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Labus J, Fassl J. Myocardial Work: A Response. J Cardiothorac Vasc Anesth 2024; 38:2130-2131. [PMID: 38880674 DOI: 10.1053/j.jvca.2024.05.014] [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: 04/15/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Jakob Labus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jens Fassl
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
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Boudabbous M, Hammemi R, Gdoura H, Chtourou L, Moalla M, Mnif L, Amouri A, Abid L, Tahri N. Cirrhotic cardiomyopathy: a subject that's always topical. Future Sci OA 2024; 10:FSO954. [PMID: 38817353 PMCID: PMC11137786 DOI: 10.2144/fsoa-2023-0110] [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: 06/13/2023] [Accepted: 12/13/2023] [Indexed: 06/01/2024] Open
Abstract
Cirrhosis is the final stage in the development of hepatic fibrosis in chronic liver disease. It is associated with major hemodynamic disturbances defining the hyperdynamic circulation and may be complicated by specific cardiac involvement or cirrhotic cardiomyopathy which is a silent clinical condition that typically remains asymptomatic until the late stages of liver disease. Recently, new criteria defining CC, based on modern concepts and knowledge of heart failure, have been proposed. Despite knowledge of the main mechanisms behind this entity, there is no specific treatment available for cirrhotic cardiomyopathy. The management approach for symptomatic cardiomyopathy in cirrhotic patients is similar to that for left ventricular failure in non-cirrhotic individuals.
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Affiliation(s)
- Mona Boudabbous
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Rania Hammemi
- Cardiology, Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Hela Gdoura
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Lassad Chtourou
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Manel Moalla
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Leila Mnif
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Ali Amouri
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Leila Abid
- Cardiology, Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
| | - Nabil Tahri
- Gastroenterology Department, Hédi Chaker Hospital, Sfax, Tunisia
- Medecin sfax university, Sfax university, Tunisia
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Costescu A, Riendeau Beaulac G, Guensch DP, Lalancette JS, Couture P, Denault AY. Perioperative echocardiographic strain analysis: what anesthesiologists should know. Can J Anaesth 2024; 71:650-670. [PMID: 38600285 DOI: 10.1007/s12630-024-02713-5] [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: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/28/2023] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly expanded over the last two decades as a sensitive marker of myocardial dysfunction with important diagnostic and prognostic values. Strain analysis has the potential to become a routine part of the perioperative echocardiographic examination for most anesthesiologist-echocardiographers but its exact role in the perioperative setting is still being defined. CLINICAL FEATURES This clinical report reviews the principles underlying strain analysis and describes its main clinical uses pertinent to the field of anesthesiology and perioperative medicine. Strain for assessment of left and right ventricular function as well as atrial strain is described. We also discuss the potential role of strain to aid in perioperative risk stratification, surgical patient selection in cardiac surgery, and guidance of anesthetic monitor choice and clinical decision-making in the perioperative period. CONCLUSION Echocardiographic strain analysis is a powerful tool that allows seeing what conventional 2D imaging sometimes fails to reveal. It often provides pathophysiologic insight into various cardiac diseases at an early stage. Strain analysis is readily feasible and reproducible thanks to the use of highly automated software platforms. This technique shows promising potential to become a valuable tool in the arsenal of the anesthesiologist-echocardiographer and aid in perioperative risk-stratification and clinical decision-making.
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Affiliation(s)
- Adrian Costescu
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Geneviève Riendeau Beaulac
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Simon Lalancette
- Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - André Y Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
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Labus J, Foit A, Mehler O, Rahmanian P, Wahlers T, Böttiger BW, Wetsch WA, Mathes A. Intraoperative Augmented Rotation and Circumferential Strain Compensate for Reduction of Left Ventricular Longitudinal Function After On-Pump CABG Surgery. J Cardiothorac Vasc Anesth 2023; 37:1912-1921. [PMID: 37393132 DOI: 10.1053/j.jvca.2023.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Left ventricular (LV) longitudinal function is reduced after on-pump coronary artery bypass grafting (CABG), while global LV function often is preserved. There are only limited data on the underlying compensatory mechanism. Therefore, the authors aimed to describe intraoperative changes of LV contractile pattern by myocardial strain analysis. DESIGN A prospective observational study. SETTING At a single university hospital. PARTICIPANTS A total of 30 patients scheduled for isolated on-pump CABG with an uneventful intraoperative course and preoperative preserved LV and RV function, sinus rhythm, without more-than-mild heart valve disease, or elevated pulmonary pressure. INTERVENTIONS Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Echocardiographic evaluation was performed under stable hemodynamics, in sinus rhythm or atrial pacing, and vasopressor support with norepinephrine ≤0.1 µg/kg/min. MEASUREMENTS AND MAIN RESULTS EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2-dimensional (2D) and 3-dimensional (3D) LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global circumferential strain (GCS), LV global radial strain (GRS), LV apical rotation (aRot), LV basal rotation (bRot), and LV twist. Strain analysis was feasible in all included patients after termination of cardiopulmonary bypass (T2). Although there were no significant differences in the values of conventional echocardiographic parameters during the intraoperative interval, GLS deteriorated significantly after CABG compared to pre-bypass assessment (T1 v T2, -13.4% ± 2.9 v -11.8% ± 2.9; p = 0.007). GCS improved significantly after surgery (T1 v T2, -19.4% (IQR -17.1% to -21.2%) v -22.8% (IQR -21.1% to -24.7%); p < 0.001) as well as aRot (T1 v T2, -9.7° (IQR -7.1° to -14.1°) v -14.5° (IQR -12.1° to -17.1°); p < 0.001), bRot (T1 v T2, 5.1° (IQR 3.8°-6.7°) v 7.2° (IQR 5.6°-8.2°); p = 0.02), and twist (T1 v T2, 15.8° (IQR 11.7°-19.4°) v 21.6° (IQR 19.2°-25.1°); p < 0.001), while GRS remained unchanged. There were no significant changes in the values of GLS, GCS, GRS, aRot, bRot, or twist, as well as in the values of 2D and 3D LV EF before and after sternal closure (T2 v T3). CONCLUSION Beyond evaluation of longitudinal LV strain, measurements of circumferential and radial strain, as well as LV rotation and twist mechanics, were feasible in the intraoperative course of this study. Reduction of longitudinal function after on-pump CABG was compensated intraoperatively by improvement of GCS and rotation in the authors' group of patients. Perioperative assessment of GCS, GRS, as well as rotation and twist, might provide deeper insight into perioperative changes of cardiac mechanics.
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Affiliation(s)
- Jakob Labus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - André Foit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Oliver Mehler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Wolfgang A Wetsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Alexander Mathes
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
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Papestiev V, Jovev S, Risteski P, Popov AF, Sokarovski M, Andova V, Georgievska-Ismail L. Myocardial Function after Coronary Artery Bypass Grafting in Patients with Preoperative Preserved Left Ventricular Ejection Fraction-The Role of the Left Ventricular Longitudinal Strain. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050932. [PMID: 37241164 DOI: 10.3390/medicina59050932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The role of coronary artery bypass grafting (CABG) on postoperative left ventricular (LV) function in patients with preoperatively preserved left ventricular ejection fraction (LVEF) is still being discussed and only a few studies address this question. This study aimed to assess LV function after CABG in patients with preoperatively preserved LVEF using left ventricular longitudinal strain assessed by 2D speckle tracking imaging (STI). Materials and Methods: Fifty-nine consecutive adult patients with coronary artery disease (CAD) referred for a first-time elective CABG surgery were enrolled in the final analysis of this prospective single-center clinical study. Transthoracic echocardiography (TTE), with conventional measures and STI measures, was performed within 1 week before CABG as well as 4 months after surgery. Patients were divided into groups based on their preoperative global longitudinal strain (GLS) value. Differences in systolic and diastolic parameters between groups were analyzed. Results: Preoperative GLS was reduced (GLS < -17%) in 39% of the patients. Parameters of systolic LV function were significantly reduced in this group of patients compared to the patient group with GLS% ≥ -17%. In both groups, 4 months after CABG there was a decline in LVEF but statistically significant only in the group with GLS% ≥ -17% (p = 0.035). In patients with reduced GLS, there was a statistically significant postoperative improvement (p = 0.004). In patients with preoperative normal GLS, there was not a significant change in any strain parameters after CABG. There was an improvement in diastolic function parameters measured by Tissue Doppler Imaging (TDI) in both groups. Conclusions: There is improvement in LV systolic and diastolic function after CABG in patients with preserved preoperative LVEF measured by STI and TDI. GLS might be more sensitive and effective than LVEF for monitoring improvements in myocardial function after CABG surgery in patients with preserved LVEF.
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Affiliation(s)
- Vasil Papestiev
- University Clinic for Cardiac Surgery, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, North Macedonia
| | - Sasko Jovev
- University Clinic for Cardiac Surgery, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, North Macedonia
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
| | - Aron Frederik Popov
- Department of Cardiothoracic Surgery, Helios Klinikum Siegburg, 53721 Siegburg, Germany
| | - Marjan Sokarovski
- University Clinic for Cardiac Surgery, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, North Macedonia
| | - Valentina Andova
- University Clinic of Cardiology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, North Macedonia
| | - Ljubica Georgievska-Ismail
- University Clinic of Cardiology, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, North Macedonia
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Castelvecchio S, Frigelli M, Sturla F, Milani V, Pappalardo OA, Citarella M, Menicanti L, Votta E. Elucidating the mechanisms underlying left ventricular function recovery in patients with ischemic heart failure undergoing surgical remodeling: A 3-dimensional ultrasound analysis. J Thorac Cardiovasc Surg 2023; 165:1418-1429.e4. [PMID: 33781593 DOI: 10.1016/j.jtcvs.2021.02.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to elucidate the mechanisms of left ventricle functional recovery in terms of endocardial contractility and synchronicity after surgical ventricular reconstruction. METHODS Real-time 3-dimensional transthoracic echocardiography was performed on 20 patients with anterior left ventricle remodeling and ischemic heart failure before surgical ventricular reconstruction and at 6-month follow-up, and on 15 healthy controls matched by age and body surface area. Real-time 3-dimensional transthoracic echocardiography datasets were analyzed through TomTec software (4D LV-Analysis; TomTec Imaging Systems GmbH, Unterschleissheim, Germany): Left ventricle volumes, ejection fraction, and global longitudinal strain were computed; the time-dependent endocardial surface yielded by 3-dimensional speckle-tracking echocardiography was postprocessed through in-house software to quantify local systolic minimum principal strain as a measure of fiber shortening and mechanical dispersion as a measure of fiber synchronicity. RESULTS Compared with controls, patients with heart failure before surgical ventricular reconstruction showed lower ejection fraction (P < .0001) and significantly impaired mechanical dispersion (P < .0001) and minimum principal strain (P < .0001); the latter worsened progressively from left ventricle base to apex. After surgical ventricular reconstruction, global longitudinal strain improved from -6.7% to -11.3% (P < .0001); mechanical dispersion decreased in every left ventricle region (P ≤ .017) and mostly in the basal region, where computed mechanical dispersion values were comparable to physiologic values (P ≥ .046); minimum principal strain improved mostly in the basal region, changing from -16.6% to -22.3% (P = .0027). CONCLUSIONS At 6-month follow-up, surgical ventricular reconstruction was associated with significant recovery in global left ventricle function, improved mechanical dispersion indicating a more synchronous left ventricle contraction, and improved left ventricle fiber shortening mostly in the basal region, suggesting the major role of the remote myocardium in enhancing left ventricle functional recovery.
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Affiliation(s)
| | - Matteo Frigelli
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Omar A Pappalardo
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michele Citarella
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Polomski EAS, Heemelaar JC, Krol ADG, Louwerens M, Beeres SLMA, Holman ER, Jukema JW, Schalij MJ, Antoni ML. Impaired Global Longitudinal Strain Is Associated with Cardiovascular Events in Hodgkin Lymphoma Survivors. Cancers (Basel) 2022; 14:cancers14092329. [PMID: 35565458 PMCID: PMC9099469 DOI: 10.3390/cancers14092329] [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: 04/12/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Treatment with thoracic irradiation for classic Hodgkin lymphoma (CHL) leads to improved survival but also increases the risk of cardiovascular events. Left ventricular (LV) dysfunction is usually assessed by echocardiographic left ventricular ejection fraction (LVEF), whereas global longitudinal strain (GLS) can detect early subclinical LV dysfunction. The purpose of this study was to evaluate if conventional echocardiographic parameters and GLS are associated with cardiovascular events during long-term follow-up. Methods: 161 consecutive CHL patients treated with radiotherapy who underwent echocardiography > 10 years after diagnosis were assessed for eligibility. Multivariable cause-specific Cox regression was performed for a composite outcome of cardiac death and cardiovascular events and the competing outcome of noncardiac death. Results: 129 patients (61.2% female, N = 79) with a mean age of 46.3 ± 11.0 years at index visit were eligible for analysis. GLS was impaired in 51 patients (39.5%) and 10.9% had a LVEF of< 50%. The median E/e’ was 9.2 [7.2;12.7]. Adjusted for confounders, GLS > −16% showed a significant association with a near four-fold risk of the composite endpoint (HR = 3.95, 95% CI: 1.83−8.52, p < 0.001). LVEF < 50% (HR = 2.99, p = 0.016) and E/e’ (HR = 1.16, p < 0.001) also showed a significant relationship with the outcome. None of the aforementioned parameters were associated with the competing outcome. Conclusions: This study shows that LV dysfunction including impaired GLS in CHL survivors is associated with cardiovascular events and cardiac death.
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Affiliation(s)
- Elissa A. S. Polomski
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
| | - Julius C. Heemelaar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
| | - Augustinus D. G. Krol
- Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Saskia L. M. A. Beeres
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
| | - Eduard R. Holman
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
| | - J. Wouter Jukema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
| | - Martin J. Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
| | - M. Louisa Antoni
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.A.S.P.); (J.C.H.); (S.L.M.A.B.); (E.R.H.); (J.W.J.); (M.J.S.)
- Correspondence: ; Tel.: +31-715262020; Fax: +31-715266809
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Nemchyna O, Solowjowa N, Dandel M, Hrytsyna Y, Stein J, Knierim J, Schoenrath F, Hennig F, Falk V, Knosalla C. Predictive Value of Two-Dimensional Speckle-Tracking Echocardiography in Patients Undergoing Surgical Ventricular Restoration. Front Cardiovasc Med 2022; 9:824467. [PMID: 35387444 PMCID: PMC8978793 DOI: 10.3389/fcvm.2022.824467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/31/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Parameters of left ventricular (LV) mechanics, obtained from speckle-tracking echocardiography (STE), were found to be of prognostic value in patients with heart failure and those who underwent cardiac surgery. This study aimed to assess the value of STE in patients scheduled to undergo surgical ventricular restoration (SVR). Methods A total of 158 consecutive patients with baseline STE who underwent SVR due to an LV anteroapical aneurysm were included in the analysis. Preoperative longitudinal STE parameters were evaluated for their association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. The echocardiographic follow-up to assess the change in the regional function of the segments remote from the aneurysm was performed in 43 patients at a median of 10 months [interquartile range (IQR): 6–12.7 months] after SVR. Results During a median follow-up of 5.1 years (IQR: 1.6–8.7 years), events occurred in 68 patients (48%). Less impaired mean basal end-systolic longitudinal strain (BLS) with a cutoff value ≤ −10.1 % demonstrated a strong association with event-free survival, also in patients with an LV shape corresponding to an intermediate shape between aneurysmal and globally akinetic. Initially hypo- or akinetic basal segments with preoperative end-systolic strain ≤ −7.8% showed a greater improvement in wall motion at the short-term follow up. Conclusion Patients with less impaired preoperative BLS exhibited a better event-free survival after SVR, also those with severe LV remodeling. The preserved preoperative segmental longitudinal strain was associated with a greater improvement in regional wall motion after SVR. BLS assessment may play a predictive role in patients with an LV anteroapical aneurysm who are scheduled to undergo SVR.
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Affiliation(s)
- Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | | | - Yuriy Hrytsyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Felix Hennig
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- ETH Zurich, Department of Health Sciences and Technology, Translational Cardiovascular Technology, Zurich, Switzerland
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Christoph Knosalla
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Ma C, Sanderson JE, Chen Q, Liang Z, Zhan X, Wu C, Liu H, Xiao L, Fang F. Fast assessment of left ventricular systolic function in obstructive sleep apnea patients with automated function imaging: Comparison with mitral annular plane systolic excursion. Echocardiography 2022; 39:426-433. [PMID: 35128719 DOI: 10.1111/echo.15308] [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: 08/04/2021] [Revised: 12/17/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early detection of left ventricular (LV) subclinical dysfunction is clinically relevant before developing irreversible impairment in obstructive sleep apnea (OSA) patients. Mitral annulus plane systolic excursion (MAPSE) is a fast tool for OSA due to high prevalent obesity; another quick but more comprehensive tool is LV global longitudinal stain (GLS) based on automated function imaging (AFI). We therefore aimed to compare the feasibility and reproducibility of AFI to MAPSE in OSA patients, as a good model in whom obesity is common. METHODS A comprehensive echocardiographic examination was done in 186 consecutive patients having polysomnography for suspected OSA. MAPSE was measured by using M-mode to calculate excursion of mitral annulus. GLS was derived by offline analysis of three long-axis views that semi-automatically detects LV endocardial boundary, which is adjusted manually as necessary with AFI measurement. Variability of AFI and MAPSE were compared among the different subgroups. RESULTS Despite a relatively high obesity rate (42.9%), the feasibility of AFI was 94% (175/186) and that of 100% in MAPSE. AFI showed excellent correlation (r = .882) superior to MAPSE (r = .819) between the Expert and Beginner. Intra- and inter- observer variability of AFI and MAPSE in Bland-Altman analysis were 5.5% and 6.5%; 6.2% and 8.8%, respectively. In repeated measurements, AFI showed higher intra-class correlation (ICC = .95) than MAPSE (ICC = .87) (p < 0.05). Furthermore, analysis showed that AFI was feasible even in more obese patients (BMI≥28 kg/m2 ). CONCLUSIONS Even in obese patients with OSA, AFI-GLS is feasible and more reliable for less expert operators than MAPSE in detecting LV longitudinal dysfunction.
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Affiliation(s)
- ChenYao Ma
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.,Department of Ultrasound, Beijing DiTan Hospital, Capital Medical University, Beijing, China
| | - John E Sanderson
- Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Qi Chen
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhe Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - XiaoJun Zhan
- Sleep Medicine Center, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chan Wu
- Sleep Medicine Center, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hu Liu
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Lei Xiao
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Fang Fang
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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10
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Labus J, Winata J, Schmidt T, Nicolai J, Uhlig C, Sveric K, Alexiou K, Scholz M, Fassl J. Perioperative Two-Dimensional Left Ventricular Global Longitudinal Strain in Coronary Artery Bypass Surgery: A Prospective Observational Pilot Study. J Cardiothorac Vasc Anesth 2021; 36:166-174. [PMID: 34526240 DOI: 10.1053/j.jvca.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There are limited data on perioperative left ventricular strain. The authors aimed to describe the entire perioperative course of two-dimensional left ventricular global longitudinal strain in patients undergoing coronary artery bypass graft (CABG) surgery and compare to common parameters of LV function assessment. DESIGN Prospective observational study. SETTING Single university hospital. PARTICIPANTS Forty patients scheduled for isolated on-pump CABG surgery with preserved left and right ventricular function with an unremarkable, complication-free perioperative course. INTERVENTIONS Two-dimensional strain analysis and standard echocardiographic assessment of left ventricular function were performed pre- (T1) and postoperatively (T4) by transthoracic echocardiography (TTE) and intraoperatively pre- (T2) and poststernotomy (T3) by transesophageal echocardiography (TEE). Echocardiography was performed under stable hemodynamics and predefined fluid management, in sinus rhythm without any vasoactive support. MEASUREMENTS AND MAIN RESULTS Analysis of two-dimensional LV global longitudinal strain (2D-LV GLS) was performed using Tomtec 2D Cardiac Performance Analysis software. Philips QLAB 10.8 was used to analyze left ventricular ejection fraction (LV EF) and tissue velocity of the lateral mitral annulus (LV S ́). There were no significant differences (median with interquartile range [IQR]) after induction of anesthesia in values of LV EF and 2D-LV GLS (T1 v T2; 59% [IQR, 52 to 64] v 56% [IQR, 51.75 to 63] and -15.2 [IQR, -18.05 to -13.08] v -15.6 [IQR, -17.65 to -13.88]; both not significant [ns]), while LV S´ declined (T1 v T2, 7 cm/s [IQR, 5.25 to 8] v 5.25 cm/s [IQR, 4.6 to 6.83]; p < 0.001). Bland-Altman analysis for this comparison of 2D-LV GLS (T1 v T2) showed that bias was not significant between both techniques; however, there were limits of agreement. After sternotomy (T2 v T3) neither LV EF nor 2D-LV GLS or LV S´ declined. 2D-LV GLS deteriorated significantly after CABG (T1 v T4; -15.2 [IQR, -18.05 to -13.08] v -11.3 [IQR, -15.8 to -9.78]; p < 0.001). In contrast, LV EF and LV S´ did not change significantly in the perioperative interval (T1 v T4; 59% [IQR, 52 to 64] v 56% [IQR, 51.5 to 64.25] and 7 cm/s [IQR, 5.25 to 8] v 7 cm/s [IQR, 6 to 8]; both ns). CONCLUSION Values of 2D-LV GLS did not differ in awake, spontaneously breathing patients assessed by TTE and in anesthetized and ventilated patients with stable hemodynamics measured by TEE. 2D-LV GLS did not change after sternotomy; however, it declined significantly after on-pump CABG, while LV EF and LV S´ remained unchanged.
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Affiliation(s)
- Jakob Labus
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne University, Cologne, Germany
| | - Johan Winata
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Torsten Schmidt
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Joachim Nicolai
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Christopher Uhlig
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Kunislav Sveric
- Department of Cardiology and Internal Medicine, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Konstantin Alexiou
- Department of Heart Surgery, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jens Fassl
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany.
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11
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Wozolek A, Jaquet O, Donneau AF, Lancellotti P, Legoff C, Cavalier E, Radermecker MA, Lavigne JP, Durieux R, Roediger L, Senard M, Hubert MB, Brichant JF, Amabili P, Hans GA. Cardiac Biomarkers and Prediction of Early Outcome After Heart Valve Surgery: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2021; 36:862-869. [PMID: 34301449 DOI: 10.1053/j.jvca.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Circulating cardiac biomarkers may improve the prediction of long-term outcomes after cardiac surgery. The authors sought to assess if cardiac biomarkers also help better predict short-term morbidity. DESIGN Prospective observational study. SETTING Single academic hospital. PARTICIPANTS A total of 250 patients undergoing aortic or mitral valve surgery with or without associated coronary artery bypass grafts. INTERVENTION None MEASUREMENT AND MAIN RESULTS: Relationships between preoperative plasma concentrations of four cardiac biomarkers (sST2, Galectin-3, GDF-15, and NT-proBNP) and postoperative outcome were assessed using logistic regressions and Cox proportional hazards models. The primary outcome was a composite of 30-day mortality, an inotropic support longer than 48 hours and an initial length of stay in the intensive care >five days. Secondary outcome measures were postoperative acute kidney injury, inotropic support duration, lengths of intensive care unit and hospital stays, and 30-day and one-year mortality. No association was observed between any of the four cardiac biomarkers and the primary outcome. The preoperative levels of Galectin-3 (hazard ratio = 1.2; p < 0.001) and sST2 (hazard ratio = 1.01, p < 0.001) were significantly associated with one-year survival, and their addition to the EuroSCORE II significantly improved the prediction of one-year mortality (p < 0.001). Similarly, Galectin-3 was associated with postoperative acute kidney injury (odds ratio = 1.15, p = 0.001) and improved the prediction of this complication when added to the EuroSCORE II (p = 0.002). CONCLUSIONS These results suggested that the ability of cardiac biomarkers to predict short-term outcome after cardiac surgery, though of interest, appears limited. Conversely, cardiac biomarkers may have the potential to refine the prediction of long-term outcome. Admittedly, all positive results were obtained on secondary outcomes and must be regarded with caution.
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Affiliation(s)
- Aaron Wozolek
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium
| | - Oceane Jaquet
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium
| | | | | | - Caroline Legoff
- Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium
| | - Marc A Radermecker
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium; Department of Public Health, University of Liège, Liège, Belgium; Department of Cardiovascular and Thoracic Surgery, CHU of Liège, Liège, Belgium; Department of Cardiology, CHU of Liège, Liège, Belgium; Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium
| | - Jean-Paul Lavigne
- Department of Cardiovascular and Thoracic Surgery, CHU of Liège, Liège, Belgium
| | - Rodolphe Durieux
- Department of Cardiovascular and Thoracic Surgery, CHU of Liège, Liège, Belgium
| | - Laurence Roediger
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium
| | - Marc Senard
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium
| | - Marie Bernard Hubert
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium
| | | | - Philippe Amabili
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium
| | - Grégory A Hans
- Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium.
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12
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Chen W, Ortiz-Leon XA, Posada-Martinez EL, Pereira J, Dewar ML, Darr U, Geirsson A, Sugeng L, Zhu Q. Acute changes of left ventricular function during surgical revascularization by 3D speckle tracking. Echocardiography 2021; 38:623-631. [PMID: 33740279 DOI: 10.1111/echo.15040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Detecting early impact of coronary artery bypass grafting (CABG) on left ventricular (LV) function is important because such measures may contribute to meaningful improvement in clinical outcomes. We aimed to gain knowledge about acute changes of LV performance during surgical revascularization using three-dimensional speckle tracking echocardiography (3D STE). METHODS Thirty-five patients scheduled for CABG surgery who underwent intraoperative transesophageal echocardiography (TEE) were enrolled (mean age 68.9 ± 7.3 years). TEE was performed before and after surgery, as well as before and after grafting. 3D LV ejection fraction (LVEF), tissue motion annular displacement (TMAD) of the mitral valves, 3D global longitudinal strain (GLS), global circumferential strain (GCS), twist, and torsion were quantified. Regional longitudinal strain (LS) was calculated based on coronary perfusion territories in a 16-segment LV model. RESULTS Despite the absence of change in TMAD and 3D LVEF, 3D GLS (-18.6 ± 4.3% at baseline vs -16.0 ± 4.0% after surgery, P = .01) was significantly decreased, followed with no significant effect on GCS, twist, and torsion during surgery. 3D GLS correlated significantly with 3D LVEF (r between -0.34 and -0.51, P < .05 for all) under the whole operation. Territorial LS did not increase immediately after surgery. CONCLUSION 3D speckle tracking imaging allows for detailed and direct evaluation of myocardial deformation, though impaired LV longitudinal function is still apparent immediately after surgery. GLS is more sensitive to an acute reduction in LV function than conventional parameters, which can be potentially useful for serial monitoring of functional recovery.
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Affiliation(s)
- Wanwen Chen
- Department of Cardiology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Xochitl A Ortiz-Leon
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael L Dewar
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Umer Darr
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Qingbing Zhu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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13
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Olsen FJ, Lindberg S, Pedersen S, Iversen A, Davidovski FS, Galatius S, Fritz-Hansen T, Gislason GH, Søgaard P, Møgelvang R, Biering-Sørensen T. Global longitudinal strain predicts cardiovascular events after coronary artery bypass grafting. Heart 2021; 107:814-821. [PMID: 33526506 DOI: 10.1136/heartjnl-2020-318462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the prognostic value of global longitudinal strain (GLS) after coronary artery bypass grafting (CABG). METHODS We performed a retrospective cohort study on patients undergoing CABG between 2006 and 2011 who had an echocardiogram available for strain analysis. The patients were followed up through nationwide registries for development of all-cause mortality, cardiovascular death (CVD) and major adverse cardiovascular events (MACEs) defined as heart failure hospitalisation and/or CVD. Multivariable Cox regression was applied to adjust for the European System for Cardiac Operative Risk Evaluation II (EuroSCORE-II). Additive value was assessed by Net Reclassification Index (NRI) improvement. RESULTS Of the 709 patients included, 80 died during a median follow-up of 3.8 years. Of these, 45 had CVD, and 72 patients experienced MACE. Mean age was 68 years and 85% were men. Left ventricular ejection fraction (LVEF) was 50% and GLS was -13%.GLS was an independent predictor when adjusted for the EuroSCORE-II (all-cause mortality: HR=1.07 (1.01-1.13), p=0.018; CVD: HR=1.11 (1.03-1.20), p=0.007; MACE: HR=1.12 (1.06-1.19), p<0.001, per 1% absolute decrease). GLS significantly improved the NRI score by 0.30 when added to the EuroSCORE-II for predicting MACE, but not significantly for the other endpoints.LVEF modified the association between GLS and outcomes (p for interaction<0.05 for CVD and MACE). GLS remained an independent predictor of outcomes in patients with preserved LVEF (LVEF≥50%) and improved the NRI score when added to the EuroSCORE-II for predicting CVD and MACE, but not all-cause mortality in these patients. CONCLUSION GLS is an independent predictor of long-term outcomes after CABG. The predictive value appears strongest among patients with preserved LVEF.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Søren Lindberg
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip Soeskov Davidovski
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Healhy and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Healhy and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Posada-Martinez EL, Fritche-Salazar JF, Arias-Godinez JA, Ortiz-Leon XA, Balderas-Muñoz K, Ruiz-Esparza ME, Sánchez EA, Sandoval JP, Morales AKT, Rodriguez-Zanella H. Right Ventricular Longitudinal Strain Predicts Low-Cardiac- Output Syndrome After Surgical Aortic Valve Replacement in Patients With Preserved and Mid-range Ejection Fraction. J Cardiothorac Vasc Anesth 2020; 35:1638-1645. [PMID: 33419684 DOI: 10.1053/j.jvca.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to analyze whether right ventricular free wall longitudinal strain (RVFWSL) could be a predictor of low-cardiac-output syndrome (LCOS) after surgical aortic valve replacement (SAVR) in patients with left ventricular ejection fraction ≥40%. DESIGN Prospective, observational study. SETTING The study was conducted at a third level university hospital. PARTICIPANTS The study comprised 75 patients with severe aortic stenosis and LVEF ≥40% who underwent SAVR. The primary outcome was the occurrence of LCOS, and secondary outcomes were in-hospital mortality, hospital stay, or vasoplegic syndrome. INTERVENTIONS Patients were divided into two groups (LCOS and no LCOS), and RVFWSL was analyzed to determine whether it is a predictor for LCOS. In addition, a receiver operating characteristic curve also was constructed, and the best cutoff value to predict LCOS was found. Furthermore, the reproducibility of RVFWSL measurements was evaluated. MEASUREMENT AND MAIN RESULTS The incidence of LCOS was 20% in the present study's cohort. After multivariate analysis, cross-clamp time (odds ratio 1.06, 95% confidence interval 1.02-1.11; p = 0.002) and RVFWSL (odds ratio 1.41, 95% confidence interval 1.07-1.87; p = 0.015) were the only predictors of LCOS. However, RVFWSL did not show association with secondary outcomes (p > 0.05 for all). The area under the curve of RVFWSL to predict LCOS was 0.75, and the best cutoff value was -17.3%, with a sensitivity of 86.7% and specificity of 61.7%. CONCLUSIONS RVFWSL seems to be a predictor of LCOS in patients with severe aortic stenosis and LVEF ≥40% undergoing SAVR. RVFWSL less than -17.3% may identify patients at increased risk for LCOS.
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Affiliation(s)
- Edith L Posada-Martinez
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Juan F Fritche-Salazar
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Jose A Arias-Godinez
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Xochitl A Ortiz-Leon
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Karla Balderas-Muñoz
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | | | - Eduardo Arias Sánchez
- Interventional Cardiology Department, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Juan Pablo Sandoval
- Pediatric Structural Intervention Department, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Ana Karla Tobias Morales
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Hugo Rodriguez-Zanella
- Echocardiography Laboratory, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico.
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15
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Zhao LT, Liu L, Meng PP, Wang YH, Li M, Yang J, Gu TX, Ma CY. Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting. Cardiovasc Ultrasound 2020; 18:27. [PMID: 32693817 PMCID: PMC7374912 DOI: 10.1186/s12947-020-00206-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods Intraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 min before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P < 0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P < 0.001). The LV volumes and LVEF remained unchanged. Conclusions Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.
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Affiliation(s)
- Lan-Ting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Lu Liu
- Department of Cardiac Surgery, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Ping-Ping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Yong-Huai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Meng Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Tian-Xiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
| | - Chun-Yan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
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16
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Kammerlander AA, Donà C, Nitsche C, Koschutnik M, Schönbauer R, Duca F, Zotter-Tufaro C, Binder C, Aschauer S, Beitzke D, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. Feature Tracking of Global Longitudinal Strain by Using Cardiovascular MRI Improves Risk Stratification in Heart Failure with Preserved Ejection Fraction. Radiology 2020; 296:290-298. [PMID: 32484413 DOI: 10.1148/radiol.2020200195] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background In heart failure with preserved ejection fraction (HFpEF), echocardiographic studies suggest that global longitudinal strain (GLS) has an impact on survival. Feature-tracking cardiovascular MRI also allows for strain analysis; however, to the knowledge of the authors, little is known about its prognostic value and whether it reflects severity of diffuse fibrosis, as assessed by cardiovascular MRI T1 mapping. Purpose To investigate the association between myocardial strain at cardiovascular MRI with extracellular volume by T1 mapping and outcome in participants with HFpEF. Materials and Methods In this secondary analysis of a prospective study (NCT03405987), consecutive participants with HFpEF underwent cardiovascular MRI between July 2012 and March 2018, including T1 mapping and three-dimensional strain analysis. Extracellular volume and strain results were assessed to determine if there was a correlation between these two factors. Cox regression was performed to determine the prognostic relevance of MRI-derived myocardial strain for a combined end point (events) of heart failure hospitalizations and cardiovascular death. Results In total, 206 consecutive participants with HFpEF (mean age, 71 years ± 8 [standard deviation]; 69% women) were included. Median myocardial global longitudinal strain (GLS) at MRI was -8.5% and showed low correlation with extracellular volume (r = 0.28; P = .003). A total of 109 events (53%) were recorded during a follow-up of 38 months ± 29. Participants with a GLS above the median had higher event rates (log-rank test, P < .001). By multivariable Cox regression analysis, GLS remained independently associated with outcome (hazard ratio, 1.06 per 1% strain increase; 95% confidence interval: 1.01, 1.11; P = .03) when corrected for risk factors including age, diabetes, renal function, N-terminal pro-b-type natriuretic peptide serum concentration, and right ventricular size and function. Conclusion In participants with heart failure with preserved ejection fraction, global longitudinal strain at cardiovascular MRI was correlated with extracellular volume by T1 mapping and was associated with cardiovascular events. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Andreas A Kammerlander
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Carolina Donà
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christian Nitsche
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Matthias Koschutnik
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Robert Schönbauer
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Franz Duca
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Caroline Zotter-Tufaro
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christina Binder
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Stefan Aschauer
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Dietrich Beitzke
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christian Loewe
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Christian Hengstenberg
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Diana Bonderman
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
| | - Julia Mascherbauer
- From the Division of Cardiology (A.A.K., C.D., C.N., M.K., R.S., F.D., C.Z.T., C.B., S.A., C.H., D. Bonderman, J.M.) and Division of Cardiovascular and Interventional Radiology (D. Beitzke, C.L.), Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria; and Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (A.A.K.)
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17
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Rong LQ, Neuburger PJ, Kim J, Devereux RB. Left ventricular global longitudinal strain and cardiac surgical outcomes. Minerva Cardioangiol 2020; 68:489-496. [PMID: 32472988 DOI: 10.23736/s0026-4725.20.05251-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Global longitudinal strain (GLS) has emerged as a valuable diagnostic and prognostic tool for evaluating left ventricular (LV) function. GLS has been shown to be a more sensitive marker of LV dysfunction than LV ejection fraction alone and have prognostic impact in non-surgical cardiac populations. GLS, is validated, reproducible, and easily obtained from 2-dimensional speckle-tracking echocardiography. While there is strong evidence for using GLS in clinical decision-making in non-surgical populations, there is less summarized evidence on using GLS in the cardiac surgical population. This review combines the evidence on the implications of using baseline transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) GLS in cardiac surgical populations including ischemic and structural heart disease to determine surgical outcomes. We found that results seem promising on the prognostic utility of LV strain in cardiac surgical populations. However due to the variability of study populations and outcomes, and modalities (TTE versus TEE), further research on normal versus abnormal values for different surgical populations, as well potential treatment options that may modify and potentially decrease surgical risk for those with abnormal GLS are needed.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA -
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Jiwon Kim
- Department of Cardiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Richard B Devereux
- Department of Cardiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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18
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Bijvoet GP, Teske AJ, Chamuleau SAJ, Hart EA, Jansen R, Schaap J. Global longitudinal strain to predict left ventricular dysfunction in asymptomatic patients with severe mitral valve regurgitation: literature review. Neth Heart J 2020; 28:63-72. [PMID: 31410717 PMCID: PMC6977936 DOI: 10.1007/s12471-019-01318-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The optimal treatment strategy for asymptomatic patients with severe mitral valve regurgitation (MR) and preserved left ventricular (LV) function is challenging. This manuscript reviews the available literature on the value of left ventricular global longitudinal strain (LV-GLS) in predicting LV dysfunction after mitral valve surgery in these patients and discusses its current place in the treatment strategy. Studies were identified from Cochrane Library, SCOPUS, PubMed and Web of Science up to February 2018. The domain used was MR. The determinant was LV-GLS; other methods of deformation imaging were excluded. The examined outcome was LV dysfunction after surgery. A total of 144 articles were retrieved, of which 11 publications met the inclusion criteria, including a total of 2415 patients. Ten studies showed a significant correlation between preoperative LV-GLS and LV dysfunction postoperatively; one study reported a negative correlation. These studies suggest that LV-GLS is a predictor of LV dysfunction after surgery in asymptomatic patients with chronic MR. Hence, incorporation of LV-GLS for clinical decision-making in these patients might be of additional value. Further research is needed to confirm the role of LV-GLS in postoperative patients, and additionally in asymptomatic MR patients during a 'watchful waiting' strategy.
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Affiliation(s)
- G P Bijvoet
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - A J Teske
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E A Hart
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Jansen
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Schaap
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
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19
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Hamidzad M, Khani M, Bayat F, Esfahani M, Saffarian F, Bakhshande H, Talebzade S. 2D Speckel Tracking of RV Function after CABG and CPB Time. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Izzy M, VanWagner LB, Lin G, Altieri M, Findlay JY, Oh JK, Watt KD, Lee SS. Redefining Cirrhotic Cardiomyopathy for the Modern Era. Hepatology 2020; 71:334-345. [PMID: 31342529 PMCID: PMC7288530 DOI: 10.1002/hep.30875] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
Abstract
Cirrhotic cardiomyopathy (CCM) is cardiac dysfunction in patients with end-stage liver disease in the absence of prior heart disease. First defined in 2005 during the World Congress of Gastroenterology, CCM criteria consisted of echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Significant advancements in cardiovascular imaging over the past 14 years, including the integration of myocardial deformation imaging into routine clinical practice to identify subclinical cardiovascular dysfunction, have rendered the 2005 CCM criteria obsolete. Therefore, new criteria based on contemporary cardiovascular imaging parameters are needed. In this guidance document, assembled by a group of multidisciplinary experts in the field, new core criteria based on contemporary cardiovascular imaging parameters are proposed for the assessment of CCM. This document provides a critical assessment of the diagnosis of CCM and ongoing assessment aimed at improving clinical outcomes, particularly surrounding liver transplantation. Key points and practice-based recommendations for the diagnosis of CCM are provided to offer guidance for clinicians and identify gaps in knowledge for future investigations.
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Affiliation(s)
- Manhal Izzy
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN
| | - Lisa B. VanWagner
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace Lin
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, MN
| | - Mario Altieri
- Division of Hepatology, Caen University, Caen, France
| | | | - Jae K. Oh
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, MN
| | - Kymberly D. Watt
- Division of Gastroenterology & Hepatology, The Mayo Clinic, Rochester, MN
| | - Samuel S. Lee
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
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21
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Myhr KA, Pedersen FHG, Kristensen CB, Køber L, Hassager C, Møgelvang R. Global longitudinal strain before cardiac surgery: Improving feasibility, reproducibility, and variability. Echocardiography 2019; 36:2176-2184. [DOI: 10.1111/echo.14529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/26/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Lars Køber
- The Heart Centre Rigshospitalet Copenhagen Denmark
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22
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Abuelkasem E, Wang DW, Omer MA, Abdelmoneim SS, Howard-Quijano K, Rakesh H, Subramaniam K. Perioperative clinical utility of myocardial deformation imaging: a narrative review. Br J Anaesth 2019; 123:408-420. [DOI: 10.1016/j.bja.2019.04.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/09/2019] [Accepted: 04/28/2019] [Indexed: 01/25/2023] Open
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Jahn L, Kramann R, Marx N, Floege J, Becker M, Schlieper G. Speckle Tracking Echocardiography and All-Cause and Cardiovascular Mortality Risk in Chronic Kidney Disease Patients. Kidney Blood Press Res 2019; 44:690-703. [DOI: 10.1159/000501225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives: Patients with chronic kidney disease (CKD) exhibit a highly increased risk of cardiovascular (CV) morbidity and mortality. Subtle changes in left ventricular function can be detected by two-dimensional (2D) speckle tracking echocardiography (STE). This study investigated whether myocardial dysfunction detected by 2D STE may aid in CV and all-cause mortality risk assessment in patients with CKD stages 3 and 4. Method: A study group of 285 patients (CKD 3: 193 patients; CKD 4: 92 patients) and a healthy control group (34 participants) were included in the retrospective study. 2D STE values as well as early and late diastolic strain rates were measured in ventricular longitudinal, circumferential and radial directions. Patients’ CV and all-cause outcome was determined. Results: In the CKD group all measured longitudinal STE values and radial strain were significantly reduced compared to the control group. Cox proportional hazards regression revealed global longitudinal strain to predict CV and all-cause mortality (hazard ratio [HR] 1.15, 95% CI 1.06–1.25; p = 0.0008 and HR 1.09, 95% CI 1.04–1.14; p = 0.0003). After adjustment for sex, age, diabetes, estimated glomerular filtration rate, and preexisting CV disease, this association was maintained for CV mortality and all-cause mortality (HR 1.16, 95% CI 1.06–1.27; p = 0.0019 and HR 1.08, 95% CI 1.03–1.14; p = 0.0026, respectively). Conclusions: The present study shows that 2D STE detects reduced left ventricular myocardial function and allows the prediction of CV and all-cause mortality in patients at CKD stages 3 and 4.
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Gozdzik A, Letachowicz K, Grajek BB, Plonek T, Obremska M, Jasinski M, Gozdzik W. Application of strain and other echocardiographic parameters in the evaluation of early and long-term clinical outcomes after cardiac surgery revascularization. BMC Cardiovasc Disord 2019; 19:189. [PMID: 31382900 PMCID: PMC6683521 DOI: 10.1186/s12872-019-1162-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background Coronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for coronary heart disease (CHD). Myocardial longitudinal strain echocardiography with 2D speckle tracking could obtain ventricular function with better accuracy and reliability than the left ventricular ejection fraction. The aim of the study was to assess changes in left ventricular function in patients before and after surgical revascularization for a 24-month period of observation, using echocardiography with speckle tracking strain imaging. We searched for echocardiographic predictors of poor early and long-term outcome after CABG. Methods We enrolled 69 patients scheduled for elective coronary bypass grafting. Patients were divided into groups based on pre-operative systolic and diastolic parameters, depending on the GLS value and the E’ Lat and E/E’ value. The correlation between these parameters and early and long-term outcomes was analyzed. Results Preoperative EF was preserved in 86, 95% (60) patients. Pre-operative reduced GLS was observed in 73.91% (51) of patients and severely reduced in 31.88% (22). In the first post-operative 6-month period, we observed a significant decrease in the GLS. The GLS was a predictor of early postoperative outcome for intubation time, the inotropes use and length of ICU stay. Diastolic dysfunction was a predictor of the greater inotrope requirements. Conclusions Global longitudinal strain and diastolic dysfunction parameters are a good predictors of worse early outcome after CABG.
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Affiliation(s)
- Anna Gozdzik
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Krzysztof Letachowicz
- Department and Clinic of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Barteczko Grajek
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Plonek
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Marta Obremska
- Department of Medical Emergency, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Jasinski
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Waldemar Gozdzik
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
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Sonny A, Alfirevic A, Sale S, Zimmerman NM, You J, Gillinov AM, Sessler DI, Duncan AE. Reduced Left Ventricular Global Longitudinal Strain Predicts Prolonged Hospitalization: A Cohort Analysis of Patients Having Aortic Valve Replacement Surgery. Anesth Analg 2019; 126:1484-1493. [PMID: 29200066 DOI: 10.1213/ane.0000000000002684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is often preserved in patients with aortic stenosis and thus cannot distinguish between normal myocardial contractile function and subclinical dysfunction. Global longitudinal strain and strain rate (SR), which measure myocardial deformation, are robust indicators of myocardial function and can detect subtle myocardial dysfunction that is not apparent with conventional echocardiographic measures. Strain and SR may better predict postoperative outcomes than LVEF. The primary aim of our investigation was to assess the association between global longitudinal strain and serious postoperative outcomes in patients with aortic stenosis having aortic valve replacement. Secondarily, we also assessed the associations between global longitudinal SR and LVEF and the outcomes. METHODS In this post hoc analysis of data from a randomized clinical trial (NCT01187329), we examined the association between measures of myocardial function and the following outcomes: (1) need for postoperative inotropic/vasopressor support; (2) prolonged hospitalization (>7 days); and (3) postoperative atrial fibrillation. Standardized transesophageal echocardiographic examinations were performed after anesthetic induction. Myocardial deformation was measured using speckle-tracking echocardiography. Multivariable logistic regression was used to assess associations between measures of myocardial function and outcomes, adjusted for potential confounding factors. The predictive ability of global longitudinal strain, SR, and LVEF was assessed as area under receiver operating characteristics curves (AUCs). RESULTS Of 100 patients enrolled in the clinical trial, 86 patients with aortic stenosis had acceptable images for global longitudinal strain analysis. Primarily, worse intraoperative global longitudinal strain was associated with prolonged hospitalization (odds ratio [98.3% confidence interval], 1.22 [1.01-1.47] per 1% decrease [absolute value] in strain; P = .012), but not with other outcomes. Secondarily, worse global longitudinal SR was associated with prolonged hospitalization (odds ratio [99.7% confidence interval], 1.68 [1.01-2.79] per 0.1 second(-1) decrease [absolute value] in SR; P = .003), but not other outcomes. LVEF was not associated with any outcomes. Global longitudinal SR was the best predictor for prolonged hospitalization (AUC, 0.72), followed by global longitudinal strain (AUC, 0.67) and LVEF (AUC, 0.62). CONCLUSIONS Global longitudinal strain and SR are useful predictors of prolonged hospitalization in patients with aortic stenosis having an aortic valve replacement.
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Affiliation(s)
| | | | - Shiva Sale
- From the Departments of Cardiothoracic Anesthesia
| | | | - Jing You
- Quantitative Health Sciences and Outcomes Research
| | | | | | - Andra E Duncan
- Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
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Chen M, Gao C, Yu J, Ren S, Wang M, Wynn RM, Chuang DT, Wang Y, Sun H. Therapeutic Effect of Targeting Branched-Chain Amino Acid Catabolic Flux in Pressure-Overload Induced Heart Failure. J Am Heart Assoc 2019; 8:e011625. [PMID: 31433721 PMCID: PMC6585363 DOI: 10.1161/jaha.118.011625] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/18/2019] [Indexed: 12/14/2022]
Abstract
Background Branched-chain amino acid (BCAA) catabolic defect is an emerging metabolic hallmark in failing hearts in human and animal models. The therapeutic impact of targeting BCAA catabolic flux under pathological conditions remains understudied. Methods and Results BT2 (3,6-dichlorobenzo[b]thiophene-2-carboxylic acid), a small-molecule inhibitor of branched-chain ketoacid dehydrogenase kinase, was used to enhance BCAA catabolism. After 2 weeks of transaortic constriction, mice with significant cardiac dysfunctions were treated with vehicle or BT2. Serial echocardiograms showed continuing pathological deterioration in left ventricle of the vehicle-treated mice, whereas the BT2-treated mice showed significantly preserved cardiac function and structure. Moreover, BT2 treatment improved systolic contractility and diastolic mechanics. These therapeutic benefits appeared to be independent of impacts on left ventricle hypertrophy but associated with increased gene expression involved in fatty acid utilization. The BT2 administration showed no signs of apparent toxicity. Conclusions Our data provide the first proof-of-concept evidence for the therapeutic efficacy of restoring BCAA catabolic flux in hearts with preexisting dysfunctions. The BCAA catabolic pathway represents a novel and potentially efficacious target for treatment of heart failure.
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Affiliation(s)
- Mengping Chen
- Key Laboratory of Cell Differentiation and Apoptosis of Ministry of EducationDepartment of PathophysiologyShanghai Jiao Tong University School of MedicineShanghaiChina
- Departments of Anesthesiology, Medicine and PhysiologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCA
| | - Chen Gao
- Departments of Anesthesiology, Medicine and PhysiologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCA
| | - Jiayu Yu
- Key Laboratory of Cell Differentiation and Apoptosis of Ministry of EducationDepartment of PathophysiologyShanghai Jiao Tong University School of MedicineShanghaiChina
- Departments of Anesthesiology, Medicine and PhysiologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCA
| | - Shuxun Ren
- Departments of Anesthesiology, Medicine and PhysiologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCA
| | - Menglong Wang
- Department of CardiologyRenmin Hospital of Wuhan UniversityCardiovascular Research InstituteWuhan UniversityHubei Key Laboratory of CardiologyWuhanChina
| | - R. Max Wynn
- Department of BiochemistryUniversity of Texas Southwestern Medical CenterDallasTX
| | - David T. Chuang
- Department of BiochemistryUniversity of Texas Southwestern Medical CenterDallasTX
| | - Yibin Wang
- Departments of Anesthesiology, Medicine and PhysiologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCA
| | - Haipeng Sun
- Key Laboratory of Cell Differentiation and Apoptosis of Ministry of EducationDepartment of PathophysiologyShanghai Jiao Tong University School of MedicineShanghaiChina
- Departments of Anesthesiology, Medicine and PhysiologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCA
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27
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Howard-Quijano K, Methangkool E, Scovotti JC, Mazor E, Grogan TR, Kratzert WB, Mahajan A. Regional Left Ventricular Myocardial Dysfunction After Cardiac Surgery Characterized by 3-Dimensional Strain. Anesth Analg 2019; 128:854-864. [PMID: 30896605 PMCID: PMC9815834 DOI: 10.1213/ane.0000000000003785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Three-dimensional (3D) strain is an echocardiographic modality that can characterize left ventricular (LV) function with greater accuracy than ejection fraction. While decreases in global strain have been used to predict outcomes after cardiac surgery, changes in regional 3D longitudinal, circumferential, radial, and area strain have not been well described. The primary aim of this study was to define differential patterns in regional LV dysfunction after cardiac surgery using 3D speckle tracking strain imaging. Our secondary aim was to investigate whether changes in regional strain can predict postoperative outcomes, including length of intensive care unit stay and 1-year event-free survival. METHODS In this prospective clinical study, demographic, operative, echocardiographic, and clinical outcome data were collected on 182 patients undergoing aortic valve replacement, mitral valve repair or replacement, coronary artery bypass graft, and combined cardiac surgery. Three-dimensional transthoracic echocardiograms were performed preoperatively and on the second to fourth postoperative day. Blinded analysis was performed for LV regional longitudinal, circumferential, radial, and area strain in the 17-segment model. RESULTS Regional 3D longitudinal, circumferential, radial, and area strains were associated with differential patterns of myocardial dysfunction, depending on the surgical procedure performed and strain measure. Patients undergoing mitral valve repair or replacement had reduced function in the majority of myocardial segments, followed by coronary artery bypass graft, while patients undergoing aortic valve replacement had reduced function localized only to apical segments. After all types of cardiac surgery, segmental function in apical segments was reduced to a greater extent as compared to basal segments. Greater decrements in regional function were seen in circumferential and area strain, while smaller decrements were observed in longitudinal strain in all surgical patients. Both preoperative regional strain and change in regional strain preoperatively to postoperatively were correlated with reduced 1-year event-free survival, while postoperative strain was not predictive of outcomes. Only preoperative strain values were predictive of intensive care unit length of stay. CONCLUSIONS Changes in regional myocardial function, measured by 3D strain, varied by surgical procedure and strain type. Differences in regional LV function, from presurgery to postsurgery, were associated with worsened 1-year event-free survival. These findings suggest that postoperative changes in myocardial function are heterogeneous in nature, depending on the surgical procedure, and that these changes may have long-term impacts on outcome. Therefore, 3D regional strain may be used to identify patients at risk for worsened postoperative outcomes, allowing early interventions to mitigate risk.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Emily Methangkool
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Jennifer C. Scovotti
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Einat Mazor
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Tristan R. Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Wolf B. Kratzert
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Health System, Los Angeles, California
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Feinman J. Beyond Ejection Fraction: The Role of Intraoperative Left Ventricular Strain Analysis. J Cardiothorac Vasc Anesth 2019; 33:1323-1324. [PMID: 30642678 DOI: 10.1053/j.jvca.2018.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jared Feinman
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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Luis SA, Chan J, Pellikka PA. Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography. Mayo Clin Proc 2019; 94:125-138. [PMID: 30611439 DOI: 10.1016/j.mayocp.2018.07.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 01/30/2023]
Abstract
Assessment of left ventricular systolic function has a central role in the evaluation of cardiac disease. Accurate assessment is essential to guide management and prognosis. Numerous echocardiographic techniques are used in the assessment, each with its own advantages and disadvantages. This review is based on a literature search of the PubMed, MEDLINE, EMBASE, and Scopus databases from inception through December 30, 2017, using the terms strain echocardiography, tissue Doppler strain, and speckle-tracking echocardiography. We provide the internist with a contemporary overview of current echocardiographic techniques used in the evaluation of left ventricular systolic function. In particular, we focus on the role of speckle-tracking echocardiography, including its utility in the detection of subclinical left ventricular dysfunction and the associated prognostic implications.
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Affiliation(s)
- Sushil A Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Jonathan Chan
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Zhang K, Sheu R, Zimmerman NM, Alfirevic A, Sale S, Gillinov AM, Duncan AE. A Comparison of Global Longitudinal, Circumferential, and Radial Strain to Predict Outcomes After Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:1315-1322. [PMID: 30581109 DOI: 10.1053/j.jvca.2018.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Myocardial strain measured by speckle-tracking echocardiography detects subtle regional and global left ventricular dysfunction. Myocardial strain is measured in the longitudinal, circumferential, and radial dimensions; however, it is unclear which dimension of strain is the best predictor of postoperative outcomes. DESIGN A secondary analysis of prospectively collected data from a clinical trial (NCT01187329). SETTING The cardiothoracic surgical operating rooms of an academic tertiary-care center. PARTICIPANTS Cardiothoracic surgery patients with aortic stenosis having aortic valve replacement (AVR) with or without coronary artery bypass grafting enrolled in a clinical trial. INTERVENTIONS Myocardial deformation analysis from standardized investigative transesophageal echocardiographic examinations performed after induction of anesthesia. MEASUREMENTS AND MAIN RESULTS The authors compared the ability of intraoperative global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) strain to predict adverse postoperative outcomes, including prolonged hospitalization and the need for pharmacologic hemodynamic support after cardiac surgery. The association of GLS, GCS, and GRS with prolonged hospitalization (>7 days) and the need for pharmacologic hemodynamic support, with epinephrine or norepinephrine after cardiopulmonary bypass, were assessed using separate multivariable logistic regression models with adjustment for multiple comparisons. Of 100 patients, 86 had acceptable measurements for GLS analysis, 73 for GCS, and 72 for GRS. Worse GLS was associated with prolonged hospitalization [odds ratio [OR] (98.3% confidence interval [CI]) of 1.21 (1.01-1.46) per-unit worsening in strain (p = 0.01, significance criterion <0.0167)] and the need for inotropic support with epinephrine [OR (99.2% CI) of 1.81 (1.10-2.97) per-unit worsening in strain (p = 0.002, significance criterion <0.0083)], but not norepinephrine. GCS and GRS were not associated with adverse outcomes. CONCLUSION GLS, but not GCS or GRS, predicts prolonged hospitalization and the requirement for inotropic support with epinephrine after AVR.
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Affiliation(s)
- Kan Zhang
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Nicole M Zimmerman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH
| | - Shiva Sale
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Andra E Duncan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH.
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Shawky AM, Hamdy RM, Elmadbouly AA. Clinical utility of left ventricular strain, wall stress and serum brain natriuretic peptide levels in chronic hemodialysis patients. Egypt Heart J 2018; 70:329-335. [PMID: 30591751 PMCID: PMC6303356 DOI: 10.1016/j.ehj.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background Left ventricular (LV) global longitudinal strain (GLS) reliably assesses LV systolic function. The precise relation between LV wall stress and serum Brain natriuretic peptide (BNP) concentrations in hemodialysis (HD) patients needs to be clarified. BNP levels are raised in patients with end-stage renal disease (ESRD) and could reflect LV impairment among HD patients. Aim of this work This study sought to evaluate the clinical utility of LV-GLS, wall stress and serum BNP levels in chronic HD patients. The correlations between BNP levels with both LV wall stress and LV-GLS were assessed. Patients and methods 30 ESRD patients on regular HD {categorized into 15 patients with LV ejection fraction (EF) ≤ 50% and 15 patients with LV EF > 50%} and 15-age matched healthy subjects were included. LV function and structure were assessed by conventional echocardiography including LV meridional wall stress (LVMWS), LV mass index (LVMI) and 2-dimensional speckle tracking echocardiography for determination of LV-GLS. Serum BNP levels were evaluated after HD session. Results There were significant increase of LVMSW (189.2 ± 81 vs. 72.2 ± 20.6 dynes/cm2 × 1000, P < 0.0001), higher levels of BNP (1238 ± 1085.5 vs. 71 ± 23.4 pg/ml, P < 0.0001) while LV-GLS was significantly reduced (15.1 ± 3.1 vs. 20.8 ± 1.7%, P < 0.0001) in HD patients compared to controls. Higher values of LVMWS (246.9 ± 67.5 vs. 131.5 ± 43.6 dynes/cm2 × 1000, P < 0.0001) and BNP (1925.4 ± 1087 vs. 550.5 ± 496.5 pg/ml, P < 0.0005) with further impairment of LV-GLS (13.8 ± 2.5 vs. 16.4 ± 5.4%, P < 0.05) were found in patients with LV EF ≤ 50% than those with LV EF > 50%. Serum levels of BNP were positively correlated with LVMI (r = 0.896, P < 0.0001) and LVMWS (r = 0.697, P < 0.0001) but negatively correlated with LV-GLS (r = −0.587, P < 0.0001). Conclusion LV-GLS and LVMWS are useful imaging markers for detection of LV dysfunction in HD patients. Serum BNP level is influenced by LV structural abnormalities and suggested to be a crucial hemodynamic biomarker in those patients.
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Affiliation(s)
- Abeer M Shawky
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Rehab M Hamdy
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Asmaa A Elmadbouly
- Department of Clinical Pathology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
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Amabili P, Benbouchta S, Roediger L, Senard M, Hubert MB, Donneau AF, Brichant JF, Hans GA. Low Cardiac Output Syndrome After Adult Cardiac Surgery. Anesth Analg 2018; 126:1476-1483. [DOI: 10.1213/ane.0000000000002605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Howard-Quijano K, Zhang K, Skubas NJ. Strain as an Outcome Predictor. Anesth Analg 2018; 126:1453-1454. [PMID: 29672386 DOI: 10.1213/ane.0000000000002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kimberly Howard-Quijano
- From the Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
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Hodzic A, Chayer B, Wang D, Porée J, Cloutier G, Milliez P, Normand H, Garcia D, Saloux E, Tournoux F. Accuracy of speckle tracking in the context of stress echocardiography in short axis view: An in vitro validation study. PLoS One 2018; 13:e0193805. [PMID: 29584751 PMCID: PMC5870957 DOI: 10.1371/journal.pone.0193805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/03/2018] [Indexed: 11/18/2022] Open
Abstract
Aim This study aimed to test the accuracy of a speckle tracking algorithm to assess myocardial deformation in a large range of heart rates and strain magnitudes compared to sonomicrometry. Methods and results Using a tissue-mimicking phantom with cyclic radial deformation, radial strain derived from speckle tracking (RS-SpT) of the upper segment was assessed in short axis view by conventional echocardiography (Vivid q, GE) and post-processed with clinical software (EchoPAC, GE). RS-SpT was compared with radial strain measured simultaneously by sonomicrometers (RS-SN). Radial strain was assessed with increasing deformation rates (60 to 160 beats/min) and increasing pulsed volumes (50 to 100 ml/beat) to simulate physiological changes occurring during stress echocardiography. There was a significant correlation (R2 = 0.978, P <0.001) and a close agreement (bias ± 2SD, 0.39 ± 1.5%) between RS-SpT and RS-SN. For low strain values (<15%), speckle tracking showed a small but significant overestimation of radial strain compared to sonomicrometers. Two-way analysis of variance did not show any significant effect of the deformation rate. For RS-SpT, the feasibility was excellent and the intra- and inter-observer variability were low (the intraclass correlation coefficients were 0.96 and 0.97, respectively). Conclusions Speckle tracking demonstrated a good correlation with sonomicrometry for the assessment of radial strain independently of the heart rate and strain magnitude in a physiological range of values. Though speckle tracking seems to be a reliable and reproducible technique to assess myocardial deformation variations during stress echocardiography, further studies are mandated to analyze the impact of angulated and artefactual out-of-plane motions and inter-vendor variability.
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Affiliation(s)
- Amir Hodzic
- Research Unit of Biomechanics and Imaging in Cardiology, University of Montreal Hospital Research Center, Montréal, Québec, Canada
- Department of Cardiology, Echocardiography Laboratory, University Hospital Center, Caen, France
- Inserm Comete, Unicaen, University of Caen Normandy, Caen, France
| | - Boris Chayer
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Diya Wang
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Jonathan Porée
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Paul Milliez
- Department of Cardiology, Echocardiography Laboratory, University Hospital Center, Caen, France
| | - Hervé Normand
- Inserm Comete, Unicaen, University of Caen Normandy, Caen, France
| | - Damien Garcia
- Research Unit of Biomechanics and Imaging in Cardiology, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Eric Saloux
- Department of Cardiology, Echocardiography Laboratory, University Hospital Center, Caen, France
| | - Francois Tournoux
- Department of Cardiology, Echocardiography Laboratory, Hospital of the University of Montréal, Montréal, Québec, Canada
- * E-mail:
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Changes in Bi-ventricular Function After Hematopoietic Stem Cell Transplant as Assessed by Speckle Tracking Echocardiography. Pediatr Cardiol 2018; 39:365-374. [PMID: 29094192 DOI: 10.1007/s00246-017-1764-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/25/2017] [Indexed: 01/25/2023]
Abstract
Hematopoietic stem cell transplant (HSCT) is a therapeutic option for patients with sickle cell disease (SCD) and severe acquired aplastic anemia (SAA). HSCT may have beneficial effects on ventricular function in damaged myocardium. We hypothesized improvement in ventricular performance and pulmonary hypertension following HSCT with strain echocardiography in SCD and SAA. Echocardiographic strain and other standard functional data were obtained via retrospective cohort analysis of patients (n = 23) with SCD and SAA who underwent HSCT and were followed at a single center between 2000 and 2014. Left ventricular global longitudinal strain was below normal at baseline, and decreased significantly (from - 16.6 to - 11.1, P = 0.05) from pre-HSCT to the initial post-HSCT echocardiogram at 109 (SD ± 83) days. At 351 (SD ± 115) days, longitudinal strain improved significantly from initial decline (from - 11.1 to - 17.5, P = 0.009) but was comparable to baseline (P = 0.43). Other measurements of bi-ventricular function did not change significantly. Tricuspid regurgitation velocities as surrogates for pulmonary hypertension improved in the subset of patients with baseline elevated values although data points were limited. Abnormal myocardial systolic function was detected at baseline with strain imaging. HSCT was associated with initial worsening longitudinal strain values, followed by improvement to baseline levels by 1 year. Insufficient data exist on whether pulmonary hypertension improves after HSCT.
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Muraru D, Niero A, Rodriguez-Zanella H, Cherata D, Badano L. Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc Diagn Ther 2018. [PMID: 29541615 DOI: 10.21037/cdt.2017.06.01] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is an advanced imaging technique designed for left ventricular (LV) myocardial deformation analysis based on 3D data sets. 3DSTE has the potential to overcome some of the intrinsic limitations of two-dimensional STE (2DSTE) in the assessment of complex LV myocardial mechanics, offering additional deformation parameters (such as area strain) and a comprehensive quantitation of LV geometry and function from a single 3D acquisition. Albeit being a relatively young technique still undergoing technological developments, several experimental studies and clinical investigations have already demonstrated the reliability and feasibility of 3DSTE, as well as several advantages of 3DSTE over 2DSTE. This technique has provided new insights into LV mechanics in several clinical fields, such as the objective assessment of global and regional LV function in ischemic and non-ischemic heart diseases, the evaluation of LV mechanical dyssynchrony, as well as the detection of subclinical cardiac dysfunction in cardiovascular conditions at risk of progression to overt heart failure. However, 3DSTE generally requires patient's breathhold and regular rhythm for enabling an ECG-gated multi-beat 3D acquisition. In addition, the measurements, normal limits and cut-off values pertaining to 3D strain parameters are currently vendor-specific and highly dependent on the 3D ultrasound equipment used. Technological advances with improvement in spatial and temporal resolution and a standardized methodology for obtaining vendor-independent 3D strain measurements are expected in the future for a widespread application of 3DSTE in both clinical and research arenas. The purpose of this review is to summarize currently available data on 3DSTE methodology (feasibility, accuracy and reproducibility), strengths and weaknesses with respect to 2DSTE, as well as the main clinical applications and future research priorities of this emerging technology.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alice Niero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Hugo Rodriguez-Zanella
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.,Echocardiography Laboratory, National Institute of Cardiology, "Ignacio Chávez", Mexico City, Mexico
| | - Diana Cherata
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.,Department of Cardiology, "Filantropia" Municipal Hospital, Craiova, Romania
| | - Luigi Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Howard-Quijano K, McCabe M, Cheng A, Zhou W, Yamakawa K, Mazor E, Scovotti JC, Mahajan A. Left ventricular endocardial and epicardial strain changes with apical myocardial ischemia in an open-chest porcine model. Physiol Rep 2017; 4:4/24/e13042. [PMID: 28039400 PMCID: PMC5210372 DOI: 10.14814/phy2.13042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
Early detection of acute myocardial ischemia is critical to prevent permanent myocardial damage. The impact of apical ischemia on global left ventricular (LV) function can be difficult to characterize using traditional volume‐based echocardiography measures. Myocardial strain imaging is a sensitive, quantitative marker of myocardial deformation that can measure ventricular function. Recent advances allow layer‐specific measurement of endo‐ and epicardial strain, enhancing the ability to evaluate myocardial ischemia. This study investigates the effects of apical ischemia on LV function using epi‐ and endocardial strain. We hypothesize that myocardial strain will identify changes in regional and global myocardial function associated with focal apical ischemia as compared to ejection fraction (EF), and that longitudinal strain will be a better indicator of myocardial dysfunction compared to circumferential or radial strain. In a porcine model (n = 9), acute ischemia was induced by left anterior descending coronary artery occlusion. Echocardiograms were performed at baseline, during 15‐min ischemia, and after reperfusion. Global longitudinal strain decreased with acute focal ischemia of the left ventricular apical region (baseline: −16.4% vs. ischemia: −12.2%; P = 0.010), with no change observed in global circumferential and radial strain or EF. Both endocardial and epicardial longitudinal strain decreased by 68% (P < 0.001) in the ischemic and peri‐ischemic zone, while circumferential and radial strain only decreased in endocardium of the ischemic zone. Longitudinal strain was more sensitive to ischemia, being able to detect changes in global LV function and thus may confer clinical diagnostic advantage in the evaluation of acute LV apical ischemia.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Melissa McCabe
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Alexander Cheng
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Wei Zhou
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Kentaro Yamakawa
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Einat Mazor
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Jennifer C Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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Magoon R, Malik V, Choudhury A, Chauhan S, Hote MP, Ramakrishnan S, Singh V. A Comparison of the Strain and Tissue Doppler-Based Indices as Echocardiographic Correlates of the Left Ventricular Filling Pressures. J Cardiothorac Vasc Anesth 2017; 32:1297-1304. [PMID: 29290381 DOI: 10.1053/j.jvca.2017.11.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Diastolic strain and strain rate, combined with E (peak transmitral velocity), have been proposed as novel noninvasive predictors of left ventricle (LV) filling pressures, avoiding angulation errors inherent to tissue Doppler indices (TDI). The primary objective was to study the correlation of strain-based indices (SBI) and TDI with pulmonary artery catheter-derived LV end-diastolic pressures (LVEDP). The secondary aim was to determine appropriate cut-off of indices to predict LVEDP ≥15 mmHg. DESIGN A prospective observational clinical study. SETTING Single university hospital. PARTICIPANTS One hundred twenty adults with preserved ejection fraction (EF) undergoing coronary artery bypass grafting. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two-dimensional speckle-tracking echocardiography estimated global longitudinal diastolic strain (Ds) and strain rate (DSr) at peak mitral filling to compute E/Ds and E/10DSr. TDI was measured as the ratio of E and e' (mitral annular diastolic velocity). E/e', E/Ds, and E/10DSr were significantly higher (p < 0.001) in patients with LVEDP ≥15 mm Hg (31/120). Correlation of E/Ds, E/10DSr with LVEDP was R = 0.86 and 0.88 (p < 0.001), respectively, compared with a correlation of R = 0.63 (p < 0.001) for E/e'. SBI correlated well with LVEDP ≥15 mm Hg compared with TDI. E/Ds ≥11 and E/10DSr ≥12 had higher sensitivity and specificity (96.77%, 93.26%; 100%, 96.63%, respectively; area under the curve [AUC] = 0.99) than E/e'≥13 (74%,75%; AUC = 0.84) for prediction of LVEDP ≥15 mmHg. SBI accurately predicted elevated LVEDP in the indeterminate zone of 8<E/e' <13. CONCLUSIONS SBI were better predictors of LVEDP, compared with TDI, in patients with preserved EF and indeterminate E/e' values.
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Affiliation(s)
- Rohan Magoon
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Arindam Choudhury
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Milind P Hote
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sivasubramanian Ramakrishnan
- Department of Cardiology, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kumar A, Puri GD, Bahl A. Transesophageal Echocardiography, 3-Dimensional and Speckle Tracking Together as Sensitive Markers for Early Outcome in Patients With Left Ventricular Dysfunction Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:1695-1701. [DOI: 10.1053/j.jvca.2017.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 01/01/2023]
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Balderas-Muñoz K, Rodríguez-Zanella H, Fritche-Salazar JF, Ávila-Vanzzini N, Juárez Orozco LE, Arias-Godínez JA, Calvillo-Argüelles O, Rivera-Peralta S, Sauza-Sosa JC, Ruiz-Esparza ME, Bucio-Reta E, Rómero A, Espinola-Zavaleta N, Domínguez-Mendez B, Gaxiola-Macias M, Martínez-Ríos MA. Improving risk assessment for post-surgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain. Int J Cardiovasc Imaging 2017; 33:1483-1489. [DOI: 10.1007/s10554-017-1139-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
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Gunasekaran P, Panaich S, Briasoulis A, Cardozo S, Afonso L. Incremental Value of Two Dimensional Speckle Tracking Echocardiography in the Functional Assessment and Characterization of Subclinical Left Ventricular Dysfunction. Curr Cardiol Rev 2017; 13:32-40. [PMID: 27411342 PMCID: PMC5324318 DOI: 10.2174/1573403x12666160712095938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 02/01/2023] Open
Abstract
Subclinical left ventricular (LV) dysfunction refers to subtle abnormalities in LV function which typically precede a reduction in the left ventricular ejection fraction (LVEF). The assessment of myocardial function using LVEF, a radial metric of systolic function, is subject to load dependence, intra-observer and inter-observer variability. Reductions in LVEF typically manifest late in the disease process thus compromising the ability to intervene before irreversible impairment of systolic performance sets in. 2-Dimensional speckle tracking echocardiography (2D-STE), a novel strain imaging modality has shown promise as a sensitive indicator of myocardial contractility. It arms the clinician with a powerful and practical tool to rapidly quantify cardiac mechanics, circumventing several inherent limitations of conventional echocardiography. This article highlights the incremental utility of 2D-STE in the detection of subclinical LV dysfunction.
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Affiliation(s)
| | | | | | | | - Luis Afonso
- Division of Cardiology, Wayne State University, Detroit Medical Center, 3990 John R, 8-Brush, Harper University Hospital, Detroit, Michigan-48201. United States
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Howard-Quijano K, Salem A, Barkulis C, Mazor E, Scovotti JC, Ho JK, Shemin RJ, Grogan T, Elashoff D, Mahajan A. Preoperative Three-Dimensional Strain Imaging Identifies Reduction in Left Ventricular Function and Predicts Outcomes After Cardiac Surgery. Anesth Analg 2017; 124:419-428. [DOI: 10.1213/ane.0000000000001440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Sulemane S, Panoulas VF, Bratsas A, Grapsa J, Brown EA, Nihoyannopoulos P. Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction. Int J Cardiovasc Imaging 2017; 33:687-698. [PMID: 28120157 PMCID: PMC5383685 DOI: 10.1007/s10554-016-1059-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/30/2016] [Indexed: 01/20/2023]
Abstract
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
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Affiliation(s)
- Samir Sulemane
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK.
| | - Vasileios F Panoulas
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
- Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Athanasios Bratsas
- Imperial College Healthcare NHS, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Julia Grapsa
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Ducane road, London, W12 0HP, UK
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart and Lung Institute, Sydney Street, London, SW6 3NP, UK
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Subclinical Myocardial Dysfunction in Asymptomatic Mitral Regurgitation. J Am Coll Cardiol 2016; 68:1987-1989. [DOI: 10.1016/j.jacc.2016.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 11/21/2022]
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Abstract
Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.
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Perdreau E, Séguéla PE, Jalal Z, Perdreau A, Mouton JB, Nelson-Veniard M, Guillet E, Iriart X, Ouattara A, Roubertie F, Mauriat P, Thambo JB. Postoperative assessment of left ventricular function by two-dimensional strain (speckle tracking) after paediatric cardiac surgery. Arch Cardiovasc Dis 2016; 109:599-606. [DOI: 10.1016/j.acvd.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/09/2016] [Accepted: 03/10/2016] [Indexed: 10/20/2022]
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Mentias A, Naji P, Gillinov AM, Rodriguez LL, Reed G, Mihaljevic T, Suri RM, Sabik JF, Svensson LG, Grimm RA, Griffin BP, Desai MY. Strain Echocardiography and Functional Capacity in Asymptomatic Primary Mitral Regurgitation With Preserved Ejection Fraction. J Am Coll Cardiol 2016; 68:1974-1986. [DOI: 10.1016/j.jacc.2016.08.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
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Alashi A, Mentias A, Patel K, Gillinov AM, Sabik JF, Popović ZB, Mihaljevic T, Suri RM, Rodriguez LL, Svensson LG, Griffin BP, Desai MY. Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004451. [DOI: 10.1161/circimaging.115.004451] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/22/2016] [Indexed: 11/16/2022]
Abstract
Background—
In asymptomatic patients with ≥3+ mitral regurgitation and preserved left ventricular (LV) ejection fraction who underwent mitral valve surgery, we sought to discover whether baseline LV global longitudinal strain (LV-GLS) and brain natriuretic peptide provided incremental prognostic utility.
Methods and Results—
Four hundred and forty-eight asymptomatic patients (61±12 years and 69% men) with ≥3+ primary mitral regurgitation and preserved left ventricular ejection fraction, who underwent mitral valve surgery (92% repair) at our center between 2005 and 2008, were studied. Baseline clinical and echocardiographic data (including LV-GLS using Velocity Vector Imaging, Siemens, PA) were recorded. The Society of Thoracic Surgeons score was calculated. The primary outcome was death. Mean Society of Thoracic Surgeons score, left ventricular ejection fraction, mitral effective regurgitant orifice, indexed LV end-diastolic volume, and right ventricular systolic pressure were 4±1%, 62±3%, 0.55±0.2 cm
2
, 58±13 cc/m
2
, and 37±15 mm Hg, respectively. Forty-five percent of patients had flail. Median log-transformed BNP and LV-GLS were 4.04 (absolute brain natriuretic peptide: 60 pg/dL) and −20.7%. At 7.7±2 years, death occurred in 41 patients (9%; 0% at 30 days). On Cox analysis, a higher Society of Thoracic Surgeons score (hazard ratio 1.55), higher baseline right ventricular systolic pressure (hazard ratio 1.11), more abnormal LV-GLS (hazard ratio 1.17), and higher median log-transformed BNP (hazard ratio 2.26) were associated with worse longer-term survival (all
P
<0.01). Addition of LV-GLS and median log-transformed BNP to a clinical model (Society of Thoracic Surgeons score and baseline right ventricular systolic pressure) provided incremental prognostic utility (χ
2
for longer-term mortality increased from 31–47 to 61;
P
<0.001).
Conclusions—
In asymptomatic patients with significant primary mitral regurgitation and preserved left ventricular ejection fraction who underwent mitral valve surgery, brain natriuretic peptide and LV-GLS provided synergistic risk stratification, independent of established factors.
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Affiliation(s)
- Alaa Alashi
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Amgad Mentias
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Krishna Patel
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - A. Marc Gillinov
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Joseph F. Sabik
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Zoran B. Popović
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Tomislav Mihaljevic
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Rakesh M. Suri
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - L. Leonardo Rodriguez
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Lars G. Svensson
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Brian P. Griffin
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Milind Y. Desai
- From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH
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50
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Jang SY, Yang DH, Kim NK, Kim CY, Bae MH, Lee JH, Park HS, Cho Y, Chae SC. Difference in the Prognostic Impact of Left Ventricular Global Longitudinal Strain between Anterior and Nonanterior Myocardial Infarction. Echocardiography 2016; 33:984-90. [PMID: 27316949 DOI: 10.1111/echo.13208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Speckle tracking-derived global longitudinal strain (GLS) of left ventricle is a potent prognostic marker for patients with ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to investigate the difference of prognostic impact of GLS between anterior and nonanterior myocardial infarction. METHODS This study included 686 patients who underwent primary percutaneous coronary intervention for their first STEMI between November 2007 and April 2012. Differences in the prognostic impact of GLS between anterior MI group and nonanterior MI group were evaluated. The composite of all-cause mortality and hospitalization for heart failure in 2 years was investigated for outcome. RESULTS During the follow-up period, 77 (11.2%) adverse events occurred. The anterior and nonanterior MI groups included 339 and 347 patients, respectively. Among patients with anterior MI, GLS significantly predicted 2-year outcome in an adjusted model (adjusted hazard ratio [HR] 1.186; 95% confidence interval [CI] 1.071-1.314, P = 0.001), whereas the association between GLS and mortality was weaker in the nonanterior MI group (adjusted HR 0.977; 95% CI 0.884-1.081, P = 0.657). The interaction between the infarction territory and GLS was significant (P for interaction = 0.018), indicating that GLS was a more sensitive predictor of mortality in patients with anterior MI than that in those with nonanterior MI. CONCLUSIONS Speckle tracking-derived GLS of left ventricle more sensitively predicted clinical outcome in patients with anterior MI than in those with nonanterior MI.
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Affiliation(s)
- Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Nam Kyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chang-Yeon Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
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