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Petoello E, Flore AI, Nogara S, Bonafiglia E, Lenzi MB, Arnone OC, Benfari G, Ciarcià M, Corsini I, De Waal K, Gottin L, Ficial B. Global longitudinal strain is an informative index of left ventricular performance in neonates receiving intensive care. Sci Rep 2024; 14:8881. [PMID: 38632330 PMCID: PMC11024117 DOI: 10.1038/s41598-024-59441-5] [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: 01/22/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
Echocardiographic assessment of left ventricular function is crucial in NICU. The study aimed to compare the accuracy and agreement of global longitudinal strain (GLS) with conventional measurements. Real-life echocardiograms of neonates receiving intensive care were retrospectively reviewed. Shortening fraction (SF), ejection fraction (EF) and S' measurements were retrieved from health records. GLS was calculated offline from stored images. The association with stroke volume indexed for body weight (iSV) was evaluated by regression analysis. The diagnostic ability to identify uncompensated shock was assessed by ROC curve analysis. Cohen's κ was run to assess agreement. 334 echocardiograms of 155 neonates were evaluated. Mean ± SD gestational age and birth weight were 34.5 ± 4.1 weeks and 2264 ± 914 g, respectively. SF, EF, S' and GLS were associated with iSV with R2 of 0.133, 0.332, 0.252 and 0.633, (all p < .001). Including all variables in a regression model, iSV prediction showed an adjusted R2 of 0.667, (p < .001). GLS explained 73% of the model variance. GLS showed a better ability to diagnose uncompensated shock (AUC 0.956) compared to EF, S' and SF (AUC 0.757, 0.737 and 0.606, respectively). GLS showed a moderate agreement with EF (κ = .500, p < .001) and a limited agreement with S' and SF (κ = .260, p < .001, κ = .242, p < .001). GLS was a more informative index of left ventricular performance, providing the rationale for a more extensive use of GLS at the cotside.
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Affiliation(s)
- Enrico Petoello
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Elena Bonafiglia
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Maria Beatrice Lenzi
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Olivia C Arnone
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Ciarcià
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Koert De Waal
- Department of Neonatology, John Hunter Children's Hospital, Newcastle, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - Leonardo Gottin
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, University and Hospital Trust of Verona, P.le A. Stefani 1, 37126, Verona, Italy.
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Phillips NS, Mulrooney DA, Williams AM, Liu W, Khan RB, Ehrhardt MJ, Folse T, Krasin M, Srivastava DK, Ness KK, Hudson MM, Sabin ND, Krull KR. Neurocognitive impairment associated with chronic morbidity in long-term survivors of Hodgkin Lymphoma. Blood Adv 2023; 7:7270-7278. [PMID: 37729618 PMCID: PMC10711168 DOI: 10.1182/bloodadvances.2023010567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
Thoracic radiation is associated with significant cardiopulmonary morbidities in survivors of long-term Hodgkin lymphoma and may affect neurocognitive outcomes. Survivors (N = 204; 52.5% female; mean [standard deviation] age, 36.6 [8.01] years) treated with thoracic radiation and age-, sex-, and race/ethnicity-matched community controls (N = 205; 51.7% female; age, 36.7 [9.17] years) completed standardized neurocognitive testing, echocardiography, pulmonary function tests, and vascular studies during the same visit. Treatments were abstracted from medical records. Cardiac (ie, left ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), vascular (ie, large and small artery elasticity [SAE]), pulmonary (ie, diffusing capacity of the lungs for carbon monoxide [DLCO] and forced expiratory volume [FEV1]), and chronic health conditions were evaluated for associations with age-adjusted neurocognitive performance using multivariable linear regression. Compared with controls, survivors had lower performance (P < 0.05) in visuomotor (0.11 vs 0.41), visual processing speed (0.25 vs 0.64), short-term recall (-0.24 vs 0.12), and flexibility (-0.04 vs 0.28). Survivors had lower pulmonary (FEV1, DLCOcorr), cardiac (LVEF, GLS), and vascular function (SAE) than controls (all P < 0.001). FEV1 was associated with visuomotor (P = .008) and visual processing speed (P = .05), and flexibility (P = .05). GLS was associated with short-term recall (P = .03). SAE was associated with flexibility (P = .007). Neurocognitive outcomes were also associated with moderate-to-severe neurologic chronic conditions (P < .05). Findings suggest a link between subclinical cardiopulmonary and vascular findings, neurologic morbidity, and neurocognitive impairments. Prevention of health morbidity may benefit neurocognitive outcomes.
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Affiliation(s)
- Nicholas S. Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - AnnaLynn M. Williams
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wei Liu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Raja B. Khan
- Department of Pediatric Medicine Division of Neurology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tim Folse
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Noah D. Sabin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN
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El-Dosouky II, Seddik EH, Wageeh S. The Use of Global Longitudinal Strain to Detect Subclinical Reduction in Left Ventricular Pump Function. Crit Pathw Cardiol 2023; 22:149-152. [PMID: 37782622 DOI: 10.1097/hpc.0000000000000335] [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: 10/04/2023]
Abstract
BACKGROUND Left ventricular (LV) ejection fraction (LVEF) is not a sensitive marker of LV systolic function in a subset of patients with preserved EF. The relation between LV pump function and global longitudinal strain (GLS) has not been elucidated well in patients with objectively preserved EF and no apparent heart failure (HF). We aimed to detect whether LV GLS can discover impaired LV pump function [presented as low stroke volume index (SVI) and low cardiac output (COP)] in patients with objectively preserved EF and no apparent clinical HF and its practice utility. METHODS In total, 100 participants with LVEF of ≥50% were studied for demographic and echocardiographic data, including LVEF, stroke volume, SVI, COP, LV longitudinal strain assessments, apical 4-, 3-, and 2-chamber views averaged for GLS, and were classified into 2 groups: group 1: normal GLS (more negative than -18%) and group 2: low GLS (less negative than -18%). RESULTS Reduced LV GLS was associated with lower SVI (35.6 ± 13.6 vs. 43.8 ± 12.7 mL/m 2 ; P = 0.01), lesser COP (5.4 ± 1.9 vs. 6.5 ± 2.1 l/min; P = 0.02), GLS had strong positive correlations with SVI ( r = 0.75; P < 0.001), and COP ( r = 0.66; P < 0.001). LV GLS at a cutoff value less negative than -15% is a strong predictor of SVI ≤35 mL/m 2 (76% sensitivity and 79% specificity) and at a cutoff value less negative than -13.5% it is a strong predictor of COP ≤4 L/min (76% sensitivity and 73% specificity). LV GLS was the best independent predictor of low SVI (<35 mL/m 2 ) and low COP (<4 L/min). CONCLUSION Impaired LV strain is associated with lower LV pump function, presented as lower COP and lower SVI in patients with preserved EF even in the absence of clinical HF. It is of great importance to incorporate GLS in the routine evaluation of LV function hand-by-hand with the noninvasive assessment of LV stroke volume and COP that can replace GLS on evaluation of LV pump function in old machines with no GLS modalities, for early pick-up of patients with impaired LV pump function before apparent HF.
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Affiliation(s)
- Ibtesam I El-Dosouky
- From the Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Lashin H, Olusanya O, Smith A, Bhattacharyya S. Left ventricular ejection fraction correlation with stroke volume as estimated by Doppler echocardiography in cardiogenic shock: A retrospective observational study. J Cardiothorac Vasc Anesth 2022; 36:3511-3516. [DOI: 10.1053/j.jvca.2022.05.009] [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: 02/08/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/11/2022]
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Usefulness and clinical relevance of left ventricular global longitudinal systolic strain in patients with heart failure with preserved ejection fraction. Heart Fail Rev 2020; 25:67-73. [PMID: 31489515 DOI: 10.1007/s10741-019-09853-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent years, several studies have shown the usefulness and clinical relevance of left ventricular global longitudinal systolic strain (GLS) in different cardiovascular diseases. In line with this, the role of GLS in patients with heart failure with preserved ejection fraction (HFpEF) has achieved great importance in this predominant form of heart failure in the last years. In this regard, GLS has shown to be not only a sensitive parameter to detect subtle myocardial abnormalities but also a parameter of clinical and prognostic relevance in patients with HFpEF. In this review, we analyze the current evidence concerning the clinical relevance of GLS in patients with HFpEF and we discuss the potential usefulness of GLS in this complex and heterogeneous condition for which so far no effective therapy exists.
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Defining the left ventricular base in mitral valve prolapse: impact on systolic function and regurgitation. Int J Cardiovasc Imaging 2020; 36:2221-2227. [PMID: 32632705 DOI: 10.1007/s10554-020-01927-0] [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] [Received: 04/19/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
In bileaflet mitral valve prolapse (BMVP) systolic leaflet displacement creates a pocket of blood on the left ventricular (LV) side of the leaflets, but on the atrial side of the annulus. This blood is excluded from the LV end-systolic volume if the mitral valve annulus is used to determine the most basal extent of the LV. The purpose of this study is to describe the quantitative implications of defining the LV base on mitral regurgitant severity and LV systolic function in BMVP. In 30 consecutive patients (53% male, 58 ± 14 years) with BMVP, LV endocardial and epicardial borders were determined from SSFP images. The LV base at end-systole was defined by the "Functional" method (at the mitral valve annulus) or the "Anatomic" method (at the mitral valve leaflets). Regurgitant volume was the difference between the LV stroke volume and mean forward flow. LV myocardial strain measurements were determined from the short axis endocardial and epicardial borders. The "Functional" method resulted in higher regurgitant volumes (mean difference: 22 ml, range 0-40 ml) and higher ejection fractions (mean difference: 9%, range 0-21%). The correlation between LV end-diastolic volume and regurgitant volume was better with the "Functional" method (r = 0.79, p < 0.0001) than the "Anatomic" method (r = 0.67, p < 0.0001). The correlation between global myocardial radial strain and LV EF was better with the "Functional" method (r = 0.86, p < 0.0001) than the "Anatomic" method (r = 0.68, p < 0.0001). In BMVP, the base of the LV should be defined at the level of the mitral valve annulus so that regurgitant volume most accurately reflects the functional significance of the mitral valve disease and LVEF most accurately reflects global systolic LV function. Defining the basal extent of the LV at the mitral valve leaflets leads to substantially lower regurgitant volumes and lower ejection fractions that could have important clinical consequences.
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Fukui M, Xu J, Abdelkarim I, Sharbaugh MS, Thoma FW, Althouse AD, Pedrizzetti G, Cavalcante JL. Global longitudinal strain assessment by computed tomography in severe aortic stenosis patients - Feasibility using feature tracking analysis. J Cardiovasc Comput Tomogr 2019; 13:157-162. [DOI: 10.1016/j.jcct.2018.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/19/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
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Kresge HA, Khan OA, Wagener MA, Liu D, Terry JG, Nair S, Cambronero FE, Gifford KA, Osborn KE, Hohman TJ, Pechman KR, Bell SP, Wang TJ, Carr JJ, Jefferson AL. Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults. J Am Heart Assoc 2018; 7:e007562. [PMID: 29440034 PMCID: PMC5850190 DOI: 10.1161/jaha.117.007562] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/03/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Global longitudinal strain (GLS), reflecting total shortening of the myocardium during the cardiac cycle, has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). Longitudinal strain may be selectively affected in subclinical heart disease, even in the presence of normal LVEF. This study examines subclinical cardiac dysfunction, assessed by GLS and LVEF, and cognition among older adults. METHODS AND RESULTS Vanderbilt Memory and Aging Project participants who were free of clinical dementia, stroke, and heart failure (n=318, 73±7 years, 58% male) completed neuropsychological assessment and cardiac magnetic resonance to quantify GLS and LVEF. Linear regression models related GLS and LVEF to neuropsychological performances, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and APOE*ε4 status. Models were repeated with a cardiac×cognitive diagnosis interaction term. Compromised GLS (reflected by higher values) related to worse naming (β=-0.07, P=0.04), visuospatial immediate recall (β=-0.83, P=0.03), visuospatial delayed recall (β=-0.22, P=0.03), and verbal delayed recall (β=-0.11, P=0.007). LVEF did not relate to worse performance on any measure (P>0.18). No diagnostic interactions were observed. CONCLUSIONS Our study results are among the first to suggest that compromised GLS relates to worse episodic memory and language performance among older adults who are free of clinical dementia, stroke, and heart failure. Subclinical cardiac dysfunction may correlate with cognitive health in late life, even when LVEF remains normal. The results add to growing evidence that GLS may be a more sensitive and preferred method for quantifying subclinical changes in cardiac function.
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Affiliation(s)
- Hailey A Kresge
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Omair A Khan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Madison A Wagener
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - James G Terry
- Radiology& Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sangeeta Nair
- Radiology& Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Francis E Cambronero
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Katherine A Gifford
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Katie E Osborn
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Timothy J Hohman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Kimberly R Pechman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
| | - Susan P Bell
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Division of General Internal Medicine, Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John Jeffrey Carr
- Radiology& Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Angela L Jefferson
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Currie KD, West CR, Stöhr EJ, Krassioukov AV. Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia. J Neurotrauma 2017; 34:591-598. [DOI: 10.1089/neu.2016.4510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katharine D. Currie
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher R. West
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric J. Stöhr
- Discipline of Physiology & Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- G.F. Strong Rehabilitation Center, Vancouver, British Columbia, Canada
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Dandel M, Hetzer R. Echocardiographic assessment of the right ventricle: Impact of the distinctly load dependency of its size, geometry and performance. Int J Cardiol 2016; 221:1132-42. [PMID: 27474972 DOI: 10.1016/j.ijcard.2016.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) size, shape and function are distinctly load-dependent and pulmonary load is an important determinant of RV function in patients with congestive heart failure (CHF) due to primary impaired left ventricular function and in those with pre-capillary pulmonary hypertension (PH). In a pressure overloaded RV, not only dilation and aggravation of tricuspid regurgitation, but also systolic dysfunction leading to RV failure (RVF) can occur already before the development of irreversible alterations in RV myocardial contractility. This explains RV ability for reverse remodeling and functional improvement in patients with post-capillary and pre-capillary PH of a different etiology, after normalization of loading conditions. There is increasing evidence that RV evaluation by echocardiography in relation with its loading conditions can improve the decision-making process and prognosis assessments in clinical praxis. Recent approaches to evaluate the RV in relation with its actual loading conditions by echo-derived composite variables which either incorporate a certain functional parameter (i.e. tricuspid annulus peak systolic excursion, stroke volume, RV end-systolic volume index, velocity of myocardial shortening) and load, or incorporate measures which reflect the relationship between RV load and RV dilation, also taking the right atrial pressure into account (i.e. "load adaptation index"), appeared particularly suited and therefore also potentially useful for evaluation of RV contractile function. Special attention is focused on the usefulness of RV echo-evaluation in relation to load for proper decision making before ventricular assist-device implantation in patients with CHF and for optimal timing of listing procedures to transplantation in patients with end-stage pre-capillary PH.
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Affiliation(s)
- Michael Dandel
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany; Deutsches Herzzentrum Berlin, Germany.
| | - Roland Hetzer
- Deutsches Herzzentrum Berlin, Germany; Cardio Centrum Berlin, Germany
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Lo Iudice F, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, D'Andrea A, Trimarco B, Galderisi M. Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation. Eur Heart J Cardiovasc Imaging 2016:jew122. [DOI: 10.1093/ehjci/jew122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Cameli M, Sparla S, Focardi M, Righini F, Solari M, Alvino F, Lisi M, D'Ascenzi F, Bernazzali S, Tsioulpas C, Sassi C, Dokollari A, Sani G, Maccherini M, Mondillo S. Evaluation of Right Ventricular Function in the Management of Patients Referred for Left Ventricular Assist Device Therapy. Transplant Proc 2015; 47:2166-8. [DOI: 10.1016/j.transproceed.2015.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/28/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
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Cameli M, Righini FM, Lisi M, Bennati E, Navarri R, Lunghetti S, Padeletti M, Cameli P, Tsioulpas C, Bernazzali S, Maccherini M, Sani G, Henein M, Mondillo S. Comparison of right versus left ventricular strain analysis as a predictor of outcome in patients with systolic heart failure referred for heart transplantation. Am J Cardiol 2013; 112:1778-84. [PMID: 24063825 DOI: 10.1016/j.amjcard.2013.07.046] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/31/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to explore the relation between right ventricular (RV) and left ventricular (LV) echocardiographic parameters with clinical outcome in patients with advanced heart failure referred for cardiac transplantation. Ninety-eight consecutive patients with advanced systolic heart failure, referred for cardiac transplant evaluation, were enrolled. All patients were prospectively followed for the development of new outcome events, which included hospitalization for acute heart failure, cardiovascular death, heart transplantation, intra-aortic balloon pump implantation, and ventricular assist device implantation. Conventional transthoracic echocardiography was performed in all subjects. RV longitudinal strain (RVLS) by speckle-tracking echocardiography was assessed by averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). LV global longitudinal and global circumferential strains were also calculated. Of the 98 subjects at baseline, 46 had 67 new events during a mean follow-up of 1.5 ± 0.9 years. Free-wall RVLS, global RVLS, N-terminal fragment of the prohormone brain natriuretic peptide, RV fractional area change, and LV end-diastolic volume were independently predictive of combined outcomes (all p <0.0001). The overall performance for the prediction of cardiovascular events was greatest for free-wall RVLS (area under the curve free-wall RVLS: 0.87; global RVLS: 0.67; RV fractional area change: 0.60; N-terminal fragment of the prohormone brain natriuretic peptide, 0.62; global circumferential strain: 0.55; global longitudinal strain: 0.35; and LV ejection fraction: 0.26). Free-wall RVLS showed the highest adjusted hazards ratio. A graded association between the grade of RV dysfunction and the risk of cardiovascular events was only evident for free-wall RVLS and global RVLS. In conclusion, in patients referred for heart transplantation, RVLS is a stronger predictor of outcome than LV longitudinal strain and other conventional parameters, providing a stronger prognostic stratification.
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Cameli M, Righini FM, Lisi M, Mondillo S. Right ventricular strain as a novel approach to analyze right ventricular performance in patients with heart failure. Heart Fail Rev 2013; 19:603-10. [DOI: 10.1007/s10741-013-9414-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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D’Ascenzi F, Cameli M, Iadanza A, Lisi M, Zacà V, Reccia R, Curci V, Torrisi A, Sinicropi G, Pierli C, Mondillo S. Improvement of left ventricular longitudinal systolic function after transcatheter aortic valve implantation: a speckle-tracking prospective study. Int J Cardiovasc Imaging 2012; 29:1007-15. [DOI: 10.1007/s10554-012-0175-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022]
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Cameli M, Lisi M, Righini FM, Tsioulpas C, Bernazzali S, Maccherini M, Sani G, Ballo P, Galderisi M, Mondillo S. Right ventricular longitudinal strain correlates well with right ventricular stroke work index in patients with advanced heart failure referred for heart transplantation. J Card Fail 2012; 18:208-15. [PMID: 22385941 DOI: 10.1016/j.cardfail.2011.12.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 11/13/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S' and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation. METHODS AND RESULTS Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S' and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S' with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = -0.75; r = -0.82; respectively; both P < .0001). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy (area under the receiver operating characteristic (ROC) curve 0.90) and good sensitivity and specificity of 92% and 86%, respectively, to predict depressed RVSWI using a cutoff value of less than -11.8%. CONCLUSIONS In a group of patients referred for heart transplantation, TAPSE and tricuspid S' did not correlate with invasively obtained RVSWI. RV longitudinal deformation analysis by STE correlated well with RVSWI, providing a better estimation of RV systolic performance.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
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Cua CL, Feltes TF. Echocardiographic evaluation of the single right ventricle in congenital heart disease: results of new techniques. Circ J 2011; 76:22-31. [PMID: 22139360 DOI: 10.1253/circj.cj-11-1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Right ventricular (RV) function is increasingly recognized as having prognostic significance in various disease processes. The current gold standard for noninvasive measurement of RV function is cardiac magnetic resonance imaging; however, because of practical considerations, echocardiography remains the most often used modality for evaluating the RV. In the past, because of its complex morphology, echocardiographic assessment of the RV was usually qualitative in nature. Current advances in echocardiographic techniques have been able to overcome some of the previous limitations and thus quantification of RV function is increasingly being performed. In addition, recent echocardiographic guidelines for evaluating the RV have been published to aid in standardizing practice. The evaluation of RV function almost certainly has no greater importance than in the congenital heart population, especially in those patients that have a single RV acting as the systemic ventricle. As this complex population continues to increase in number, accurate and precise evaluation of RV function will be a major issue in determining clinical care.
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Affiliation(s)
- Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.
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