyloidosis. Int J Cardiol 2024; 398:131599. [PMID: 37979786 DOI: 10.1016/j.ijcard.2023.131599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Amyloid light-chain amyloidosis is a rare condition characterized by the abnormal production of immunoglobulin light chain that misshape and form amyloid fibrils. Over time, these amyloid deposits can accumulate slowly, causing dysfunction in organs and tissues. Early identification is crucial to ensure optimal treatment. We aim to identify a better marker of cardiac amyloidosis, using advanced echocardiography, to improve diagnosis and the timing of available treatments. MATERIALS AND METHODS 108 consecutive hematological patients (32, 30% female and 76, 70% male) with a plasma cell disorder referred to our Cardiological center underwent ECG, first and second-level echocardiography (Speckle Tracking) and complete biochemical profile. The best predictors of ALCA (AUC ≥ 0.8) were included in a further analysis stratified by AL score. RESULTS At ROC analysis, the best bio-humoral predictors for the diagnosis of ALCA were Nt-pro-BNP (AUC: 0.97; p < 0.01) and Hs-Tn (AUC: 0.87; p < 0.01). Regarding echocardiography, the best diagnostic predictors were left atrial stiffness (LAS) (AUC: 0.83; p < 0.01) for the left atrium; free wall thickness for the right ventricle (AUC: 0.82; <0.01); left ventricular global longitudinal strain (LVGLS) (AUC: 0.92; p < 0.01) and LVMi (AUC 0.80; p < 0.001) for the left ventricle; and AL-score (AUC 0.83 p < 0.01). In patients with AL-SCORE < 1, LAS (AUC 0.86 vs AUC 0.79), LVGLS (AUC 0.92 vs AUC 0.86) and LV mass (AUC 0.91 vs AUC 0.72) had better diagnostic accuracy than patients with higher AL-score (AL SCORE ≥ 1). CONCLUSION Multi-parametric imaging approach with LVGLS and LAS may be helpful for detecting early cardiac involvement in AL amyloidosis.
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Affiliation(s)
- G De Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - G E Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - C Salvatici
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - G Biagioni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - C Marallo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - F Turchini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - N Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - A Melani
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M C Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - A Gozzetti
- Department of Hematology, Siena University, Siena, Italy
| | - F D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - L Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - E Giacomin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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16
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Sezenöz B, Ünlü S, Yalçın Y, Yamak BA, Yazgan E, Türkoğlu S, Taçoy G. The effect of body weight on left atrial function determined by longitudinal strain analysis in young adults. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:407-414. [PMID: 37953372 DOI: 10.1007/s10554-023-03008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Obesity is a risk factor for various cardiovascular disorders. Left atrial (LA) function is vital for predicting adverse outcomes in many diseases. LA strain was recently proposed as a noninvasive and valuable parameter for LA functional evaluation. We investigated the effect of body mass index (BMI) values on left atrial functions determined by longitudinal strain analysis in young adults without concomitant disease. METHODS We prospectively included 134 subjects in our study. Participants were categorized into three subgroups, obese, overweight, and control, according to their BMI. Conventional echocardiographic measurements and strain analysis were performed on all patients. RESULTS There were 41 patients (30.5%) in the obesity group, 46 patients (34.3%) in the overweight group, and 47 patients (35.0%) in the control group. Obese patients had significantly larger LA volume (46.9 ± 12.1 ml; p < 0.001) compared to overweight and control subjects; however, LA volume index (21.4 ± 6.1 ml/m2 vs. 22.4 ± 6.1 ml/m2 vs. 22.4 ± 5.0 ml/m2; p = 0.652) were similar between groups. In the LA strain analysis, obese patients were found to have lower left atrial reservoir longitudinal strain (LASr) compared to both the overweight and control group (44.2 ± 5.8% vs. 39.1 ± 3.7% vs. 36.5 ± 4.9%; p < 0.001); moreover obese patients had significantly worse left atrial contraction phase longitudinal strain (LASct) (-15.1 ± 3.1% vs. -13.1 ± 2.5%; p = 0.007) and left atrial conduit phase longitudinal strain (LAScd) (-29.0 ± 7.1% vs. -23.3 ± 5.4%; p < 0.001) values compared to the control group. However, LASct and LAScd values did not differ between overweight and obese patients. CONCLUSION LA function determined by LA strain analysis was impaired in obese and overweight individuals compared to the control group, even in the early stages of life. The prognostic significance of this finding should be investigated in prospective studies.
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Affiliation(s)
- Burak Sezenöz
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
| | - Serkan Ünlü
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey.
| | - Yakup Yalçın
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
| | - Betül Ayça Yamak
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
| | - Elif Yazgan
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
| | - Sedat Türkoğlu
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
| | - Gülten Taçoy
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
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17
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Buendía-Fuentes F, Lozano-Edo S, Jover-Pastor P, Sánchez-Martínez JC, Martínez-Sole J, Rodríguez-Serrano M, Aguero J, Arnau-Vives MA, Osa-Sáez A, Martínez-Dolz LV, Rueda J. Left atrial strain in adults after the arterial switch operation for transposition of the great arteries. Echocardiography 2024; 41:e15750. [PMID: 38284674 DOI: 10.1111/echo.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. METHODS A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. RESULTS LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13 ± 7.67 vs. 49.71 ± 8.38; LAS cd: -22.91 ± 5.69 vs. -34.55 ± 6.54; LASct: -8.14 ± 4.93 vs. -15.15 ± 6.07, p < .001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29 ± 2.68 vs. -21.98 ± 1.84, p < .001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38 ± 8.23 vs. 69.28 ± 5.92, p = .001) and 3D analysis (57.97% ± 4.16 vs. 60.67 ± 3.39, p = .011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. CONCLUSIONS LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.
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Affiliation(s)
- Francisco Buendía-Fuentes
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Silvia Lozano-Edo
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Pablo Jover-Pastor
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Julia Martínez-Sole
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel A Arnau-Vives
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luis V Martínez-Dolz
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Joaquín Rueda
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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18
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Wessly P, Lazzara GE, Buergler JM, Nagueh SF. Early Observations on Effects of Mavacamten on Left Atrial Function in Obstructive Hypertrophic Cardiomyopathy Patients. JACC Cardiovasc Imaging 2023; 16:1633-1634. [PMID: 37452821 DOI: 10.1016/j.jcmg.2023.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
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19
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Giang M N, Nguyen H H, Vo DT, Ho Huynh Quang T, Phan DTH, Chau NH. Superiority of left heart deformation in early anthracycline-related cardiac dysfunction detection. Open Heart 2023; 10:e002493. [PMID: 38011990 PMCID: PMC10685923 DOI: 10.1136/openhrt-2023-002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE This study aimed to assess the incidence of early cancer therapy-related cardiac dysfunction (CTRCD) and the characteristics of left and right heart deformations during anthracycline chemotherapy. METHODS We prospectively enrolled a cohort of 351 chemotherapy-naïve women with breast cancer and cardiovascular risk factors who were scheduled to receive anthracycline. The left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV-GLS) and right ventricular and left atrial longitudinal strains were evaluated using echocardiography at baseline, before every subsequent cycles and at 3 weeks after the final anthracycline dose. CTRCD was defined as a new LVEF reduction by ≥10 percentage points to an LVEF<50% and/or a new relative decline in GLS by >15% from the baseline value. RESULTS Eighteen (5.1%) patients had evidence of asymptomatic CTRCD during anthracycline treatment, and 50% developed CTRCD before completing the chemotherapy regimen. In the CTRCD group, while LV-GLS decrease significantly after the first dose of anthracycline, the reduction of right ventricular free-wall longitudinal strain and left atrial reservoir strain were observed after the second dose. Other strain indices could not be used to identify early CTRCD. CONCLUSIONS Cardiotoxicity appeared soon after the initiation of anthracycline chemotherapy. Among the left-heart and right-heart mechanics, LV-GLS remains the best deformation indicator for detecting early CTRCD.
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Affiliation(s)
- Nhat Giang M
- Department of Cardiac Intensive Care and Cardiomyopathy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
- Internal Medicine Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hai Nguyen H
- Department of Cardiac Intensive Care and Cardiomyopathy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Duc Tan Vo
- Diagnostic Imaging Department, University Medical Center of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tri Ho Huynh Quang
- Department of Cardiac Intensive Care, Heart Institute, Ho Chi Minh City, Vietnam
| | - Duc Thi Hong Phan
- Medical Oncology Department, Ho Chi Minh City Oncology Hospital, Ho Chi Minh, Vietnam
| | - Ngoc-Hoa Chau
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
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20
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Nagueh SF. Left Atrial Function in Cardiac Amyloidosis. JACC Cardiovasc Imaging 2023; 16:1384-1386. [PMID: 37565962 DOI: 10.1016/j.jcmg.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Sherif F Nagueh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
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21
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Nishida G, Calvilho Junior AA, Assef JE, Dos Santos NSS, de Andrade Vilela A, Braga SLN. Left atrial strain as a predictor of left ventricular filling pressures in coronary artery disease with preserved ejection fraction: a comprehensive study with left ventricular end-diastolic and pre-atrial contraction pressures. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2193-2204. [PMID: 37665484 DOI: 10.1007/s10554-023-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Assessing left ventricular (LV) filling pressure (LVFP) is challenging in patients with coronary artery disease (CAD) and preserved LV ejection fraction (LVEF). We aimed to correlate left atrial strain (LAS) with two invasive complementary parameters of LVFP and compared its accuracy to other echocardiographic data to predict high LVFP. This cross-sectional, single-center study enrolled 81 outpatients with LVEF > 50% and significant CAD from a database. Near-simultaneous echocardiography and invasive measurements of both LV end-diastolic pressure (LVEDP) and LV pre-atrial contraction (pre-A) pressure were performed in each patient, based on the definition of LVEDP > 16 mmHg and LV pre-A > 12 mmHg as high LVFP. A moderate to strong correlation was observed between LAS reservoir (LASr), contractile strain, and LVEDP (r: 0.67 and 0.62, respectively; p < 0.001); the same was true for LV pre-A (r: 0.65 and 0.63, respectively; p < 0.001). LASr displayed good diagnostic performance to identify elevated LVFP, which was higher when compared to traditional parameters. Median value of LASr was higher for an isolated increase of LVEDP than for simultaneously high LV pre-A. The cutoff found to predict high LVFP was lower for LV pre-A than that one for LVEDP. In the current study, LASr did not provide an additional contribution to the 2016 diastolic function algorithm. LAS is a valuable tool for predicting LVFP in patients with CAD and preserved LVEF. The choice of LVEDP or LV pre-A as the representative marker of LVFP leads to different cutoffs to predict high pressures. The best strategy for adding this tool to a multiparametric algorithm requires further investigation.
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Affiliation(s)
- Gustavo Nishida
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil.
| | | | - Jorge Eduardo Assef
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil
| | | | - Andrea de Andrade Vilela
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil
| | - Sergio Luiz Navarro Braga
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil
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Shi R, Jiang YN, Qian WL, Guo YK, Gao Y, Shen LT, Jiang L, Li XM, Yang ZG, Li Y. Assessment of left atrioventricular coupling and left atrial function impairment in diabetes with and without hypertension using CMR feature tracking. Cardiovasc Diabetol 2023; 22:295. [PMID: 37904206 PMCID: PMC10617180 DOI: 10.1186/s12933-023-01997-z] [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] [Received: 07/08/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE The study was designed to assess the effect of co-occurrence of diabetes mellitus (DM) and hypertension on the deterioration of left atrioventricular coupling index (LACI) and left atrial (LA) function in comparison to individuals suffering from DM only. METHODS From December 2015 to June 2022, we consecutively recruited patients with clinically diagnosed DM who underwent cardiac magnetic resonance (CMR) at our hospital. The study comprised a total of 176 patients with DM, who were divided into two groups based on their blood pressure status: 103 with hypertension (DM + HP) and 73 without hypertension (DM-HP). LA reservoir function (reservoir strain (εs), total LA ejection fraction (LAEF)), conduit function (conduit strain (εe), passive LAEF), booster-pump function (booster strain (εa) and active LAEF), LA volume index (LAVI), LV global longitudinal strain (LVGLS), and LACI were evaluated and compared between the two groups. RESULTS After adjusting for age, sex, body surface area (BSA), and history of current smoking, total LAEF (61.16 ± 14.04 vs. 56.05 ± 12.72, p = 0.013) and active LAEF (43.98 ± 14.33 vs. 38.72 ± 13.51, p = 0.017) were lower, while passive LAEF (33.22 ± 14.11 vs. 31.28 ± 15.01, p = 0.807) remained unchanged in the DM + HP group compared to the DM-HP group. The DM + HP group had decreased εs (41.27 ± 18.89 vs. 33.41 ± 13.94, p = 0.006), εe (23.69 ± 12.96 vs. 18.90 ± 9.90, p = 0.037), εa (17.83 ± 8.09 vs. 14.93 ± 6.63, p = 0.019), and increased LACI (17.40±10.28 vs. 22.72±15.01, p = 0.049) when compared to the DM-HP group. In patients with DM, multivariate analysis revealed significant independent associations between LV GLS and εs (β=-1.286, p < 0.001), εe (β=-0.919, p < 0.001), and εa (β=-0.324, p = 0.036). However, there was no significant association observed between LV GLS and LACI (β=-0.003, p = 0.075). Additionally, hypertension was found to independently contribute to decreased εa (β=-2.508, p = 0.027) and increased LACI in individuals with DM (β = 0.05, p = 0.011). CONCLUSIONS In DM patients, LV GLS showed a significant association with LA phasic strain. Hypertension was found to exacerbate the decline in LA booster strain and increase LACI in DM patients, indicating potential atrioventricular coupling index alterations.
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Affiliation(s)
- Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yi-Ning Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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23
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de Waal K, Phad N, Crendal E. Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants. Echocardiography 2023; 40:1099-1106. [PMID: 37658834 DOI: 10.1111/echo.15686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Relaxation, restoring forces, myocardial stiffness and atrial function determine left ventricular (LV) diastolic function. This study aims to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging and determine the diagnostic accuracy of various algorithms to detect high left atrial pressure (LAP). METHODS Preterm infants received an echocardiogram 1 week after birth and diastolic reference values were derived from the outer percentiles of stable preterm infants. Impaired relaxation, LV stiffness and high LAP were defined by using algorithms where at least half of the parameters were outside the normal range. Diastolic function was graded using the 2016 American Society of Echocardiography algorithm and expanded with the EA ratio and left atrial strain. The diagnostic accuracy of various algorithms to detect high LAP was determined with sensitivity analysis. RESULTS We studied 146 infants (59 stable) with a mean of 27(1) weeks gestation. Impaired relaxation, LV stiffness and high LAP were found in 8%, 7%, and 14% of infants. The patent ductus arteriosus was a contributing factor to high LAP and LV stiffness, not impaired relaxation. Diagnostic accuracy improved from 90% to 96% and sensitivity from 40% to 90% by adding left atrial strain to the 2016 algorithm. CONCLUSION Various grades of diastolic dysfunction could be appreciated in preterm infants using a multi-parameter approach. Adding left atrial strain improved sensitivity to detect infants with high LAP.
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Affiliation(s)
- Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
| | - Edward Crendal
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
- Department of Cardiology, John Hunter Hospital Department of Cardiology, Newcastle NSW, Australia
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24
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Chan N, Wang TKM, Anthony C, Hassan OA, Chetrit M, Dillenbeck A, Smiseth OA, Nagueh SF, Klein AL. Echocardiographic Evaluation of Diastolic Function in Special Populations. Am J Cardiol 2023; 202:131-143. [PMID: 37429061 DOI: 10.1016/j.amjcard.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/10/2023] [Accepted: 05/13/2023] [Indexed: 07/12/2023]
Abstract
Left ventricular (LV) diastolic dysfunction results from a combination of impaired relaxation, reduced restoring forces, and increased chamber stiffness. Noninvasive assessment of diastology uses a multiparametric approach involving surrogate markers of increased filling pressures, which include mitral inflow, septal and lateral annular velocities, tricuspid regurgitation velocity, and left atrial volume index. However, these parameters must be used cautiously. This is because the traditional algorithms for evaluating diastolic function and estimation of LV filling pressures (LVFPs), as recommended by the American Society of Echocardiography and European Association of Cardiovascular Imaging 2016 guidelines, do not apply to unique patients with underlying cardiomyopathies, significant valvular disease, conduction abnormalities, arrhythmias, LV assist devices, and heart transplants, which alter the relation between the conventional indexes of diastolic function and LVFP. The purpose of this review is to provide solutions for evaluating LVFP through illustrative examples of these special populations, incorporating supplemental Doppler indexes, such as isovolumic relaxation time, mitral deceleration time, and pulmonary venous flow analysis, as needed to formulate a more comprehensive approach.
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Affiliation(s)
- Nicholas Chan
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chris Anthony
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ossama Abou Hassan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Chetrit
- Division of Cardiology, McGill University, Montreal, Québec, Canada
| | - Amy Dillenbeck
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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25
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Monte IP, Faro DC, Trimarchi G, de Gaetano F, Campisi M, Losi V, Teresi L, Di Bella G, Tamburino C, de Gregorio C. Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy. J Cardiovasc Dev Dis 2023; 10:261. [PMID: 37367426 DOI: 10.3390/jcdd10060261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Left atrial (LA) function is crucial for assessing left ventricular filling in various cardiovascular conditions. Cardiac Amyloidosis (CA) is characterized by atrial myopathy and LA function impairment, with diastolic dysfunction up to restrictive filling pattern, leading to progressive heart failure and arrhythmias. This study evaluates LA function and deformation using speckle tracking echocardiography (STE) in patients with CA compared to a cohort of patients with sarcomeric Hypertrophic Cardiomyopathy (HCM) and a control group. Methods: We conducted a retrospective, observational study (from January 2019 to December 2022) including a total of 100 patients: 33 with ATTR-CA, 34 with HCMs, and 33 controls. Clinical evaluation, electrocardiograms, and transthoracic echocardiography were performed. Echocardiogram images were analyzed in post-processing using EchoPac software for LA strain quantification, including LA-reservoir, LA-conduit, and LA-contraction strain. Results: The CA group exhibited significantly impaired LA function compared to HCMs and control groups, with LA-reservoir median values of -9%, LA-conduit -6.7%, and LA-contraction -3%; this impairment was consistent even in the CA subgroup with preserved ejection fraction. LA strain parameters correlated with LV mass index, LA volume index, E/e', and LV-global longitudinal strain and were found to be associated with atrial fibrillation and exertional dyspnea. Conclusions: LA function assessed by STE is significantly impaired in CA patients compared to HCMs patients and healthy controls. These findings highlight the potential supportive role of STE in the early detection and management of the disease.
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Affiliation(s)
- Ines Paola Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Denise Cristiana Faro
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
| | - Fabrizio de Gaetano
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Mariapaola Campisi
- Azienda Ospedaliera Provinciale di Catania, Santa Maria e Santa Venera Hospital, 95024 Acireale, Italy
| | - Valentina Losi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Lucio Teresi
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
| | - Corrado Tamburino
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98121 Messina, Italy
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26
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Hiraldo AT. Speckle-tracking echocardiography in atrial fibrillation: Philosopher's stone or integral tool. Int J Cardiol 2023:S0167-5273(23)00730-1. [PMID: 37245542 DOI: 10.1016/j.ijcard.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Amparo Taveras Hiraldo
- Hospital Santa Caterina, Girona, Spain Grisel Canahuate Rodriguez, FACC, Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic.
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