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Qin X, Dan Y, Wang H, Sun L, Ji W, Bai J, Mamtili I, Zhang K, Zheng J. Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study. J Cardiothorac Vasc Anesth 2024; 38:2341-2348. [PMID: 38908938 DOI: 10.1053/j.jvca.2024.05.036] [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: 03/25/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE The current work was designed to compare the effects of ciprofol and propofol on left ventricular systolic function and myocardial work by noninvasive speckle-tracking echocardiography in children undergoing surgical repair of atrial septal or ventricular septal defects. DESIGN A single-center double-blind randomized noninferiority study was conducted. SETTING The research occurred at a tertiary care center affiliated with Shanghai Jiao Tong University, China. PARTICIPANTS One hundred and twelve children aged 1 month to 16 years undergoing atrial septal or ventricular septal defect surgery with cardiopulmonary bypass were included. INTERVENTIONS One hundred and twelve children were allocated randomly to receive ciprofol (n = 67) or propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were intravenously infused at loading doses of 0.4 mg/kg or 2.0 mg/kg, respectively, over 30 seconds, depending on the physical condition of each patient. When the bispectral index was maintained between 45 and 55 after induction, transthoracic echocardiography, including apical two-chamber, three-chamber, and four-chamber views, were collected bedside. MEASUREMENTS AND MAIN RESULTS Of the 112 patients enrolled, 104 completed the study. Global longitudinal strain in the ciprofol and propofol groups after anesthesia was -17.3% (95% confidence interval [CI] -18.0% to -16.6%) and -17.8% (95% CI -18.7 to -17.0%) in the full analysis set and -17.5% (95% CI -18.2% to -16.9%) and -17.8% (95% CI -18.7% to -17.0%) in the per-protocol set, respectively. The noninferiority margin was set at 2% and confirmed with a lower limit of two-sided 95% CI for the intergroup difference of 1.58% in the full analysis set and 1.34% in the per-protocol set. There were no significant differences between the groups in left ventricular systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, and the length of stay in the cardiac intensive care unit and hospital were also comparable between the two groups (all p > 0.05). CONCLUSIONS Ciprofol did not show different effects on myocardial function and postoperative outcomes from propofol. Further, on the sensitive cardiac systole marker global longitudinal strain, ciprofol demonstrated noninferiority to propofol. Ciprofol might be an alternative solution for cardiac anesthesia in children with congestive heart disease with mild lesion.
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Affiliation(s)
- Xiaoxue Qin
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yingzhi Dan
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | | | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Wei Ji
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ilyar Mamtili
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China.
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Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Jensen GB, Schnohr P, Marott JL, Søgaard P, Gislason G, Svendsen JH, Møgelvang R, Aalen JM, Smiseth OA, Remme EW, Biering-Sørensen T. Association between myocardial work indices and cardiovascular events according to hypertension in the general population. Eur Heart J Cardiovasc Imaging 2024; 25:413-424. [PMID: 37930752 DOI: 10.1093/ehjci/jead292] [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: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
AIMS Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population. METHODS AND RESULTS This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6-4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07-1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08-1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04-1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003). CONCLUSION Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
| | - Peter Søgaard
- Department of Cardiology, Copenhagen University Hospital-North Zealand, Dyrehavevej 29, Hilleroed 3400, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - John Moene Aalen
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Rikshospitalet, Sognsvannsveien 20, Oslo 0372, Norway
| | - Otto Armin Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Rikshospitalet, Sognsvannsveien 20, Oslo 0372, Norway
| | - Espen Wattenberg Remme
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Rikshospitalet, Sognsvannsveien 20, Oslo 0372, Norway
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo 0372, Norway
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
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de Gregorio C, Trimarchi G, Faro DC, De Gaetano F, Campisi M, Losi V, Zito C, Tamburino C, Di Bella G, Monte IP. Myocardial Work Appraisal in Transthyretin Cardiac Amyloidosis and Nonobstructive Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 208:173-179. [PMID: 37852127 DOI: 10.1016/j.amjcard.2023.09.055] [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: 07/26/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
Global left ventricular (LV) myocardial work (MW) indexes can be recognized at ultrasound imaging from the LV pressure/global longitudinal strain (GLS) loop analysis. A total of 4 indexes, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), have been demonstrated to overcome the methodological limitations of GLS and provide useful information on myocardial dysfunction in some clinical settings. Although impaired MW indexes have been demonstrated in patients with transthyretin cardiac amyloidosis (ATTR) or with nonobstructive hypertrophic cardiomyopathy (HCM), there are no comparative studies at present. This study aimed to describe the characteristics of MW in both these clinical settings compared with patients with well-controlled hypertension (HTN). A total of 83 patients, 32 with ATTR (aged 70 ± 11 years, 32% mutated, 68% wild-type, 72% men), 29 with HCM (aged 57 ± 17 years), and 22 HTN controls (aged 56 ± 5.6 years, 59% men) were prospectively enrolled at 2 clinical centers. All participants had New York Heart Association class I or II. Overall, the LV mass index was greater in both study groups than in HTN, whereas the LV ejection fraction (EF) was significantly lower in ATTR compared with other groups. Based on this finding, patients with ATTR were further divided into 2 subgroups: ATTR1 (LVEF ≤0.50), n = 14 (44%) and ATTR2 (LVEF >0.50), n = 18 (56%). Overall, the GWI and GCW were lower in all ATTR patients (mostly in ATTR1) than in the other groups (p <0.001), whereas only small differences in GWE and none in GWW were found among the groups. Of interest, the pairwise comparison and receiver operating characteristic analysis in preserved LVEF patients showed that GWI was a better discriminator of ATTR2 from HCM patients than GLS, with the cut-off value ≤1,419 mm Hg% (89% sensitivity; 55% specificity; p = 0.013). In conclusion, MW analysis was confirmed to be a modern way to investigate myocardial function in patients with hypertrophic phenocopies. GWI and GCW were more impaired in patients with ATTR compared with HCM and HTN controls. Furthermore, this study likely revealed an additional discriminative value of GWI over GLS alone in preserved LVEF settings.
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Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy.
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Denise Cristiana Faro
- Department of Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Fabrizio De Gaetano
- Department of Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Mariapaola Campisi
- Azienda Ospedaliera Provinciale di Catania, Santa Maria e Santa Venera Hospital, Acireale (Catania), Italy
| | - Valentina Losi
- Department of Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Corrado Tamburino
- Department of Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Ines Paola Monte
- Department of Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
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Chao CT, Liao MT, Wu CK. Left Ventricular Hypertrophy Geometry and Vascular Calcification Co-Modify the Risk of Cardiovascular Mortality in Patients with End-Stage Kidney Disease: A Retrospective Cohort Study. J Atheroscler Thromb 2023; 30:1242-1254. [PMID: 36567124 PMCID: PMC10499460 DOI: 10.5551/jat.63870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 12/25/2022] Open
Abstract
AIM Patients with end-stage kidney disease (ESKD) have an unparalleled risk of left ventricular hypertrophy (LVH) and vascular calcification (VC), both of which introduce excessive cardiovascular risk. However, it remains unclear whether LVH geometry co-modulates cardiovascular outcomes with VC in this population. METHODS A retrospective cohort study was conducted. Patients with ESKD requiring chronic hemodialysis were identified from Shin Kong Wu Ho-Su Memorial Hospital between October and December 2018, with echocardiographic LVH geometry and aortic arch calcification (AoAC) determined. They were divided into four groups according to AoAC severity and eccentric or concentric LVH. We used Kaplan-Meier analysis and Cox proportional hazard regression to analyze their cardiovascular and all-cause mortality after multivariate adjustment. RESULTS Overall, 223 patients with ESKD with LVH were analyzed, among whom 29.1%, 23.3%, 25.1%, and 22.4% had non-to-mild AoAC with eccentric and concentric LVH and moderate-to-severe AoAC with eccentric and concentric LVH, respectively. After 3.5 years of follow-up, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher risk of cardiovascular mortality than those with non-to-mild AoAC and eccentric LVH (hazard ratio 3.35, p=0.002). However, those with moderate-to-severe AoAC but eccentric LVH did not have higher cardiovascular mortality. Similarly, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher all-cause mortality than those with non-to-mild AoAC and eccentric LVH, whereas the other two groups did not have higher risk. CONCLUSION LVH geometry could help stratify the risk of patients with ESKD when they had severe VC, and co-existing severe VC and concentric LVH aggravated cardiovascular risk.
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Affiliation(s)
- Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Huang H, Ruan Q, You Z, Fu L. Segmental and global myocardial work in hypertensive patients with different left ventricular ejection fraction: what's the role of the apex played? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1505-1514. [PMID: 37258991 DOI: 10.1007/s10554-023-02874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
We investigated myocardial work in hypertension (HT) among patients with different left ventricular ejection fraction (LVEF) to analyze the contribution of segmental myocardial work to global myocardial work. 114 patients with HT were divided into 4 groups: HTsnEF ("supra-normal" EF, > 65%); HTnEF ("normal" EF, 60-65%); HTmEF (designed as "middle" EF, 50-60%, within an abnormal LV geometry); HTrEF (reduced EF, < 50%). Longitudinal strain (LS) and myocardial work indices were obtained by echocardiography: myocardial work index (MWI), constructive work (MCW), wasted work (MWW), myocardial work efficiency (MWE), and percentages of apical work were calculated (PApi-MWI, PApi-MCW). Global LS (GLS) and global MWE (GWE) decreased in HTmEF and HTrEF groups. Global MWI(GWI) and MCW(GCW) increased in HTsnEF and HTnEF groups, and subsequently decreased, particularly in HTrEF group (P < 0.05). GWW increased in all HT subgroups. All segmental MWI and MCW were elevated or preserved initially in HTsnEF and HTnEF groups, and subsequently decreased, obviously in basal and middle segments in HTrEF group (P < 0.05). All segmental MWW increased and MWE decreased in HTmEF and HTrEF groups (P < 0.05). PApi-MWI and PApi-MCW increased initially, and subsequently decreased in HTmEF group, and elevated significantly in HTrEF group. Correlation analysis revealed a close connection of GLS and myocardial work parameters with LVEF. Apical myocardial work increased at the early stages of hypertensive systolic dysfunction, as a compensatory mechanism. Segmental myocardial work analysis added value to explore the distribution of myocardial impairment.
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Affiliation(s)
- Huimei Huang
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China
| | - Qinyun Ruan
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China.
| | - Ziling You
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China
| | - Liyun Fu
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Department of Ultrasound, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou, 350212, China
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Huang H, Fu L, Ruan Q, You Z, Yan L. Segmental and global myocardial work in hypertensive patients with different left ventricular geometry. Cardiovasc Ultrasound 2023; 21:11. [PMID: 37370171 DOI: 10.1186/s12947-023-00310-y] [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] [Received: 12/18/2022] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Myocardial work acquired by echocardiography has emerged as a novel method to evaluate myocardial function. We investigated global and segmental myocardial work in hypertension (HT) among patients with different patterns of left ventricular (LV) geometry in order to analyze the contribution of segmental myocardial work to global myocardial work. METHODS AND RESULTS One hundred twenty-five patients with HT were divided into 4 groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). Longitudinal strain (LS) and the following indices were obtained by echocardiography: myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). The global longitudinal strain (GLS) decreased gradually among the groups: NG, CR, CH and EH (P < 0.001). Global MWI (GWI) and global MCW (GCW) did not change across the different LV remodeling groups. Global MWW (GWW) increased and global MWE (GWE) decreased in both CH and EH group (P < 0.001). The LS of basal and middle regions reduced gradually in all HT subgroups, while apical LS decreased only in the CH and EH groups (P < 0.001). Basal MWI and MCW decreased in the CH and EH groups (P = 0.025, 0.007, respectively). Apical MWI and MCW increased in the NG and CR groups (P = 0.015, 0.044, respectively), with a decreasing trend in the CH and EH groups. All segmental MWW elevated and MWE reduced significantly in the CH and EH groups (P < 0.001). Univariate and multivariate logistic regression analyses demonstrated a significant association between left atrial volume index (LAVI), GLS, GWE and LV hypertrophy. At the receiver operating characteristic (ROC) analysis, optimal cutoff values of GLS, Apical LS, GWE and Apical MWE discriminating LV hypertrophy were 0.9072, 0.8049, 0.8325 and 0.7414, respectively. CONCLUSION Apical myocardial work increases in the early stages of LV remodeling, likely as a compensatory mechanism to maintain normal global myocardial work. Segmental myocardial work analysis offers a reliable means to explore the distribution of myocardial impairment in hypertensive patients at different LV remodeling stages.
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Affiliation(s)
- Huimei Huang
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Liyun Fu
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Qinyun Ruan
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China.
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| | - Ziling You
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Lei Yan
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, China
- Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
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Li X, Zhang P, Li M, Zhang M. Myocardial work: the analytical methodology and clinical utilities. Hellenic J Cardiol 2022; 68:46-59. [PMID: 35931412 DOI: 10.1016/j.hjc.2022.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/03/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
The evaluation of left ventricular (LV) systolic function is an essential part of the clinical practice of cardiology. Although left ventricular ejection fraction (LVEF) is the most validated and widely used parameter, it has fundamental limitations. LV strain is more sensitive to detect subtle myocardial dysfunction when LVEF was preserved, but it is load-dependent. Invasive left ventricular pressure-volume loop (LV-PVL) is the reliable standard to evaluate cardiac function, but its wide clinical application is limited by the risk of invasive LV pressure detection. Until the advent of non-invasive LV pressure-strain loop (LV-PSL), things have changed. LV-PSL is in good agreement with regional myocardial oxygen consumption and metabolism. Compared with traditional echocardiographic parameters or LV strain, myocardial work (MW) derived from LV-PSL is a more advanced tool that combines deformation as well as hemodynamics through integration of global longitudinal strain and non-invasive LV systolic pressure. In recent years, researches on MW are going on in full swing and show many advantages of MW. This review described the method and discussed the applications, advantages, limitations, and prospects of MW in multiple cardiovascular diseases. The goal is to provide the readers new insights for evaluating LV systolic function and promote the incorporation of MW into daily practice.
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Affiliation(s)
- Xinhao Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China
| | - Pengfei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
| | - Mengmeng Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qala Hospital, CeeLo College of Medicine, Shandong University, Shandong, China.
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Zhao Q, Cui C, Li Y, Liu Y, Huang D, Wang Y, Hu Y, Liu R, Zhu H, Liu L. Evaluation of myocardial work in patients with hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy based on non-invasive pressure-strain loops. Front Cardiovasc Med 2022; 9:767875. [PMID: 35958393 PMCID: PMC9360312 DOI: 10.3389/fcvm.2022.767875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The capacity to distinguish hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) based on morphological features obtained by conventional echocardiography is limited. We investigated the global myocardial work of the left ventricle in two types of hypertrophies using the non-invasive myocardial work index (NMWI). Methods Conventional echocardiography was performed on 107 subjects with preserved left ventricular ejection fraction (LVEF ≥ 50%), who comprised patients with HCM (n = 40), H-LVH (n = 35), and healthy people with normal blood pressure and left ventricular structure (n = 32). Except for the conventional echocardiographic parameters, the left ventricular myocardial work parameters based on pressure-strain loops, including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were evaluated in three groups. Multivariate discriminant analysis and receiver operating characteristic (ROC) curve were used to evaluate the incremental value of NMWI for distinguishing HCM from H-LVH. Results Compared to the control group, GWI and GCW were significantly lower in HCM patients (P < 0.05), whereas GWI was significantly higher in H-LVH patients. GWW was higher and GWE was significantly decreased in both HCM and H-LVH patients than in the control group (P < 0.05). Multivariate discriminant analysis and ROC curve revealed that the inter-ventricular septum thickness (IVST)/left ventricular posterior wall thickness (LVPWT) and GCW were each able to distinguish HCM from H-LVH. The combination of IVST/LVPWT and GCW discriminated HCM and H-LVH with a higher predictive accuracy of 94.7%. Conclusion NMWI may provide additional information in evaluating the myocardial function in patients with HCM and H-LVH. Myocardial work combined with conventional echocardiography could improve the clinical diagnostic accuracy of distinguishing HCM and H-LVH.
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Zhan J, Van den Eynde J, Ozdemir E, Long R, Hays A, Danford DA, Barnes B, Kutty S. Left ventricular myocardial work indices in pediatric hypertension: correlations with conventional echocardiographic assessment and subphenotyping. Eur J Pediatr 2022; 181:2643-2654. [PMID: 35366110 DOI: 10.1007/s00431-022-04447-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 12/18/2022]
Abstract
Myocardial work (MW) is a novel parameter that incorporates non-invasive estimates of left ventricular (LV) systolic pressure into the interpretation of strain, thus overcoming the limitations of load dependency traditionally encountered with LV fractional shortening (LVFS), ejection fraction (LVEF), and global longitudinal strain (GLS). However, data on MW in the pediatric population with hypertension are lacking. Conventional markers of LV function and MW indices were obtained from 88 echocardiographic examinations in 76 children with hypertension (47 males, 15.5 ± 2.96 years). When compared with a previously published cohort of 52 healthy controls, global work index (GWI) and global constructive work (GCW) were both significantly elevated while LVEF and GLS were not impaired but rather mildly increased. On multivariable analysis, GWI was correlated with systolic blood pressure (slope = + 16, p < 0.001) and GLS (slope = -100, p < 0.001), while GCW was correlated with systolic blood pressure (slope = + 18, p < 0.001), GLS (slope = -101, p < 0.001), male sex (slope = -75, p = 0.016), and LV mass (slope = -0.93, p < 0.001). Global wasted work (GWW) was correlated with age at echo visit (slope = -4.5, p = 0.005) and GLS (slope = + 5.5, p < 0.001). The opposite occurred for global work efficiency (GWE; slope = + 0.20, p = 0.011, and slope = -0.48, p < 0.001, respectively). Principal component analysis and k-means clustering revealed 4 subphenotypes which differed in terms of etiology, afterload, and compensation stage of the disease. Conclusion: Non-invasive MW shows a good correlation with conventional markers of LV function and may help refine the assessment of hypertensive heart disease in children. What is Known: • Myocardial work (MW) is a novel parameter that incorporates non-invasive estimates of left ventricular (LV) systolic pressure into the interpretation of strain, thereby accounting for both deformation and afterload. • Although the usefulness of MW in the assessment of myocardial function beyond conventional markers has been demonstrated in various clinical populations, data in the pediatric population with hypertension are currently lacking. What is New: • Compared to normal values in healthy children, global work index and global constructive work were increased in those with hypertension, while LV ejection fraction and global longitudinal strain were not impaired. • Machine learning identified 4 subphenotypes which differed in terms of etiology, afterload, and compensation stage of the disease.
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Affiliation(s)
- Junzhen Zhan
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Jef Van den Eynde
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA.,Department of Cardiovascular Sciences, KU Leuven & Congenital and Structural Cardiology, UZ Leuven, Leuven, Belgium
| | - Ege Ozdemir
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Rita Long
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Allison Hays
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - David A Danford
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Benjamin Barnes
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA
| | - Shelby Kutty
- Department of Pediatrics, The Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, M231521287, USA.
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Ventricular-Arterial Uncoupling and Hypertension Mediated Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:361-366. [PMID: 35460512 DOI: 10.1007/s40292-022-00521-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The increase in the pulsatile component of left ventricle afterload is suspected to cause a mismatch between the left ventricle (LV) and the vascular tree. AIM To demonstrate that ventricular-arterial uncoupling is frequently present in the development of LV hypertrophy (H) and diastolic dysfunction (DD) in hypertension (HBP). METHODS Observational study, HBP patients with ejection fraction > 54%. Conventional 2D echocardiography and tissue Doppler performed following imaging guidelines. LV end systolic elastance (Ees), the effective arterial elastance (Ea), and ventricular-arterial coupling (VAC) measured by Chen single beat method. RESULTS 288 patients, mean age 56.3 ± 12.5 years and 168 patients (58.3%) males. Mean LV mass index was 87.2 ± 20.4 grs/m2 and frequency of LVH 20.1% (58 patients). The mean VAC was 0.54 ± 9.23. LV Stroke volume, stroke work and systolic stress were 46.2 ± 10.3 cc/m2, 91.4 ± 22.2 g-min/m2, and 57 ± 14.6 dynes/cm2 in quartile 1, and 33.5 ± 6.6 cc/m2, 65.5 ± 15.2 g-min/m2, and 77.8 ± 17.1 dynes/cm2, in quartile 4, respectively (p < 0.001). Peripheral resistance index was 3349 ± 1072 and 4410 ± 1143 dynes*s/cm-5/m2 quartiles 1 vs. 4 (p < 0.005). The frequency of LVH was 31.9% in quartile 1 and 11.3% in quartile 4 (p < 0.005) and LVH or DD was 37.5% and 12.7%, respectively (p < 0.001). CONCLUSIONS Stroke volume and stroke work were significantly increased while systolic stress and peripheral resistance index were significantly reduced in patients with worst VAC. Ventricular-arterial uncoupling is mostly caused by an increase in Ees rather than by an elevation of Ea. LVH or DD are more frequent in the worst cases of ventricular-arterial uncoupling.
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