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Tomlinson S, Chan J, Appadurai V, Edwards N, Savage M, Lam AKY, Scalia GM. The LATE score: A novel framework for echocardiographic evaluation of left ventricular filling pressure. Int J Cardiol 2024; 413:132371. [PMID: 39047795 DOI: 10.1016/j.ijcard.2024.132371] [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: 04/18/2024] [Revised: 06/19/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The LATE score (LATE: Left Atrial reservoir strain (LASr), Tricuspid regurgitation maximum velocity (TR Vmax), and E/e' average) is a novel framework for echocardiographic assessment of left ventricular filling pressure (LVFP). LATE = 0 indicates normal LVFP. LATE = 1 indicates resting LVFP is borderline elevated, and the patient may be at risk of pathological elevation of LVFP during exertion. LATE ≥2 indicates LVFP is severely elevated. METHODS The LATE score was derived from reported thresholds of LASr and conventional echocardiographic parameters for predicting LVFP. The LATE score was prospectively evaluated in a cross-sectional study of 63 patients undergoing transthoracic echocardiography immediately prior to cardiac catheterization with invasive assessment of LVFP. Accuracy of the LATE score was compared to 2016 ASE diastology algorithms. RESULTS Mean patient age was 62.9 ± 13.6 years with 22% female. LATE = 0 in 29 patients, of which 24 (83%) had normal LVFP (mean LVFP 9 mmHg, SD ±3 mmHg). LATE = 1 in 23 patients, of which 11 (48%) had elevated LVFP (mean LVFP 12 mmHg, SD ± 4 mmHg). LATE was ≥2 in 11 patients, all of which had elevated LVFP (100%) (mean LVFP 16 mmHg, SD ±3 mmHg). The LATE score showed greater agreement with invasive assessment than the 2016 algorithms (LATE kappa = 0.73, 2016 kappa = 0.37). CONCLUSIONS The LATE score is a simple and effective tool for evaluation of LVFP that is more accurate than the 2016 algorithms. The LATE score provides insight beyond binary classification of normal versus elevated LVFP.
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Affiliation(s)
- Stephen Tomlinson
- The Prince Charles Hospital, Department of Cardiology, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Jonathan Chan
- The Prince Charles Hospital, Department of Cardiology, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Vinesh Appadurai
- The Prince Charles Hospital, Department of Cardiology, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Natalie Edwards
- The Prince Charles Hospital, Department of Cardiology, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Michael Savage
- The Prince Charles Hospital, Department of Cardiology, 627 Rode Road, Chermside, QLD 4032, Australia
| | - Alfred K-Y Lam
- Griffith University, School of Medicine and Menzies Health Institute Queensland, Griffith Health Centre, Level 8.86, QLD 4215, Australia
| | - Gregory M Scalia
- The Prince Charles Hospital, Department of Cardiology, 627 Rode Road, Chermside, QLD 4032, Australia.
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Istratoaie S, Bourg C, Donal E. The LATE score unveiled: A new frontier in left ventricular filling pressure evaluation. Int J Cardiol 2024; 417:132530. [PMID: 39245071 DOI: 10.1016/j.ijcard.2024.132530] [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: 08/15/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024]
Affiliation(s)
- Sabina Istratoaie
- Department of Pharmacology, Toxicology, and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Corentin Bourg
- Department of Cardiology, University of Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Erwan Donal
- Department of Cardiology, University of Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, F-35000 Rennes, France.
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Abou Kamar S, Aga YS, de Bakker M, van den Berg VJ, Strachinaru M, Bowen D, Frowijn R, Akkerhuis KM, Brugts JJ, Manintveld O, Umans V, Geleijnse M, de Boer RA, Boersma E, Kardys I, van Dalen BM. Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction. Clin Res Cardiol 2024; 113:1306-1316. [PMID: 37311973 PMCID: PMC11371887 DOI: 10.1007/s00392-023-02244-x] [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: 03/24/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND We investigated whether repeatedly measured left atrial reservoir strain (LASr) in heart failure with reduced ejection fraction (HFrEF) patients provides incremental prognostic value over a single baseline LASr value, and whether temporal patterns of LASr provide incremental prognostic value over temporal patterns of other echocardiographic markers and NT-proBNP. METHODS In this prospective observational study, 153 patients underwent 6-monthly echocardiography, during a median follow-up of 2.5 years. Speckle tracking echocardiography was used to measure LASr. Hazard ratios (HRs) were calculated for LASr from Cox models (baseline) and joint models (repeated measurements). The primary endpoint (PEP) comprised HF hospitalization, left ventricular assist device, heart transplantation, and cardiovascular death. RESULTS Mean age was 58 ± 11 years, 76% were men, 82% were in NYHA class I/II, mean LASr was 20.9% ± 11.3%, and mean LVEF was 29% ± 10%. PEP was reached by 50 patients. Baseline and repeated measurements of LASr (HR per SD change (95% CI) 0.20 (0.10-0.41) and (0.13 (0.10-0.29), respectively) were both significantly associated with the PEP, independent of both baseline and repeated measurements of other echo-parameters and NT-proBNP. Although LASr was persistently lower over time in patients with PEP, temporal trajectories did not diverge in patients with versus without the PEP as the PEP approached. CONCLUSION LASr was associated with adverse events in HFrEF patients, independent of baseline and repeated other echo-parameters and NT-proBNP. Temporal trajectories of LASr showed decreased but stable values in patients with the PEP, and do not provide incremental prognostic value for clinical practice compared to single measurements of LASr.
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Affiliation(s)
- S Abou Kamar
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Y S Aga
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - M de Bakker
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - V J van den Berg
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Strachinaru
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - R Frowijn
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - K M Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - O Manintveld
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - V Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - M Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - R A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - I Kardys
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - B M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Meloni A, Saba L, Positano V, Pistoia L, Porcu M, Massei F, Sanna PMG, Longo F, Giovangrossi P, Argento C, Gerardi C, Cademartiri F, Cau R. Left atrial strain in patients with β-thalassemia major: a cross-sectional CMR study. Eur Radiol 2024; 34:5965-5977. [PMID: 38478060 DOI: 10.1007/s00330-024-10667-x] [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: 12/20/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 08/31/2024]
Abstract
OBJECTIVES The aim of this cross-sectional study was to investigate the association of left atrial (LA) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in a cohort of patients with β-thalassemia major (β-TM). MATERIALS AND METHODS We considered 264 β-TM patients (133 females, 36.79 ± 11.95 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. Moreover, we included 35 sex- and age-matched healthy controls (14 females, mean age 37.36 ± 17.52 years). Reservoir, conduit, and booster LA functions were analysed by CMR feature tracking using dedicated software. RESULTS Compared to the healthy control group, β-TM patients demonstrated lower LA reservoir strain and booster strains, as well as LA reservoir and booster strain rates. However, no differences were found in LA conduit deformation parameters. In β-TM patients, ageing, sex, and left ventricle (LV) volume indexes were independent determinants of LA strain parameters. The number of segments with late gadolinium enhancement (LGE) significantly correlated with all LA strain parameters, with the exception of the LA conduit rate. Patients with cardiac complications exhibited significantly impaired strain parameters compared to patients without cardiac complications. CONCLUSION In patients with β-TM, LA strain parameters were impaired compared to control subjects, and they exhibited a significant correlation with the number of LV segments with LGE. Furthermore, patients with cardiac complications had impaired left atrial strain parameters. Clinical relevance statement In patients with β-thalassemia major, left atrial strain parameters were impaired compared to control subjects and emerged as a sensitive marker of cardiac complications, stronger than cardiac iron levels. KEY POINTS • Compared to healthy subjects, β-thalassemia major patients demonstrated significantly lower left atrial reservoir strain and booster strains, as well as left atrial reservoir and booster strain rates. • In β-thalassemia major, ageing, sex, and left ventricular volume indexes were independent determinants of left atrial strain parameters, while left atrial strain parameters were not correlated with myocardial iron overload. • An independent association between reduced left atrial strain parameters and a history of cardiac complications was found in β-thalassemia major patients.
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Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy
- U.O.C. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Michele Porcu
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Francesco Massei
- U.O. Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Pisana - Stabilimento S. Chiara, Pisa, Italy
| | | | - Filomena Longo
- Unità Operativa Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria "S. Anna", Cona, FE, Italy
| | - Piera Giovangrossi
- Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale S. M. Goretti, Latina, Italy
| | - Crocetta Argento
- Centro di Talassemia, Ospedale "San Giovanni Di Dio", Agrigento, Italy
| | - Calogera Gerardi
- Unità Operativa Semplice Dipartimentale di Talassemia, Presidio Ospedaliero "Giovanni Paolo II" - Distretto AG2 di Sciacca, Sciacca, AG, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy.
| | - Riccardo Cau
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
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Lai KY, Lee CY, Chang YC, Liu K, Takeuchi M, Yang LT, Ho YL. Prognostic value of fully-automated left atrial strain in patients with asymptomatic chronic severe aortic regurgitation. Int J Cardiol 2024; 416:132487. [PMID: 39209033 DOI: 10.1016/j.ijcard.2024.132487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/29/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND To examine whether left atrial (LA) strain was associated with adverse outcomes in asymptomatic chronic aortic regurgitation (AR). METHODS Asymptomatic patients with ≥moderate-severe AR were retrospectively identified from 2008 through 2022 from a university hospital. Apical 4-chamber left ventricular longitudinal strain (A4C-LVLS), LA reservoir (LASr), conduit (LAScd), and contractile strain (LASct) were measured using fully-automated software. Primary endpoint was all-cause death (ACD); secondary endpoints were heart failure (HF) development or aortic valve surgery (AVS). RESULTS Of 352 patients (59 ± 17 years; 19 % female), the mean LV ejection fraction (LVEF) was 60 ± 8 %. The median follow-up during medical surveillance was 4.7 (interquartile range: 1.8-9.0) years; during which 68 patients died. Multivariable analysis adjusted for covariates showed that larger maximal LA volume index (iLAVmax), lower LASr and LASct were independently associated with ACD (all P ≤ 0.047); A4C-LVLS and LAScd were not (P ≥ 0.15). Besides, iLAVmax, LASr, and LASct provided incremental prognostic value over A4C-LVLS in terms of ACD (all P ≤ 0.048). HF symptoms occurred in 126 patients at a median of 2 years. Multivariable determinants for HF development included larger minimal LAV index, lower LASr and LASct (all P ≤ 0.03). Adjusted spline curves showed LASr <38-40 % and LASct <20-24 % were associated with increased risks of ACD and HF development, respectively. Using abovementioned LASr and LASct cutoffs, adjusted Kaplan-Meier curves risk-stratified patients for ACD successfully (P ≤ 0.02). Lower LASr was also independently associated with AVS (Hazard ratio per 1 % increase: 0.98)(P = 0.02). CONCLUSIONS In patients with asymptomatic AR, fully-automated LASr and LASct were robust markers for outcome determination; these markers may identify those who need timely surgical referral.
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Affiliation(s)
- Kuan-Yu Lai
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Yen Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ching Chang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kang Liu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Li-Tan Yang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Lwun Ho
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
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Li L, You C, Zhang L, Yang J, Wang Y, Zhang P. Prognostic values of left atrial strain analyzed by four-dimensional speckle tracking echocardiography in uremia with preserved ejection fraction. Sci Rep 2024; 14:18971. [PMID: 39152294 PMCID: PMC11329677 DOI: 10.1038/s41598-024-69904-4] [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: 05/08/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024] Open
Abstract
Little is known about the prognostic value of left atrial strain by four-dimensional speckle-tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction. This prospective study collected clinical and echocardiographic data from 80 stable dialysis patients (mean age 57 ± 10 years; 62.5% men). All patients underwent the dedicated four-dimensional speckle-tracking echocardiography to measure LASr (peak longitudinal strain of reservoir function), LAScd (peak longitudinal strain of conduit function), LASct (peak longitudinal strain of contractile function), LASr_c (peak circumferential strain of reservoir function), LAScd_c (peak circumferential strain of conduit function) and LASct_c (peak circumferential strain of contractile function). These patients were enrolled from August 2021 to August 2023 and followed-up for 19 months (interquartile-range 15 to 20 months). The primary outcome was a composite of all-cause mortality or major adverse cardiovascular events (MACEs). The study patients were classified into event (developed mortality or MACEs) and event-free group according to the primary outcome. Multivariate Cox regression analysis was used to investigate risk factors for all-cause mortality or MACEs. The event group had lower LASr (16.4% vs. 21.2%, P = 0.0003), LASct (8.2% vs. 11.2%, P = 0.01), LASr_c (25.2% vs. 35.0%, P = 0.0004) and LASct_c (14.9% vs. 20.9%, P = 0.001) than the event-free group. Using optimal cut-off value determined by ROC curve, the less LASr (LASr < 18.5%), LASct (LASct < 8.5%), LASr_c (LASr_c < 28.5%), and LASct_c (LASct_c < 17.5%) group had a higher mortality or MACEs rate. Multivariate cox regression analyses revealed that LASr (HR = 0.81, 95% CI [0.17; 0.91], P = 0.0005, per 1% increase) and LASr_c (HR = 0.93, 95% CI [0.87; 0.98], P = 0.01, per 1% increase) were independent predictors of all-cause mortality or MACEs. Less peak longitudinal and circumferential strains of reservoir function are predictive of poor prognosis among end-stage renal disease patients with preserved left ventricular ejection fraction.
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Affiliation(s)
- Lei Li
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, 210006, Jiangsu Province, China
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Chunyuan You
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Lai Zhang
- Department of Nephrology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
| | - Jun Yang
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Yang Wang
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Pingyang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, 210006, Jiangsu Province, China.
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Orso D, Sabbadin M, Bacchetti G, Simeoni G, Bove T. Correlation Between Tissue Doppler Imaging Method (E/e') and Invasive Measurements of Left Ventricular Filling Pressures: A Systematic Review, Meta-Analysis, and Meta-Regression. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00534-2. [PMID: 39218765 DOI: 10.1053/j.jvca.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/21/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Evaluation of pulmonary capillary wedge pressure (PCWP) through right heart catheterization can indirectly provide an estimation of the filling pressure of the left ventricle. Echocardiography can estimate left ventricular compliance using mitral annular tissue Doppler imaging (TDI). The E/e' ratio refers to the correlation between the peak mitral inflow (E-wave) velocity and early diastolic tissue Doppler mitral annular velocity (e'). The main purpose of this systematic review was to establish the correlation between echocardiographic E/e' ratio and PCWP. The correlation between E/e' and left ventricular end-diastolic pressure (LVEDP) was evaluated as a secondary objective. DESIGN A systematic review and meta-analysis of observational studies was conducted. The search was based on Medline (PubMed), Scopus, and Web of Science. SETTING Intensive care unit or cardiac intensive care unit. PARTICIPANTS Adult patients. INTERVENTIONS Any study comparing the left ventricular filling pressure obtained by cardiac catheterization (reference) and echocardiographic evaluation, in particular TDI analysis (intervention), were included. MEASUREMENTS AND MAIN RESULTS The pooled analysis included 94 studies from the initially identified 7,304 records. The correlation was 0.48 (95% CI 0.42-0.54, Q = 420.52, I2 = 84.8%) for PCWP and 0.50 (95% CI 0.38-0.60, Q = 210.91, I2 = 89.1%) for LVEDP. CONCLUSIONS The E/e' ratio moderately correlated with PCWP/LVEDP. The correlation was stable irrespective of the sites where e' was measured, but each site has its own limitations for specific patient subpopulations. The correlation was weak in patients with heart failure with a preserved ejection fraction.
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy.
| | - Marta Sabbadin
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | | | - Gabriele Simeoni
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy; Department of Medicine (DAME), University of Udine, Udine, Italy
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8
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Mascarenhas LA, Ji Y, Wang W, Inciardi RM, Parikh RR, Eaton AA, Cheng S, Alonso A, Matsushita K, Shah AM, Solomon SD, Meyer ML, Chen LY, Zhang MJ. Association of central arterial stiffness with atrial myopathy: the Atherosclerosis Risk in Communities (ARIC) study. Hypertens Res 2024:10.1038/s41440-024-01831-3. [PMID: 39117948 DOI: 10.1038/s41440-024-01831-3] [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: 05/26/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024]
Abstract
Atrial myopathy-defined as abnormal left atrial (LA) size and function-is associated with an increased risk of atrial fibrillation, heart failure, and dementia. Central arterial stiffness is associated with increased atrial afterload and fibrosis and may be a risk factor for atrial myopathy. We examined the association of carotid-femoral pulse wave velocity (cfPWV) with LA function and assessed potential causal relationships. We included 2825 Atherosclerosis Risk in Communities (ARIC) study participants from Visit 5 (2011-2013). cfPWV was related to echocardiographic LA function continuously per 1-SD and categorically in quartiles. Mendelian randomization (MR) analysis was performed using U.K. Biobank-derived genetic variants associated with arterial stiffness index and cardiac magnetic resonance measures of LA function. When analyzed per SD increment (297.6 cm/s), higher cfPWV was significantly associated with lower LA reservoir and conduit strain (β = -0.53%, 95% CI [-0.81, -0.25] and β = -0.46%, 95% CI [-0.68, -0.25], respectively) after adjusting for demographics, clinical characteristics, systolic blood pressure, and left ventricular (LV) morphology and function. In MR analyses there was a non-significant inverse association of arterial stiffness index with LA total, passive, and active emptying fractions. Higher cfPWV is associated with lower LA reservoir and conduit strain, independent of systolic blood pressure and LV morphology and function. No evidence for a causal relationship between arterial stiffness index and alterations in LA function was found. Future studies should examine the prospective association of central arterial stiffness with LA function alterations.
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Affiliation(s)
- Lorraine A Mascarenhas
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yuekai Ji
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Riccardo M Inciardi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne A Eaton
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amil M Shah
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael J Zhang
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, MN, USA.
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9
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Mangia M, D'Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J Cardiovasc Dev Dis 2024; 11:241. [PMID: 39195149 DOI: 10.3390/jcdd11080241] [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: 04/25/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
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Affiliation(s)
- Mario Mangia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Emilio D'Andrea
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Stefano Nistri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
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10
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Iwano H. Echocardiographic estimation of left ventricular filling pressure in atrial fibrillation using left atrial strain: Ready for practical use? Echocardiography 2024; 41:e15899. [PMID: 39074118 DOI: 10.1111/echo.15899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Affiliation(s)
- Hiroyuki Iwano
- Division of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
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11
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Wang N, Rueter P, Ng M, Chandramohan S, Hibbert T, O'Sullivan JF, Kaye D, Lal S. Echocardiographic predictors of cardiovascular outcome in heart failure with preserved ejection fraction. Eur J Heart Fail 2024; 26:1778-1787. [PMID: 38714362 DOI: 10.1002/ejhf.3271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 05/09/2024] Open
Abstract
AIMS The optimal echocardiographic predictors of cardiovascular outcome in heart failure (HF) with preserved ejection fraction (HFpEF) are unknown. We aimed to identify independent echocardiographic predictors of cardiovascular outcome in patients with HFpEF. METHODS AND RESULTS Systematic literature search of three electronic databases was conducted from date of inception until November 2022. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for echocardiographic variables from multivariate prediction models for the composite primary endpoint of cardiovascular death and HF hospitalization were pooled using a random effects meta-analysis. Specific subgroup analyses were conducted for studies that enrolled patients with acute versus chronic HF, and for those studies that included E/e', pulmonary artery systolic pressure (PASP), renal function, natriuretic peptides and diuretic use in multivariate models. Forty-six studies totalling 20 056 patients with HFpEF were included. Three echocardiographic parameters emerged as independent predictors in all subgroup analyses: decreased left ventricular (LV) global longitudinal strain (HR 1.24, 95% CI 1.10-1.39 per 5% decrease), decreased left atrial (LA) reservoir strain (HR 1.30, 95% CI 1.13-1.1.50 per 5% decrease) and lower tricuspid annular plane systolic excursion (TAPSE) to PASP ratio (HR 1.17, 95% CI 1.07-1.25 per 0.1 unit decrease). Other independent echocardiographic predictors of the primary endpoint were a higher E/e', moderate to severe tricuspid regurgitation, LV mass index and LA ejection fraction, although these variables were less robust. CONCLUSIONS Impaired LV global longitudinal strain, lower LA reservoir strain and lower TAPSE/PASP ratio predict cardiovascular death and HF hospitalization in HFpEF and are independent of filling pressures, clinical characteristics and natriuretic peptides. These echocardiographic parameters reflect key functional changes in HFpEF, and should be incorporated in future prospective risk prediction models.
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Affiliation(s)
- Nelson Wang
- The George Institute for Global Health UNSW, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Phidias Rueter
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Melvin Ng
- UNSW Medical School, University of New South Wales, Sydney, Australia
| | - Sashiruben Chandramohan
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thomas Hibbert
- UNSW Medical School, University of New South Wales, Sydney, Australia
| | - John F O'Sullivan
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia
- Baker Heart and Diabetes Institute Melbourne, Melbourne, Australia
| | - Sean Lal
- Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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12
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Wang AP, Polsen C, Penk J, Husain N, Hauck A, Jone PN. Common atrial reservoir strain during the interstage period is a predictor of poor outcomes prior to Fontan completion in hypoplastic left heart syndrome. Echocardiography 2024; 41:e15910. [PMID: 39189828 DOI: 10.1111/echo.15910] [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: 06/24/2024] [Revised: 07/26/2024] [Accepted: 08/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The atrium augments ventricular function, but the significance of atrial function in hypoplastic left heart syndrome (HLHS) has not been well evaluated. OBJECTIVE We investigated the association of atrial reservoir strain (common atrial strain [CAS]) to death or need for transplantation in patients with HLHS. METHODS In this retrospective single-center study, echocardiograms from three timepoints (pre-stage 1 palliation [S1P], 4-8 weeks post-S1P, and pre-Glenn) were analyzed in infants with classic HLHS. Patients were separated based on transplant-free survival to Fontan (survivors) versus death or heart transplant prior to Fontan (composite outcome). Echocardiographic parameters evaluated included CAS, right ventricle (RV) global longitudinal strain (RVGLS), RV fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE). An equal variance t-test, regression, and receiver operating characteristic (ROC) analyses were performed. RESULTS A total of 45 HLHS patients (25 survivors, 20 patients meeting endpoint) were included in this study. There were no significant differences in any of the functional parameters during the pre-stage 1 or post-stage 1 timepoints. Pre-Glenn CAS and RVGLS were significantly worse in those meeting composite endpoint compared to survivors. CAS was significantly correlated to RVGLS during the pre-S1P and pre-Glenn timepoints. A pre-Glenn CAS < 19.5 had an area under the curve of .78 and a 75% sensitivity and 83% specificity for death or need for transplantation. CONCLUSION Pre-Glenn CAS is significantly lower in patients with mortality or need for the transplantation prior to Fontan completion and may carry prognostic significance in patients with HLHS.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Cassandra Polsen
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jamie Penk
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nazia Husain
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amanda Hauck
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Pei-Ni Jone
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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13
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Tamaki S, Inoue K, Kawakami H, Fujisawa T, Miyabe R, Nakao Y, Miyazaki S, Akazawa Y, Miyoshi T, Higaki A, Seike F, Higashi H, Nishimura K, Ikeda S, Yamaguchi O. Remote dielectric sensing predicts elevated left atrial pressure in patients with atrial fibrillation. IJC HEART & VASCULATURE 2024; 53:101459. [PMID: 39045570 PMCID: PMC11265582 DOI: 10.1016/j.ijcha.2024.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
Background There are currently no established non-invasive indices of echocardiography for elevated left atrial pressure (LAP) especially in patients with atrial fibrillation (AF). Remote dielectric sensing (ReDS) is a novel non-invasive electromagnetic energy-based technology that quantifies total lung fluid, enabling the monitoring of volume status in patients with heart failure. The utility of ReDS for estimating LAP in patients with AF remains unknown. Methods We prospectively investigated patients with AF in whom LAP was directly measured during catheter ablation for AF, and ReDS measurements were conducted the day before ablation. Elevated LAP was defined as LAP ≥ 15 mmHg. Results A total of 61 patients were included (median age 66 years, 38 % female). Among them, 26 patients had elevated LAP. There was a positive correlation between ReDS and LAP (r = 0.363, P = 0.004). Receiver operating characteristic curve analysis for the prediction of elevated LAP demonstrated that the best cut-off value of ReDS was 30 %, with a sensitivity of 65 %, specificity of 69 %, and an area under the curve of 0.703 (95 % confidence interval 0.568-0.837). Multivariate logistic regression analysis revealed that ReDS was an independent predictor of elevated LAP, among covariates including left ventricular ejection fraction, the ratio of early transmitral flow velocity to septal mitral annular early diastolic velocity, and left atrial volume index. Conclusions Our results suggest ReDS could be a valuable marker of elevated LAP even in patients with AF. Further studies are needed to elucidate the effectiveness of a ReDS-guided decongestive strategy in patients with heart failure.
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Affiliation(s)
- Shunsuke Tamaki
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Tomoki Fujisawa
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Ryo Miyabe
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Yasuhisa Nakao
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Shigehiro Miyazaki
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Toru Miyoshi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Akinori Higaki
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Fumiyasu Seike
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Kazuhisa Nishimura
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Japan
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14
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Inoue K, Smiseth OA. Left atrium as key player and essential biomarker in heart failure. J Cardiol 2024:S0914-5087(24)00135-7. [PMID: 39084316 DOI: 10.1016/j.jjcc.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/05/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
This article reviews roles of the left atrium as regulator of left ventricular filling, as compensatory reserve in left ventricular dysfunction and as diagnostic marker in patients with cardiovascular disorders. Application of novel imaging tools to assess left atrial function and their integration with conventional clinical methods are discussed. This includes a review of clinical applications of left atrial strain as a method to quantify the reservoir and booster pump components of left atrial function. Emerging methods for assessing left atrial wall stiffness and active work by pressure-strain loop analysis are discussed. Recommendations for how to apply left atrial strain in clinical routine to diagnose elevated left ventricular filling pressure are provided. Furthermore, a role for left atrial strain in the diagnostic work-up in patients suspected of pre-capillary pulmonary hypertension is proposed. The article also reviews how to implement parameters of atrial structure and function in clinical routine as recommended by recent international guidelines for imaging of heart failure.
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Affiliation(s)
- Katsuji Inoue
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Yawatahama, Ehime, Japan.
| | - Otto A Smiseth
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital and University of Oslo, Oslo, Norway
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15
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Dhont S, Verbrugge FH, Verwerft J, Bertrand PB. Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:575-582. [PMID: 38683589 DOI: 10.1093/ehjacc/zuae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024]
Abstract
Non-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.
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Affiliation(s)
- Sebastiaan Dhont
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Verwerft
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Philippe B Bertrand
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
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16
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Camilli M, Ferdinandy P, Salvatorelli E, Menna P, Minotti G. Anthracyclines, Diastolic Dysfunction and the road to Heart Failure in Cancer survivors: An untold story. Prog Cardiovasc Dis 2024:S0033-0620(24)00099-9. [PMID: 39025347 DOI: 10.1016/j.pcad.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
Many cardiovascular diseases are characterized by diastolic dysfunction, which associates with worse clinical outcomes like overall mortality and hospitalization for heart failure (HF). Diastolic dysfunction has also been suspected to represent an early manifestation of cardiotoxicity induced by cancer drugs, with most of the information deriving from patients treated with anthracyclines; however, the prognostic implications of diastolic dysfunction in the anthracycline-treated patient have remained poorly explored or neglected. Here the molecular, pathophysiologic and diagnostic aspects of anthracycline-related diastolic dysfunction are reviewed in the light of HF incidence and phenotype in cancer survivors. We describe that the trajectories of diastolic dysfunction toward HF are influenced by a constellation of patient- or treatment- related factors, such as comorbidities and exposure to other cardiotoxic drugs or treatments, but also by prospective novel opportunities to treat diastolic dysfunction. The importance of a research-oriented multidimensional approach to patient surveillance or treatment is discussed within the framework of what appears to be a distinct pathophysiologic entity that develops early during anthracycline treatment and gradually worsens over the years.
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Affiliation(s)
- Massimiliano Camilli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary; Pharmahungary Group, Szeged, Hungary; MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | | | - Pierantonio Menna
- Unit of Drug Sciences, University Campus Bio-Medico, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giorgio Minotti
- Unit of Drug Sciences, University Campus Bio-Medico, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
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17
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Bukhari S, Bashir Z. Diagnostic Modalities in the Detection of Cardiac Amyloidosis. J Clin Med 2024; 13:4075. [PMID: 39064115 PMCID: PMC11278232 DOI: 10.3390/jcm13144075] [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: 05/30/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Cardiac amyloidosis (CA) results mainly from the infiltration of the myocardium by either immunoglobulin light-chain fibrils (AL) or transthyretin fibrils (ATTR), causing restrictive cardiomyopathy and eventually death if untreated. AL derives from monoclonal immunoglobulin light chains produced by plasma cell clones in the bone marrow, while ATTR is the misfolded form of hepatically derived transthyretin (TTR) protein and can be hereditary (ATTRv) or wild-type (ATTRwt). Over the last decade, improvements in diagnostic imaging and better clinical awareness have unleashed a notable presence of CA in the community, especially ATTR in the elderly population. These multimodality imaging modalities include echocardiography, cardiac magnetic resonance, and radionuclide scintigraphy with bone-avid tracers. There has been remarkable progress in the therapeutic landscape as well, and there are disease-modifying therapies available now that can alter the course of the disease and improve survival if initiated at an early stage of the disease. There remains an unmet need for detecting this disease accurately and early so that these patients can benefit the most from newly emerging therapies.
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Affiliation(s)
- Syed Bukhari
- Department of Medicine, Temple University Hospital, Philadelphia, PA 19111, USA
| | - Zubair Bashir
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA;
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Antit S, Abdelhedi M, Fekih R, Bahri K, Boussabah E, Zakhama L. Left Atrial Strain for assessment of left ventricle diastolic dysfunction in acute coronary syndrome patients. LA TUNISIE MEDICALE 2024; 102:399-405. [PMID: 38982963 PMCID: PMC11358800 DOI: 10.62438/tunismed.v102i7.4875] [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: 02/19/2024] [Accepted: 04/16/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Patients with acute coronary syndrome (ACS) have a high incidence of Left ventricle diastolic dysfunction (DD). Latest algorithms for the assessment of DD lay on 2D parameters and describe a grading to quantify its severity. However, there persists a "gray zone" of values in which DD remains indeterminate. AIM to analyze the diagnostic value of Left atrium strain (LAS) for categorization of LV DD and assessment of LV filling pressures in ACS patients. METHODS Cross-sectional study that prospectively evaluated 105 patients presenting ACS with preserved LV ejection fraction (LVEF). Patients were divided in 4 groups according to the DD grade. Mean values of LAS, corresponding to three phases of atrial function: reservoir (LASr), conduit (LAScd) and contraction (LASct), were obtained by speckle-tracking echocardiography. RESULTS Mean age was 60±10 years, with a gender ratio of 6.14. LASr and LASct were significantly lower according to DD severity (p combined=0.021, p combined=0.034; respectively). E/e' ratio was negatively correlated to LASr (r= - 0.251; p= 0.022) and LASct (r= -0.197; p=0.077). Left atrial volume index (LAVI) was also negatively correlated to LASr (r= -0.294, p= 0.006) and LASct (r= -0.3049, p=0.005). Peak tricuspid regurgitation was negatively correlated to LASr (r=-0.323, p=0.017) and LASct (r=-0.319, p=0.020). Patients presenting elevated LV filling pressures had lower LASr and LASct (p=0.049, p=0.022, respectively) compared to patients witn normal LV filling pressures. ROC curve analysis showed that a LASr < 22% (Se= 75%, Sp= 73%) and a LASct < 13% (Se= 71%, Sp=58%) can increase the likelihood of DD grade II or III by 4.6 (OR= 4.6; 95% CI: 1.31-16.2; p=0.016) and 3.7 (OR= 3.7; 95% CI: 1.06-13.1; p= 0.047), respectively. CONCLUSION LAS is a valuable tool, which can be used to categorize DD in ACS patients.
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Affiliation(s)
- Saoussen Antit
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Security Forces Hospital, La Marsa, Tunisia
| | - Marwa Abdelhedi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Security Forces Hospital, La Marsa, Tunisia
| | - Ridha Fekih
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Security Forces Hospital, La Marsa, Tunisia
| | - Khalil Bahri
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Security Forces Hospital, La Marsa, Tunisia
| | - Elhem Boussabah
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Security Forces Hospital, La Marsa, Tunisia
| | - Lilia Zakhama
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Cardiology, Security Forces Hospital, La Marsa, Tunisia
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19
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Pastore MC, Stefanini A, Mandoli GE, Piu P, Diviggiano EE, Iuliano MA, Carli L, Marchese A, Martini L, Pecere A, Cavigli L, Giacomin E, Pagliaro A, Righini FM, Sorini Dini C, Soliman Aboumarie H, Focardi M, D'Ascenzi F, Valente S, Cameli M. Dapagliflozin Effects on Cardiac Deformation in Heart Failure and Secondary Clinical Outcome. JACC Cardiovasc Imaging 2024:S1936-878X(24)00226-2. [PMID: 39023499 DOI: 10.1016/j.jcmg.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors were shown to reduce morbidity and mortality in patients with heart failure. OBJECTIVES This study aims to assess potential effects of dapagliflozin in nondiabetic patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF) on cardiac function assessed by speckle tracking echocardiography (STE). METHODS This randomized, prospective, single-center, open-label trial compared consecutive nondiabetic outpatients with HFrEF or HFmrEF receiving dapagliflozin with patients treated with optimal medical therapy (OMT) except sodium-glucose cotransporter type 2 inhibitors. Primary endpoint was the presence of a significant modification of left ventricular global longitudinal strain, diastolic function (as peak atrial longitudinal strain) and right ventricular function by STE from baseline to 6 months. Cardiovascular events and parameters of congestion were assessed as safety-exploratory endpoints. RESULTS Overall, 88 patients (38% HFmrEF) were enrolled and randomized to start dapagliflozin on top of OMT (n = 44) or to continue with OMT (n = 44). All STE values improved in the dapagliflozin group after 6 months, whereas there was a nonsignificant improvement in OMT group. Moreover, when comparing the modification of STE parameters at follow-up in patients with HFrEF and HFmrEF, only the main treatment effect resulted statistically significant in both groups (P < 0.0001), indicating a significant difference between dapagliflozin and OMT. CONCLUSIONS This study provided randomized data on the beneficial effect of dapagliflozin in nondiabetic patients with HFrEF and HFmrEF in terms of myocardial performance measured by the most sensitive echocardiographic technique, ie, STE. This suggests its usefulness for left ventricular reverse remodeling and better quality of life in patients with HFrEF and HFmrEF. (Effects of Dapagliflozin on cardiac deformation and clinical outcomes in heart failure with reduced and mildly reduced ejection fraction [DAPA ECHO trial]; EudraCT number: 2021-005394-66).
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Andrea Stefanini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Pietro Piu
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Enrico Emilio Diviggiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Alma Iuliano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Leonardo Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Andrea Marchese
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luca Martini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Alessio Pecere
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Elisa Giacomin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Carlotta Sorini Dini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Hatem Soliman Aboumarie
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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20
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Ficial B, Dolce P, Petoello E, Flore AI, Nogara S, Ciarcià M, Brancolini G, Alfarano A, Marzollo R, Bosio I, Raimondi F, Risso FM, Beghini R, Dani C, Benfari G, Ribichini FL, Corsini I. Left atrial strain assessment unveils left ventricular diastolic dysfunction in neonates with transient tachypnea of the newborn: A prospective observational study. Pediatr Pulmonol 2024. [PMID: 38953730 DOI: 10.1002/ppul.27156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/02/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION An inadequate clearance of lung fluid plays a key role in the pathogenesis of transient tachypnea of the newborn (TTN). OBJECTIVES To evaluate if left ventricular diastolic dysfunction contributes to reduced clearance of lung fluid in TTN. MATERIALS AND METHODS This was a prospective, observational study. Echocardiography and lung ultrasound were performed at 2, 24 and 48 h of life (HoL) to assess biventricular function and calculate lung ultrasound score (LUS). Left atrial strain reservoir (LASr) provided surrogate measurement of left ventricular diastolic function. RESULTS Twenty-seven neonates with TTN were compared with 27 controls with no difference in gestation (36.1 ± 2 vs. 36.9 ± 2 weeks) or birthweight (2508 ± 667 vs. 2718 ± 590 g). Biventricular systolic function was normal in both groups. LASr was significantly lower in cases at 2 (21.0 ± 2.7 vs. 38.1 ± 4.4; p < 0.01), 24 (25.2 ± 4.5 vs. 40.6 ± 4.0; p < 0.01) and 48 HoL (36.5 ± 5.8 and 41.6 ± 5.2; p < 0.01), resulting in a significant group by time interaction (p < 0.001), after adjusting for LUS and gestational diabetes. A logistic regression model including LUS, birth weight and gestational diabetes as covariates, showed that LASr at 2 HoL was a predictor of respiratory support at 24 HoL, with an adjusted odds ratio of 0.60 (CI 0.36-0.99). CONCLUSIONS LASr was reduced in neonates with TTN, suggesting diastolic dysfunction, that may contribute to the delay in lung fluid clearance.
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Affiliation(s)
- Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Pasquale Dolce
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Enrico Petoello
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Martina Ciarcià
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanna Brancolini
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angela Alfarano
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberto Marzollo
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilaria Bosio
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Raimondi
- Division of Neonatology and Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
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21
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Lisi M, Luisi GA, Pastore MC, Mandoli GE, Benfari G, Ilardi F, Malagoli A, Sperlongano S, Henein MY, Cameli M, D'Andrea A. New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure. Heart Fail Rev 2024; 29:799-809. [PMID: 38507022 PMCID: PMC11189326 DOI: 10.1007/s10741-024-10398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
International Guidelines consider left ventricular ejection fraction (LVEF) as an important parameter to categorize patients with heart failure (HF) and to define recommended treatments in clinical practice. However, LVEF has some technical and clinical limitations, being derived from geometric assumptions and is unable to evaluate intrinsic myocardial function and LV filling pressure (LVFP). Moreover, it has been shown to fail to predict clinical outcome in patients with end-stage HF. The analysis of LV antegrade flow derived from pulsed-wave Doppler (stroke volume index, stroke distance, cardiac output, and cardiac index) and non-invasive evaluation of LVFP have demonstrated some advantages and prognostic implications in HF patients. Speckle tracking echocardiography (STE) is able to unmask intrinsic myocardial systolic dysfunction in HF patients, particularly in those with LV preserved EF, hence allowing analysis of LV, right ventricular and left atrial (LA) intrinsic myocardial function (global peak atrial LS, (PALS)). Global PALS has been proven a reliable index of LVFP which could fill the gaps "gray zone" in the previous Guidelines algorithm for the assessment of LV diastolic dysfunction and LVFP, being added to the latest European Association of Cardiovascular Imaging Consensus document for the use of multimodality imaging in evaluating HFpEF. The aim of this review is to highlight the importance of the hemodynamics multiparametric approach of assessing myocardial function (from LVFP to stroke volume) in patients with HF, thus overcoming the limitations of LVEF.
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Affiliation(s)
- Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
| | - Giovanni Andrea Luisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Via S. Pansini 5, 80131, Naples, Italy
- Mediterranea Cardiocentro, 80122, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Baggiovara, Italy
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Matteo Cameli
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014, Nocera Inferiore, SA, Italy
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22
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Cau R, Pisu F, Muscogiuri G, Suri JS, Montisci R, Saba L. Atrial and Ventricular Involvement in Acute Myocarditis Patients with Preserved Ejection Fraction: A Single-Center Cardiovascular Magnetic Resonance Study. J Cardiovasc Dev Dis 2024; 11:191. [PMID: 39057613 PMCID: PMC11276940 DOI: 10.3390/jcdd11070191] [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: 05/15/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Cardiac magnetic resonance (CMR) is commonly employed to confirm the diagnosis of acute myocarditis (AM). However, the impact of atrial and ventricular function in AM patients with preserved ejection fraction (EF) deserves further investigation. Therefore, the aim of this study was to explore the incremental diagnostic value of combining atrial and strain functions using CMR in patients with AM and preserved EF. This retrospective study collected CMR scans of 126 consecutive patients with AM (meeting the Lake Louise criteria) and with preserved EF, as well as 52 age- and sex-matched control subjects. Left atrial (LA) and left ventricular (LV) strain functions were assessed using conventional cine-SSFP sequences. In patients with AM and preserved EF, impaired ventricular and atrial strain functions were observed compared to control subjects. These impairments remained significant even in multivariable analysis. The combined model of atrial and ventricular functions proved to be the most effective in distinguishing AM patients with preserved ejection fraction from control subjects, achieving an area under the curve of 0.77 and showing a significant improvement in the likelihood ratio. These findings suggest that a combined analysis of both atrial and ventricular functions may improve the diagnostic accuracy for patients with AM and preserved EF.
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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 (Cagliari), 09045 Cagliari, Italy;
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato s.s. 554 Monserrato (Cagliari), 09045 Cagliari, Italy;
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy;
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA;
| | - Roberta Montisci
- Department of Cardiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato s.s. 554 Monserrato (Cagliari), 09045 Cagliari, Italy;
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari—Polo di Monserrato s.s. 554 Monserrato (Cagliari), 09045 Cagliari, Italy;
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23
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Inoue K. The Left Atrium Is a Window to the Outcomes of Patients With Atrial Fibrillation. Circ J 2024; 88:1165-1166. [PMID: 38072439 DOI: 10.1253/circj.cj-23-0788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
- Katsuji Inoue
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine
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24
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Khan FH, Zhao D, Ha JW, Nagueh SF, Voigt JU, Klein AL, Gude E, Broch K, Chan N, Quill GM, Doughty RN, Young A, Seo JW, García-Izquierdo E, Moñivas-Palomero V, Mingo-Santos S, Wang TKM, Bezy S, Ohte N, Skulstad H, Beladan CC, Popescu BA, Kikuchi S, Panis V, Donal E, Remme EW, Nash MP, Smiseth OA. Evaluation of left ventricular filling pressure by echocardiography in patients with atrial fibrillation. Echo Res Pract 2024; 11:14. [PMID: 38825684 PMCID: PMC11145766 DOI: 10.1186/s44156-024-00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation. The objective of the present study was to determine if a combination of several echocardiographic and clinical parameters may be used to evaluate LV filling pressure in patients with atrial fibrillation. RESULTS In a multicentre study of 148 atrial fibrillation patients, several echocardiographic parameters were tested against invasively measured LV filling pressure as the reference method. No single parameter had sufficiently strong association with LV filling pressure to be recommended for clinical use. Based on univariate regression analysis in the present study, and evidence from existing literature, we developed a two-step algorithm for differentiation between normal and elevated LV filling pressure, defining values ≥ 15 mmHg as elevated. The parameters in the first step included the ratio between mitral early flow velocity and septal mitral annular velocity (septal E/e'), mitral E velocity, deceleration time of E, and peak tricuspid regurgitation velocity. Patients who could not be classified in the first step were tested in a second step by applying supplementary parameters, which included left atrial reservoir strain, pulmonary venous systolic/diastolic velocity ratio, and body mass index. This two-step algorithm classified patients as having either normal or elevated LV filling pressure with 75% accuracy and with 85% feasibility. Accuracy in EF ≥ 50% and EF < 50% was similar (75% and 76%). CONCLUSIONS In patients with atrial fibrillation, no single echocardiographic parameter was sufficiently reliable to be used clinically to identify elevated LV filling pressure. An algorithm that combined several echocardiographic parameters and body mass index, however, was able to classify patients as having normal or elevated LV filling pressure with moderate accuracy and high feasibility.
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Affiliation(s)
- Faraz H Khan
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | - Debbie Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jong-Won Ha
- Cardiology Division, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, Department of Cardiovascular Sciences, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium
| | | | - Einar Gude
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | - Kaspar Broch
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | | | - Gina M Quill
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Alistair Young
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ji-Won Seo
- Cardiology Division, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | - Susana Mingo-Santos
- Cardiology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Stephanie Bezy
- Department of Cardiovascular Diseases, Department of Cardiovascular Sciences, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium
| | - Nobuyuki Ohte
- Department of cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Helge Skulstad
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | - Carmen C Beladan
- University of Medicine and Pharmacy "Carol Davila", Emergency Institute for, Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, Euroecolab, Bucharest, 0223228, Romania
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Emergency Institute for, Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, Euroecolab, Bucharest, 0223228, Romania
| | - Shohei Kikuchi
- Department of cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Vasileios Panis
- Department of Cardiology, CHU Rennes and Inserm, LTSI, University of Rennes, Rennes, France
| | - Erwan Donal
- Department of Cardiology, CHU Rennes and Inserm, LTSI, University of Rennes, Rennes, France
| | - Espen W Remme
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Martyn P Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Otto A Smiseth
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway.
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25
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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [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: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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26
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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; 26:593-600. [PMID: 38647564 PMCID: PMC11199230 DOI: 10.1007/s11886-024-02058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 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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27
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Solberg MG, Enger S, Berge T, Rønningen PS, Aagaard EN, Pervez MO, Orstad EB, Kvisvik B, Lyngbakken MN, Røsjø H, Steine K, Tveit A. Left atrial function in middle-aged men and women with and without paroxysmal atrial fibrillation: Data from the Akershus Cardiac Examination (ACE) 1950 study. Echocardiography 2024; 41:e15852. [PMID: 38837738 DOI: 10.1111/echo.15852] [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: 04/05/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. METHODS The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. RESULTS LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. CONCLUSION Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF.
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Affiliation(s)
- Magnar G Solberg
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter S Rønningen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Erika N Aagaard
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Mohammad Osman Pervez
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Eivind B Orstad
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Brede Kvisvik
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Magnus N Lyngbakken
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Luna-Alcala S, Espejel-Guzmán A, Lerma C, Leon P, Guerra EC, Fernández JRE, Martinez-Dominguez P, Serrano-Roman J, Cabello-Ganem A, Aparicio-Ortiz AD, Keirns C, Lerma A, Ana-Bayona MJS, Espinola-Zavaleta N. Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:32. [PMID: 38812020 PMCID: PMC11134897 DOI: 10.1186/s40959-024-00236-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown. METHODS Fifty BC patients underwent TTE assessment before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant. RESULTS TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%). CONCLUSIONS BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.
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Affiliation(s)
- Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | | | - Claudia Lerma
- Department of Molecular Biology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano 1, Tlalpan, Mexico City, 14080, Mexico
| | - Paula Leon
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City, 09340, México
| | - Enrique C Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | | | - Pavel Martinez-Dominguez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Alexis D Aparicio-Ortiz
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | | | - Abel Lerma
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Agustín Tlaxiaca, 42160, Mexico
| | - Maria Jose Santa Ana-Bayona
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Colonia Seccion XVI, Juan Badiano No 1, Colonia Seccion XVI, Tlalpan, Mexico City, 14080, Mexico.
- Department of Echocardiography, ABC Medical Center, I.A.P, Mexico City, Mexico.
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29
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Spencer L, Wright L, Foulkes SJ, Rowe SJ, Dillon HT, Climie R, Bigaran A, Janssens K, Mitchell A, Wallace I, Lindqvist A, Burnham L, Prior DL, Howden EJ, La Gerche A. Characterizing the influence of cardiorespiratory fitness on left atrial size and function in the general population. Am J Physiol Heart Circ Physiol 2024; 326:H1269-H1278. [PMID: 38457351 DOI: 10.1152/ajpheart.00422.2023] [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: 07/11/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/10/2024]
Abstract
Increased left atrial (LA) size and reduced LA function have been associated with heart failure and atrial fibrillation (AF) in at-risk populations. However, atrial remodeling has also been associated with exercise training and the relationship between fitness, LA size, and function has not been defined across the fitness spectrum. In a cross-sectional study of 559 ostensibly healthy participants, comprising 304 males (mean age, 46 ± 20 yr) and 255 females (mean age, 47 ± 15 yr), we sought to define the relationship between cardiorespiratory fitness (CRF), LA size, and function. We also aimed to interrogate sex differences in atrial factors influencing CRF. Echocardiographic measures included biplane measures of LA volumes indexed to body surface area (LAVi) and atrial deformation using two-dimensional speckle tracking. CRF was measured as peak oxygen consumption (V̇o2peak) during cardiopulmonary exercise testing (CPET). Using multivariable regression, age, sex, weight, and LAVi (P < 0.001 for all) predicted V̇o2peak (P < 0.001, R2 = 0.66 for combined model). After accounting for these variables, heart rate reserve added strength to the model (P < 0.001, R2 = 0.74) but LA strain parameters did not predict V̇o2peak. These findings add important nuance to the perception that LA size is a marker of cardiac pathology. LA size should be considered in the context of fitness, and it is likely that the adverse prognostic associations of increased LA size may be confined to those with LA enlargement and low fitness.NEW & NOTEWORTHY Left atrial (LA) structure better predicts cardiorespiratory fitness (CRF) than LA function. LA function adds little statistical value to predictive models of peak oxygen uptake (V̇o2peak) in healthy individuals, suggesting limited discriminatory for CRF once LA size is factored. In the wider population of ostensibly healthy individuals, the association between increased LA volume and higher CRF provides an important counter to the association between atrial enlargement and heart failure symptoms in those with cardiac pathology.
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Affiliation(s)
- Luke Spencer
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Stephanie J Rowe
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kristel Janssens
- St Vincent's Institute, Fitzroy, Victoria, Australia
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Amy Mitchell
- St Vincent's Institute, Fitzroy, Victoria, Australia
| | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Lauren Burnham
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David L Prior
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Erin J Howden
- University of Melbourne, Parkville, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Victor Chang Cardiac Research Centre, Darlinghurst, New South Wales, Australia
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Yang Z, Wen J, Tang D, Luo Y, Xiang C, Xia L, Huang L. Sex-Related Differences of Left Atrial Strain in Patients With Hypertension Using Cardiac Magnetic Resonance Feature Tracking. J Thorac Imaging 2024; 39:W40-W47. [PMID: 37982515 DOI: 10.1097/rti.0000000000000760] [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: 11/21/2023]
Abstract
PURPOSE Previous studies demonstrated the impact of sex on left ventricular (LV) strain in patients with essential hypertension. However, little is known about the effect of sex on left atrial (LA) strain in patients with hypertension. This study aimed to explore the sex-related differences of LA strain by using cardiac magnetic resonance feature tracking in patients with hypertension and preserved LV ejection fraction. MATERIALS AND METHODS One hundred and fifty hypertensive patients (100 men and 50 women) and 105 age-matched and sex-matched normotensive controls (70 men and 35 women) were retrospectively enrolled and underwent cardiac magnetic resonance examination. LA strain parameters included LA reservoir strain (εs), conduit strain (εe), pump strain (εa), and their corresponding strain rate (SRs, SRe, and SRa). RESULTS Men had significantly higher LV mass index, lower εs and εe than women in both patients and controls (all P <0.05). LA strain and strain rate were significantly reduced in hypertensive patients compared with controls, both in men and women (all P <0.05). In men, hypertension and its interaction were associated with increased LV mass index and decreased εs and εe. In multivariable analysis, men, LV ejection fraction, and LA minimum volume index remained independent determinants of εs and εe in all hypertensive patients (all P <0.05). CONCLUSION LA strain was significantly impaired in hypertensive patients, and men had more impaired LA strain than women. These findings further emphasize the sex-related differences in the response of LA strain to hypertension in the early stage.
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Affiliation(s)
- Zhaoxia Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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31
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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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32
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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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33
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Chen EW, Bashir Z, Churchill JL, Has P, Klas B, Aurigemma GP, Bisaillon J, Dickey JB, Haines P. Evaluating left atrial strain and left ventricular diastolic strain rate as markers for diastolic dysfunction in patients with mitral annular calcification. Int J Cardiovasc Imaging 2024; 40:733-743. [PMID: 38289428 PMCID: PMC11052839 DOI: 10.1007/s10554-023-03041-3] [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: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) poses many challenges to the evaluation of diastolic function using standard echocardiography. Left atrial (LA) strain and left ventricular early diastolic strain rate (DSr) measured by speckle-tracking echocardiography (STE) are emerging techniques in the noninvasive evaluation of diastolic function. We aim to evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC and compare their effectiveness to ratio of mitral inflow velocity in early and late diastole (E/A). METHODS We included adult patients with MAC who presented between January 1 and December 31, 2014 and received a transthoracic echocardiogram (TTE) and cardiac catheterization with measurement of LVFP within a 24-h period. We used Spearman's rank correlation coefficient to assess associations of LA reservoir strain and average early DSr with LVFP. Receiver operating characteristic (ROC) curves were computed to assess the effectiveness of LA strain and DSr in discriminating elevated LVFP as a dichotomized variable and to compare their effectiveness with E/A ratio categorized according to grade of diastolic dysfunction. RESULTS Fifty-five patients were included. LA reservoir strain demonstrated poor correlation with LVFP (Spearman's rho = 0.03, p = 0.81) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.54, 95% CI 0.38-0.69). Categorical E/A ratio alone also demonstrated poor discriminatory ability (AUC = 0.53, 95% CI 0.39-0.67), and addition of LA reservoir strain did not significantly improve effectiveness (AUC = 0.58, 95% CI 0.42-0.74, p = 0.56). Average early DSr also demonstrated poor correlation with LVFP (Spearman's rho = -0.19, p = 0.16) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.59, 95% CI 0.44-0.75). Addition of average early DSr to categorical E/A ratio failed to improve effectiveness (AUC = 0.62, 95% CI 0.46-0.77 vs. AUC = 0.54, 95% CI 0.39-0.69, p = 0.38). CONCLUSIONS In our sample, LA reservoir strain and DSr do not accurately predict diastolic filling pressure. Further research is required before LA strain and early DSr can be routinely used in clinical practice to assess filling pressure in patients with MAC.
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Affiliation(s)
- Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zubair Bashir
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica L Churchill
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, RI, USA
| | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Jonathan Bisaillon
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Philip Haines
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
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Tan Y, Li Y, Deng W, Zhang R, Zhao R, Abulipizi A, Zhang J, Ji X, Hou Q, Liu T, Fang L, Zhang L, Xie M, Wang J. Prognostic Implications of Left Atrial Strain in Bicuspid Aortic Valve With Chronic Aortic Regurgitation. J Am Heart Assoc 2024; 13:e032770. [PMID: 38497457 PMCID: PMC11009999 DOI: 10.1161/jaha.123.032770] [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: 09/22/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Left atrial reservoir strain (LARS) is a novel imaging biomarker of left ventricular diastolic dysfunction. This study aimed to examine the prognostic implications of LARS in patients with bicuspid aortic valve and significant (moderate-severe to severe) aortic regurgitation. METHODS AND RESULTS A total of 220 patients with bicuspid aortic valve and significant aortic regurgitation were prospectively enrolled in our study. LARS and left ventricular global longitudinal strain were derived from speckle-tracking echocardiography. The end point was a composite of all-cause mortality, heart failure hospitalization, and aortic valve repair or replacement. The threshold value of LARS <24% was used to identify impaired left atrial mechanics based on prior results. During a median follow-up of 364 (interquartile range, 294-752) days, 46 patients (20.9%) reached the composite end points. On multivariable Cox analysis, impaired LARS (adjusted hazard ratio, 2.08 [95% CI, 1.05-4.11]; P=0.036) was a statistically significant predictor of composite end points after adjustment for other statistically significant predictors. Finally, adding impaired LARS to other statistically significant predictors (New York Heart Association functional class and left ventricular global longitudinal strain) significantly improved the global χ2 (from 32.19 to 36.56; P=0.037) and reclassification (continuous net reclassification index=0.55; P<0.001) of the prediction model. CONCLUSIONS In patients with bicuspid aortic valve and significant aortic regurgitation, the impairment of LARS is a strong independent prognostic predictor and confers incremental prognostic utility over clinical and other echocardiographic parameters. These findings suggest that LARS could be considered in risk stratification for such populations.
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Affiliation(s)
- YuTing Tan
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - YuMan Li
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - WenHui Deng
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - RuiZe Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - RuoHan Zhao
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Abudukadier Abulipizi
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Jing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Xiang Ji
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - QuanFei Hou
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Tianshu Liu
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - MingXing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanHubei ProvinceChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanHubei ProvinceChina
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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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Mancusi C, Basile C, Spaccarotella C, Gargiulo G, Fucile I, Paolillo S, Gargiulo P, Santoro C, Manzi L, Marzano F, Ambrosino P, De Luca N, Esposito G. Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. High Blood Press Cardiovasc Prev 2024; 31:127-140. [PMID: 38489152 PMCID: PMC11043114 DOI: 10.1007/s40292-024-00629-1] [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: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
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Tsartsalis D, Tsioufis C, Aggeli C. Left atrial strain: The conduit role in diastolic dysfunction. Hellenic J Cardiol 2024; 76:113-114. [PMID: 37716468 DOI: 10.1016/j.hjc.2023.09.008] [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: 07/22/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- Dimitrios Tsartsalis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 11527, Athens, Greece.
| | - Constantinos Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 11527, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 11527, Athens, Greece
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von Roeder M, Maeder M, Wahl V, Kitamura M, Rotta Detto Loria J, Dumpies O, Rommel KP, Kresoja KP, Blazek S, Richter I, Majunke N, Desch S, Thiele H, Lurz P, Abdel-Wahab M. Prognostic significance and clinical utility of left atrial reservoir strain in transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2024; 25:373-382. [PMID: 37862161 DOI: 10.1093/ehjci/jead268] [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: 04/03/2023] [Revised: 08/29/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023] Open
Abstract
AIMS Patients with diastolic dysfunction (DD) experience worse outcomes after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value and clinical utility of left atrial reservoir strain (LARS) in patients undergoing TAVR for aortic stenosis (AS). METHODS AND RESULTS All consecutive patients undergoing TAVR between January 2018 and December 2018 were included if discharge echocardiography and follow-up were available. LARS was derived from 2D-speckle-tracking. Patients were grouped into three tertiles according to LARS. DD was analysed using the ASE/EACVI-algorithm. The primary outcome was a composite of all-cause death and readmission for worsening heart failure 12 months after TAVR. Overall, 606 patients were available [age 80 years, interquartile range (IQR) 77-84], including 53% women. Median LARS was 13.0% (IQR 8.4-18.3). Patients were classified by LARS tertiles [mildly impaired 21.4% (IQR 18.3-24.5), moderately impaired 13.0% (IQR 11.3-14.6), severely impaired 7.1% (IQR 5.4-8.4), P < 0.0001]. The primary outcome occurred more often in patients with impaired LARS (mildly impaired 7.4%, moderately impaired 13.4%, and severely impaired 25.7%, P < 0.0001). On adjusted multivariable Cox regression analysis, LARS tertiles [hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.44-0.86, P = 0.005] and higher degree of tricuspid regurgitation (HR 1.82, 95% CI 1.23-2.98, P = 0.003) were the only significant predictors of the primary endpoint. Importantly, DD was unavailable in 56% of patients, but LARS assessment allowed for reliable prognostication regarding the primary endpoint in subgroups without DD assessment (HR 0.64, 95% CI 0.47-0.87, P = 0.003). CONCLUSION Impaired LARS is independently associated with worse outcomes in patients undergoing TAVR. LARS allows for risk stratification at discharge even in patients where DD cannot be assessed by conventional echocardiographic means.
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Affiliation(s)
- Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Mauritius Maeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Vincent Wahl
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Johannes Rotta Detto Loria
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Oliver Dumpies
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
- Cardiovascular Research Foundation, NewYork, NY, USA
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Stephan Blazek
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Ines Richter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Nicolas Majunke
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
- Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
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Barki M, Losito M, Caracciolo MM, Sugimoto T, Rovida M, Viva T, Arosio R, Alfonzetti E, Bandera F, Moroni A, Guazzi M. Left atrial strain in acute heart failure: clinical and prognostic insights. Eur Heart J Cardiovasc Imaging 2024; 25:315-324. [PMID: 37930715 DOI: 10.1093/ehjci/jead287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023] Open
Abstract
AIMS In acute heart failure (AHF), the consequences of impaired left atrial (LA) mechanics are not well understood. We aimed to define the clinical trajectory of LA mechanics by left atrial strain (LAS) analysis. METHODS AND RESULTS Eighty-five consecutive AHF patients with reduced, mildly reduced, and preserved left ventricular ejection fraction (LVEF) were enrolled in the LAS-AHF trial and underwent LA mechanics analysis by speckle tracking echocardiography. Seventy-seven patients were followed-up (FU) at 6 and 12 months. At hospital admission, discharge, 6 and 12 months post-discharge, LA reservoir function (LAS), LA pump strain, LAVi, LA stiffness, indicators of right ventricular (RV) and left ventricular (LV) function, congestion indexes (B lines, inferior vena cava, X-ray congestion score index), and biomarkers (NT-pro-BNP) were measured. The primary outcome was time to first event of re-hospitalization, worsening HF, or cardiovascular death. From admission to discharge, RV function significantly improved after decongestion, whereas no significant differences were observed in LA dynamics and LV function. In sinus rhythm patients with mild or no mitral regurgitation, decongestion was associated with a significant improvement of LAS and LA pump strain rate during hospitalization. At 12 months, 24 CV events occurred and lack of LAS improvement at 12 months FU emerged as the most powerful predictor followed by NT-pro-BNP. Kaplan-Meier curves showed a better survival for LAS >16%, improvement of LAS > 5%, and an LAS/LAVi ratio >0.25%/mL/m2 compared with lower cut-off values [log-rank: heart rate (HR) 3.5, 95% confidence interval (CI) 1.8-7.3, P = 0.004; log-rank: HR 3.6, 95% CI 2-7.9, P < 0.01; log-rank: HR 3.27, 95% CI 1.4-7.7, P = 0.007]. CONCLUSION In AHF of any LVEF, LA dynamics is highly predictive of re-hospitalization and cardiovascular outcome and allows to ease risk-stratification, potentially becoming an early reference target for improving long-term outcome.
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Affiliation(s)
- Monica Barki
- Department of Biological Sciences, Cardiology Division, San Paolo University Hospital, University of Milano School of Medicine, Via A di Rudinì, 8, 20142 Milano, Italy
| | - Maurizio Losito
- Department of Biological Sciences, Cardiology Division, San Paolo University Hospital, University of Milano School of Medicine, Via A di Rudinì, 8, 20142 Milano, Italy
| | | | - Tadafumi Sugimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Marina Rovida
- Policlinico San Donato, University of Milano, Milano, Italy
| | - Tommaso Viva
- Department of Biological Sciences, Cardiology Division, San Paolo University Hospital, University of Milano School of Medicine, Via A di Rudinì, 8, 20142 Milano, Italy
| | - Roberto Arosio
- Department of Biological Sciences, Cardiology Division, San Paolo University Hospital, University of Milano School of Medicine, Via A di Rudinì, 8, 20142 Milano, Italy
| | | | | | - Alice Moroni
- Department of Biological Sciences, Cardiology Division, San Paolo University Hospital, University of Milano School of Medicine, Via A di Rudinì, 8, 20142 Milano, Italy
| | - Marco Guazzi
- Department of Biological Sciences, Cardiology Division, San Paolo University Hospital, University of Milano School of Medicine, Via A di Rudinì, 8, 20142 Milano, Italy
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40
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Gillebert TC, Smiseth OA. Left atrial reservoir strain in prognosis of heart failure and time for getting terminology straight. Eur Heart J Cardiovasc Imaging 2024; 25:325-327. [PMID: 37966264 DOI: 10.1093/ehjci/jead311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Thierry C Gillebert
- Department of Cardiology, Ghent University and Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
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41
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Palka P, Hilling-Smith R, Swann R, Allwood S, Moore A, Bian C, Lange A. Left ventricular to left arial volume ratio in the assessment of filling pressure in patients with dyspnoea and preserved ejection fraction. Front Cardiovasc Med 2024; 11:1357006. [PMID: 38404723 PMCID: PMC10884309 DOI: 10.3389/fcvm.2024.1357006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Assessing filling pressure (FP) remains a clinical challenge despite advancements in non-invasive imaging techniques. This study investigates the utility of echocardiographic left ventricular (LV) to left atrial (LA) volume ratio in estimating the resting FP in patients with dyspnoea and preserved ejection fraction (EF). Methods This study is a prospective, single-centre analysis of 53 consecutive patients with dyspnoea (New York Heart Association grade 2 or 3) and LVEF of ≥50% (mean age 71 ± 10 years) who underwent cardiac catheterisation, including direct measurement of LA pressure at rest using retrograde technique. Echocardiographic data were obtained 1.5 ± 1.0 h after cardiac catheterisation. The patients were divided into two groups: Group 1 consisted of individuals with elevated FP, indicated by a mean LA pressure or mean pulmonary capillary wedge pressure of >12 mmHg, and Group 2 comprised of patients with normal FP. The LV and LA volumes were measured at three specific points: the minimum volume (LVES, LAmin), the volume during diastasis (LVdias, LAdias), and the maximum volume (LVED, LAmax). The corresponding LV/LA volume ratios were analysed: end-systole (LVES/LAmax), diastasis (LVdias/LAdias), and end-diastole (LVED/LAmin). Results The patients in Group 1 exhibited lower LV/LA volume ratios compared with those in Group 2 (LVES/LAmax 0.44 ± 0.12 vs. 0.60 ± 0.23, P = 0.0032; LVdias/LAdias 1.13 ± 0.30 vs. 1.56 ± 0.49, P = 0.0007; LVED/LAmin 2.71 ± 1.57 vs. 4.44 ± 1.70, P = 0.0004). The LV/LA volume ratios correlated inversely with an increased FP (LVES/LAmax, r = -0.40, P = 0.0033; LVdias/LAdias, r = -0.45, P = 0.0007; LVED/LAmin, r = -0.55, P < 0.0001). Among all the measurements, the LVdias/LAdias ratio demonstrated the highest discriminatory power to distinguish patients with elevated FP from normal FP, with a cut-off value of ≤1.24 [area under the curve (AUC) = 0.822] for the entire group, encompassing both sinus rhythm and atrial fibrillation. For patients in sinus rhythm specifically, the cut-off value was ≤1.28 (AUC = 0.799), with P < 0.0001 for both. The LVdias/LAdias index demonstrated non-inferiority to the E/e' ratio [ΔAUC = 0.159, confidence interval (CI) = -0.020-0.338; P = 0.0809], while surpassing the indices of LA reservoir function (ΔAUC = 0.249, CI = 0.044-0.454; P = 0.0176), LA reservoir strain (ΔAUC = 0.333, CI = 0.149-0.517; P = 0.0004), and LAmax index (ΔAUC = 0.224, CI = 0.043-0.406; P = 0.0152) in diagnosing patients with elevated FP. Conclusion The study presents a straightforward and reproducible method for non-invasive estimation of FP using routine TTE in patients with dyspnoea and preserved EF. The LVdias/LAdias index emerges as a promising indicator for identifying elevated FP, demonstrating comparable or even superior performance to established parameters.
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Affiliation(s)
- Przemysław Palka
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
- Cardiac Catheterisation Laboratory, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Roland Hilling-Smith
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
- Cardiac Catheterisation Laboratory, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Rohan Swann
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
- Cardiac Catheterisation Laboratory, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Sean Allwood
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
- Cardiac Catheterisation Laboratory, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Alexander Moore
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
- Cardiac Catheterisation Laboratory, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Chris Bian
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
| | - Aleksandra Lange
- Queensland Cardiovascular Group, Brisbane, QLD, Australia
- Cardiac Catheterisation Laboratory, St Andrew's War Memorial Hospital, Brisbane, QLD, Australia
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Gonzalez FA, Santonocito C, Maybauer MO, Lopes LR, Almeida AG, Sanfilippo F. Diastology in the intensive care unit: Challenges for the assessment and future directions. Echocardiography 2024; 41:e15773. [PMID: 38380688 DOI: 10.1111/echo.15773] [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: 12/17/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Myocardial dysfunction is common in patients admitted to the intensive care unit (ICU). Septic disease frequently results in cardiac dysfunction, and sepsis represents the most common cause of admission and death in the ICU. The association between left ventricular (LV) systolic dysfunction and mortality is not clear for critically ill patients. Conversely, LV diastolic dysfunction (DD) seems increasingly recognized as a factor associated with poor outcomes, not only in sepsis but also more generally in critically ill patients. Despite recent attempts to simplify the diagnosis and grading of DD, this remains relatively complex, with the need to use several echocardiographic parameters. Furthermore, the current guidelines have several intrinsic limitations when applied to the ICU setting. In this manuscript, we discuss the challenges in DD classification when applied to critically ill patients, the importance of left atrial pressure estimates for the management of patients in ICU, and whether the study of cardiac dysfunction spectrum during critical illness may benefit from the integration of left ventricular and left atrial strain data to improve diagnostic accuracy and implications for the treatment and prognosis.
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Affiliation(s)
- Filipe A Gonzalez
- Intensive Care Department of Hospital Garcia de Orta, Almada, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Luís Rocha Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre St Bartholomew's Hospital London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Stefani LD, Trivedi SJ, Ferkh A, Emerson P, Marschner S, Gan G, Altman M, Thomas L. Left atrial mechanics evaluated by two-dimensional strain analysis: alterations in essential hypertension. J Hypertens 2024; 42:274-282. [PMID: 37937486 DOI: 10.1097/hjh.0000000000003615] [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: 11/09/2023]
Abstract
BACKGROUND Hypertension is a cardiovascular risk factor that predisposes to cardiac structural alterations namely increased left ventricular (LV) wall thickness, reduced LV compliance and diastolic dysfunction, with consequent left atrial (LA) dilation and functional impairment. In this article, we evaluated differences in left atrial structure and function using two-dimensional speckle tracking echocardiography in patients with hypertension compared with controls. METHODS This was a retrospective cross-sectional study of 208 hypertensive patients and 157 controls who underwent a comprehensive transthoracic echocardiogram. Patients with hypertension were stratified by the presence of left ventricular hypertrophy (LVH). RESULTS Non-LVH hypertension patients had lower left atrial reservoir strain (LAS RES ) (34.78 ± 29.78 vs. 29.78 ± 6.08; P = 0.022) and conduit strain (LAS CD ) (19.66 ± 7.29 vs. 14.23 ± 4.59; P = 0.014) vs. controls despite similar left atrial volumes (LAV) . Left atrial contractile strain (LAS CT ) was not significantly different between non-LVH hypertension patients and controls (15.12 ± 3.77 vs. 15.56 ± 3.79; P = 0.601). Left atrial mechanical dispersion was significantly higher in the LVH group compared with the non-LVH hypertension group (42.26 ± 13.01 vs. 50.06 ± 14.95; P = 0.009). In multivariate regression analysis, LVH correlated with left atrial mechanical dispersion ( P = 0.016). An age-hypertension interaction independently correlated with LAS CT ( P < 0.001). CONCLUSION Hypertension results in functional left atrial changes even before development of LV hypertrophy and structural left atrial changes with increased left atrial volume. We demonstrate both a likely hypertension-associated left atrial myopathy that prevents age-related compensatory increase in left atrial contractile function, and impact of LVH in hypertension on left atrial dyssynchrony.
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Affiliation(s)
- Luke D Stefani
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Siddharth J Trivedi
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Aaisha Ferkh
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Peter Emerson
- Westmead Clinical School, University of Sydney
- Cardiology Department, Westmead Hospital
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead
| | - Gary Gan
- Cardiology Department, Blacktown Hospital, Sydney
| | - Mikhail Altman
- Westmead Clinical School, University of Sydney
- Cardiology Department, Blacktown Hospital, Sydney
| | - Liza Thomas
- Westmead Clinical School, University of Sydney
- Cardiology Department, Blacktown Hospital, Sydney
- Southwestern Clinical School, University of New South Wales, Sydney, NSW, Australia
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Oka H, Nakau K, Shibagaki Y, Ito K, Sasaki Y, Imanishi R, Shimada S, Takahashi S. Postoperative evaluation of left atrial stiffness in patients with congenital heart diseases. Heart Vessels 2024; 39:117-122. [PMID: 37740077 DOI: 10.1007/s00380-023-02313-1] [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: 04/17/2023] [Accepted: 09/06/2023] [Indexed: 09/24/2023]
Abstract
Left atrial (LA) stiffness is one of the most important factors involved in LA remodeling. LA stiffness has rarely been studied postoperatively in patients with congenital heart diseases (CHDs). This study aimed to evaluate LA stiffness in CHD patients postoperatively. Seventy-five patients (CHDs, 67; controls, 8; age range, 10-41 years) who underwent cardiac catheterization at our institution were included in this study. From the pulmonary artery wedge pressure waveform obtained during cardiac catheterization, the pressure range between the v wave and x trough was determined, and this value was divided by the LA reservoir strain obtained by echocardiography to calculate LA stiffness, as previously reported. LA stiffness was significantly higher in postoperative CHD patients than in controls (0.28 ± 0.17 vs. 0.13 ± 0.03, p = 0.001). Nineteen of 52 (37%) patients in their teens, 8 of 11 (73%) patients in their 20 s, and 1 of 4 (25%) patients aged > 30 years had elevated LA stiffness values. In particular, all patients with an LA reservoir strain < 20% had elevated LA stiffness. In postoperative CHD patients, LA stiffness was frequently elevated from a young age. CHD patients with elevated LA stiffness should be cautious of possible LA dysfunction in the future.
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Affiliation(s)
- Hideharu Oka
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Kouichi Nakau
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yuki Shibagaki
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Keita Ito
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yuki Sasaki
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Rina Imanishi
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Sorachi Shimada
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
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Egbe AC, Younis A, Miranda WR, Jain CC, Connolly HM, Borlaug BA. Determinants and prognostic implications of left atrial reverse remodelling after coarctation of aorta repair in adults. Eur Heart J Cardiovasc Imaging 2024; 25:249-256. [PMID: 37585542 PMCID: PMC10824485 DOI: 10.1093/ehjci/jead203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Abstract
AIMS Left atrial (LA) dysfunction and atrial fibrillation are also relatively common in adults with coarctation of aorta (COA), and the severity of LA dysfunction is associated with a higher risk of atrial fibrillation in this population. The purpose of this study was to determine whether LA function improved after COA repair (LA reverse remodelling), and the relationship between LA reverse remodelling and atrial fibrillation. METHODS AND RESULTS Retrospective cohort study of adults undergoing COA repair (2003-20). LA reservoir strain was assessed pre intervention and 12-24 months post intervention, using speckle tracking echocardiography. Incident atrial fibrillation was assessed from COA repair to last follow-up. Of 261 adults who underwent COA repair [age 37 ± 13 years; males 148 (57%)], 124 (47%) and 137 (53%) presented with native vs. recurrent COA, respectively. Of 261 patients, 231 (82%) and 48 (18%) underwent surgical and transcatheter COA repair, respectively. The LA reservoir strain increased from 32 ± 8% (pre intervention) to 39 ± 7% (post intervention), yielding a relative increase of 21 ± 5%. Older age [β ± standard error (SE) -0.16 ± 0.09 per 5 years, P = 0.02], higher systolic blood pressure (β ± SE -0.12 ± 0.04 per 5 mmHg, P = 0.005), and higher residual COA mean gradient (β ± SE -0.17 ± 0.06 per 5 mmHg, P = 0.002) post intervention were associated with less LA reverse remodelling, after adjustment for sex, hypertension diagnosis, and left ventricular indices. LA reverse remodelling (hazard ratio 0.97, 95% confidence interval 0.96-0.98 per 1% increase from pre-intervention LA function, P = 0.006) was associated with a lower risk of atrial fibrillation after adjustment for age, sex, pre-intervention LA reservoir strain, and history of atrial fibrillation. CONCLUSION COA repair resulted in improved LA function and decreased risk for atrial fibrillation, especially in patients without residual hypertension or significant residual COA gradient.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ahmed Younis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Vîjîiac A, Scărlătescu AI, Petre IG, Vîjîiac C, Vătășescu RG. Three-Dimensional Combined Atrioventricular Coupling Index-A Novel Prognostic Marker in Dilated Cardiomyopathy. Biomedicines 2024; 12:302. [PMID: 38397904 PMCID: PMC10886977 DOI: 10.3390/biomedicines12020302] [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: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Atrioventricular coupling has recently emerged as an outcome predictor. Our aim was to assess, through three-dimensional (3D) echocardiography, the role of the left atrioventricular coupling index (LACI), right atrioventricular coupling index (RACI) and a novel combined atrioventricular coupling index (CACI) in a cohort of patients with dilated cardiomyopathy (DCM). One hundred twenty-one consecutive patients with DCM underwent comprehensive 3D echocardiographic acquisitions. LACI was defined as the ratio between left atrial and left ventricular 3D end-diastolic volumes. RACI was defined as the ratio between right atrial and right ventricular 3D end-diastolic volumes. CACI was defined as the sum of LACI and RACI. Patients were prospectively followed for death, heart transplant, nonfatal cardiac arrest and hospitalization for heart failure. Fifty-five patients reached the endpoint. All three coupling indices were significantly more impaired in patients with events, with CACI showing the highest area under the curve (AUC = 0.66, p = 0.003). All three indices were independent outcome predictors when tested in multivariable Cox regression (HR = 2.62, p = 0.01 for LACI; HR = 2.58, p = 0.004 for RACI; HR = 2.37, p = 0.01 for CACI), but only CACI showed an incremental prognostic power over traditional risk factors such as age, left ventricular strain, right ventricular strain and mitral regurgitation severity (likelihood ratio χ2 test = 28.2, p = 0.03). CACI assessed through 3D echocardiography, reflecting both left and right atrioventricular coupling, is an independent predictor of adverse events in DCM, yielding an incremental prognostic power over traditional risk factors.
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Affiliation(s)
- Aura Vîjîiac
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.G.P.); (R.G.V.)
| | | | - Ioana Gabriela Petre
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.G.P.); (R.G.V.)
- Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
| | | | - Radu Gabriel Vătășescu
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.G.P.); (R.G.V.)
- Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
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Inoue K, Andersen OS, Remme EW, Khan FH, Andreassen AK, Skulstad H, Gude E, Smiseth OA. Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Pulmonary Hypertension. JACC Cardiovasc Imaging 2024:S1936-878X(24)00024-X. [PMID: 38340138 DOI: 10.1016/j.jcmg.2023.12.004] [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: 07/21/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 02/12/2024]
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Lu SR, Zhu Y, Zhou W, Zhang J, Deng YB, Liu YN. Incremental prognostic utility of left ventricular and left atrial strains in coronary artery disease patients with reduced systolic function. Echocardiography 2024; 41:e15740. [PMID: 38284688 DOI: 10.1111/echo.15740] [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: 07/18/2023] [Revised: 11/21/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the predictive value of left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LARS) on adverse events in chronic coronary artery disease (CAD) patients with reduced systolic function. METHODS A total of 192 consecutive patients clinically diagnosed with chronic CAD and left ventricular ejection fraction (LVEF) ≤ 50% were finally included. Multiple strain parameters were analyzed with speckle tracking echocardiography. The composite endpoint included all-cause mortality, rehospitalization due to heart failure, myocardial infarction, and stroke. RESULTS Patients experiencing the endpoint showed lower LVEF, lower absolute GLS and LARS than those without events. Both GLS (AUC = 0.82 [GLS] vs. 0.58 [LVEF], p < 0.001) and LARS (AUC = 0.71 [LARS] vs. 0.58 [LVEF], p = 0.033) were superior to LVEF in predicting adverse events. Multivariate cox regression analysis showed that both GLS (hazard ratio, 0.71; 95% CI, 0.63-0.79; p < 0.001) and LARS (hazard ratio, 0.96; 95% CI, 0.93-0.98; p < 0.001) were independent predictors for the endpoint. The addition of LARS (global chi-squared, 35.7 vs. 17.4; p < 0.05), GLS (global chi-squared, 58.6 vs. 17.4; p < 0.05) or both LARS and GLS (global chi-squared, 79.6 vs. 17.4; p < 0.05) to LVEF in the prediction model significantly improved its performance. The same significant improvement was also shown in the subgroups of mild (30% < LVEF ≤ 50%) and severe (LVEF ≤ 30%) reduced systolic function. CONCLUSIONS Regarding CAD patients with reduced LVEF, both GLS and LARS are superior to LVEF in predicting adverse events, providing significant incremental value to LVEF.
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Affiliation(s)
- Shi-Rui Lu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ródenas-Alesina E, Lozano-Torres J, Tobías-Castillo PE, Badia-Molins C, Vila-Olives R, Calvo-Barceló M, Casas G, Soriano-Colomé T, San Emeterio AO, Fernández-Galera R, Méndez-Fernández AB, Barrabés JA, Ferreira-González I, Rodríguez-Palomares J. Left atrial deformation analysis in patients with non-ischaemic dilated cardiomyopathy in atrial fibrillation. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae063. [PMID: 39224100 PMCID: PMC11367969 DOI: 10.1093/ehjimp/qyae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/09/2024] [Indexed: 09/04/2024]
Abstract
Aims Atrial fibrillation (AF) is a common comorbidity in non-ischaemic dilated cardiomyopathy (NIDCM) affecting conventional measures of left atrial (LA) function. We aimed to determine whether LA function analysis could identify patients at higher risk of major cardiovascular events (MACEs). Methods and results A retrospective study of patients with NIDCM in AF referred to a single centre for transthoracic echocardiography (TTE) between 2015 and 2019. Peak atrial longitudinal strain (PALS) was measured along with LA emptying fraction and LA filling index (LAFI = E wave/PALS). Cox regression analysis was conducted. A total of 153 patients were included [median age 74 years, left ventricular ejection fraction (LVEF) 35%], and 57 (37.3%) had MACE after a median follow-up of 3.2 years. LAFI was the only independent TTE parameter associated with MACE after adjustment for age, diabetes, LVEF, left ventricular global longitudinal strain (LV-GLS), and LA volume index [adjusted hazard ratio (HR) = 1.02 per point increase, P = 0.024], with the best cut-off at ≥15. LAFI ≥15 predicted each of MACE components when separately analysed: MACE HR = 1.95, 95% confidence interval (CI) 1.16-3.30; cardiovascular death HR = 3.68, 95% CI 1.41-9.56, heart failure admission HR = 2.13, 95% CI 1.19-3.80, and ventricular arrhythmia HR = 4.72, 95% CI 1.52-14.67. Higher LAFI was associated with worsening LV-GLS, E/e', systolic pulmonary artery (PA) pressure, tricuspid annular plane systolic excursion, and right ventricular to PA coupling. Conclusion LA deformation analysis is feasible in patients with NIDCM presenting with AF. LAFI may identify patients at higher risk of MACE and correlates with higher pulmonary pressures and worse right ventricular function, suggesting an elevation of left-sided ventricular pressures in patients with higher LAFI.
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Affiliation(s)
- Eduard Ródenas-Alesina
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Lozano-Torres
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Pablo Eduardo Tobías-Castillo
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Clara Badia-Molins
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Rosa Vila-Olives
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Maria Calvo-Barceló
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Guillem Casas
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Toni Soriano-Colomé
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Aleix Olivella San Emeterio
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Rubén Fernández-Galera
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - Ana B Méndez-Fernández
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
| | - José A Barrabés
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - José Rodríguez-Palomares
- Department of Cardiology, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d‘Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
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Shen LT, Shi R, Yang ZG, Gao Y, Jiang YN, Fang H, Min CY, Li Y. Progress in Cardiac Magnetic Resonance Feature Tracking for Evaluating Myocardial Strain in Type-2 Diabetes Mellitus. Curr Diabetes Rev 2024; 20:98-109. [PMID: 38310480 PMCID: PMC11327751 DOI: 10.2174/0115733998277127231211063107] [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: 08/13/2023] [Revised: 10/28/2023] [Accepted: 11/10/2023] [Indexed: 02/05/2024]
Abstract
The global prevalence of type-2 diabetes mellitus (T2DM) has caused harm to human health and economies. Cardiovascular disease is one main cause of T2DM mortality. Increased prevalence of diabetes and associated heart failure (HF) is common in older populations, so accurately evaluating heart-related injury and T2DM risk factors and conducting early intervention are important. Quantitative cardiovascular system imaging assessments, including functional imaging during cardiovascular disease treatment, are also important. The left-ventricular ejection fraction (LVEF) has been traditionally used to monitor cardiac function; it is often preserved or increased in early T2DM, but subclinical heart deformation and dysfunction can occur. Myocardial strains are sensitive to global and regional heart dysfunction in subclinical T2DM. Cardiac magnetic resonance feature-tracking technology (CMR-FT) can visualize and quantify strain and identify subclinical myocardial injury for early management, especially with preserved LVEF. Meanwhile, CMR-FT can be used to evaluate the multiple cardiac chambers involvement mediated by T2DM and the coexistence of complications. This review discusses CMR-FT principles, clinical applications, and research progress in the evaluation of myocardial strain in T2DM.
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Affiliation(s)
- Li-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi-Ning Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Fang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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