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Akay Caglayan H, Kjønås D, Kornev M, Iqbal A, Jazbani M, Rösner A. Resting segmental speckle tracking strain and strain rate in stable coronary artery disease and revascularized myocardial infarction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03200-0. [PMID: 39179715 DOI: 10.1007/s10554-024-03200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 07/16/2024] [Indexed: 08/26/2024]
Abstract
Patients with acute coronary artery disease (CAD) exhibit reduced global and regional strain and strain rate (S/SR). However, knowledge about segmental S/SR in stable CAD patients is still limited. This study aimed to investigate whether resting segmental S/SR measurements differ in patients with chronic chest pain who have normal coronary arteries or stenotic coronary arteries, and to compare these measurements to those in patients with revascularized myocardial infarction (MI). We prospectively enrolled 510 patients with chronic chest pain referred for coronary computed tomography angiography (CCTA) and 102 patients revascularized after MI. All participants underwent transthoracic echocardiography featuring S/SR analysis. In addition to the patients with MI, patients with suspected CAD based on CCTA findings subsequently underwent invasive coronary angiography (CAG). We assessed global longitudinal strain (GLS) and averaged segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), and post systolic shortening (PSS). We also determined functionally reduced segment percentages using differing S/SR cut-off values. There were significant disparities in all average segmental S/SR metrics between the No-CAD and MI groups. SRe was the only S/SR metric that differed significantly between the No-CAD and PCI groups. Differences in SRe, PLS and GLS measurements were observed between the No-CAD and CABG groups. The proportion of diminished segmental S/SR mirrored these findings. For the percentage of pathological segments with varying cut-off values, segmental SRe below 1.5 s- 1 displayed the most marked difference among the four groups (p < 0.001). Revascularized MI patients or those referred to CABG present with diminished segmental S/SR values. However, among patients with chronic chest pain, only segmental SRe discerns subtle disparities between the No-CAD and the PCI group. The diagnostic accuracy of SRe warrants further exploration in subsequent studies.
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Affiliation(s)
- Hatice Akay Caglayan
- Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Didrik Kjønås
- Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Gastrointestinal surgery, University Hospital of North Norway, Tromsø, Norway
| | - Mikhail Kornev
- Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Amjid Iqbal
- Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mehran Jazbani
- Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Assami Rösner
- Department of Cardiology, Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Chen EW, Bashir Z, Churchill JL, Has P, Klas B, Aurigemma GP, Bisaillon J, Dickey JB, Haines P. Evaluating left atrial strain and left ventricular diastolic strain rate as markers for diastolic dysfunction in patients with mitral annular calcification. Int J Cardiovasc Imaging 2024; 40:733-743. [PMID: 38289428 PMCID: PMC11052839 DOI: 10.1007/s10554-023-03041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) poses many challenges to the evaluation of diastolic function using standard echocardiography. Left atrial (LA) strain and left ventricular early diastolic strain rate (DSr) measured by speckle-tracking echocardiography (STE) are emerging techniques in the noninvasive evaluation of diastolic function. We aim to evaluate the utility of LA strain and early DSr in predicting elevated left ventricular filling pressures (LVFP) in patients with MAC and compare their effectiveness to ratio of mitral inflow velocity in early and late diastole (E/A). METHODS We included adult patients with MAC who presented between January 1 and December 31, 2014 and received a transthoracic echocardiogram (TTE) and cardiac catheterization with measurement of LVFP within a 24-h period. We used Spearman's rank correlation coefficient to assess associations of LA reservoir strain and average early DSr with LVFP. Receiver operating characteristic (ROC) curves were computed to assess the effectiveness of LA strain and DSr in discriminating elevated LVFP as a dichotomized variable and to compare their effectiveness with E/A ratio categorized according to grade of diastolic dysfunction. RESULTS Fifty-five patients were included. LA reservoir strain demonstrated poor correlation with LVFP (Spearman's rho = 0.03, p = 0.81) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.54, 95% CI 0.38-0.69). Categorical E/A ratio alone also demonstrated poor discriminatory ability (AUC = 0.53, 95% CI 0.39-0.67), and addition of LA reservoir strain did not significantly improve effectiveness (AUC = 0.58, 95% CI 0.42-0.74, p = 0.56). Average early DSr also demonstrated poor correlation with LVFP (Spearman's rho = -0.19, p = 0.16) and poor discriminatory ability for detecting elevated LVFP (AUC = 0.59, 95% CI 0.44-0.75). Addition of average early DSr to categorical E/A ratio failed to improve effectiveness (AUC = 0.62, 95% CI 0.46-0.77 vs. AUC = 0.54, 95% CI 0.39-0.69, p = 0.38). CONCLUSIONS In our sample, LA reservoir strain and DSr do not accurately predict diastolic filling pressure. Further research is required before LA strain and early DSr can be routinely used in clinical practice to assess filling pressure in patients with MAC.
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Affiliation(s)
- Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zubair Bashir
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica L Churchill
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, RI, USA
| | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Jonathan Bisaillon
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Philip Haines
- Department of Cardiology, Alpert Medical School of Brown University, Providence, RI, USA
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Lassen MCH, Biering-Sørensen T, Jørgensen PG, Bahrami HSZ, Andersen HU, Rossing P, Jensen MT. Ratio of transmitral early filling velocity to diastolic strain rate and prognosis in type-1 diabetes. Int J Cardiol 2024; 397:131653. [PMID: 38101702 DOI: 10.1016/j.ijcard.2023.131653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/13/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Impaired diastolic function is a hallmark of diabetic cardiomyopathy and a common feature in type 1 diabetes mellitus (T1DM). The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has in recent studies proved to have strong prognostic value. This study aimed to investigate the prognostic value of E/e'sr compared to E/e' in T1DM without known heart disease. METHODS In this prospective cohort of T1DM patients, echocardiography was performed including two-dimensional speckle tracking. Follow-up was performed using nationwide registries. Outcomes were all-cause mortality and major cardiovascular events (MACE). RESULTS In total 1079 patients (age: 49.6 ± 14.5 years, 52.5% male, duration of diabetes 25.8 ± 14.6 years) were included in the study. During follow-up (median 6.3 years, IQR:5.7-6.9) 13.2% experienced MACE and 5.8% died. Following multivariable adjustment, both E/e'sr and E/e' was significantly associated with both MACE (E/e'sr: HR 1.16 CI95%:[1.05-1.29], p = 0.005, per 10 cm increase) vs. (E/e': HR 1.09 CI95%:[1.03-1.15], p = 0.001, per 1 unit increase) and all-cause mortality (E/e'sr: HR 1.20 [1.03-1.40], p = 0.016) vs. (E/e': HR: 1.11 [1.02-1.20], p = 0.016). Sex modified the association between E/e'sr and MACE (p for interaction = 0.008) such that E/e'sr after multivariable adjustment only remained significantly associated with MACE in females (HR: 1.41 [1.19-1.67], p < 0.001) but not in males (HR: 1.06 [0.93-1.20], p = 0.42). In females, E/e'sr provided incremental information beyond the Steno T1 Risk Engine (Harrell's C-statistic: 0.78 (0.72-0.83) vs. 0.81 (0.75-0.86), p = 0.007). CONCLUSION In patients with T1DM, both E/e'sr and E/e' provides independent prognostic information regarding prognosis. E/e'sr seems to have stronger prognostic value in females with T1DM.
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Affiliation(s)
- Mats Christian Højbjerg Lassen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København, Denmark; Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Hashmat S Z Bahrami
- Department of Cardiology, Amager & Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, 2650 Hvidovre, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Magnus T Jensen
- Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Bjerregaard CL, Olsen FJ, Lassen MCH, Svartstein ASW, Hansen TF, Galatius S, Iversen A, Pedersen S, Biering-Sørensen T. Ratio of early transmitral inflow velocity to early diastolic strain rate predicts atrial fibrillation following acute myocardial infarction. Int J Cardiovasc Imaging 2024; 40:331-340. [PMID: 37957448 PMCID: PMC10884066 DOI: 10.1007/s10554-023-02991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
The ratio of early transmitral filling velocity to early diastolic strain rate (E/SRe) has been proposed as a new non-invasive measurement of left ventricular filling pressure. We aimed to investigate the ability of E/SRe to predict atrial fibrillation (AF) after ST-elevation myocardial infarction (STEMI). This was a prospective cohort study of patients (n = 369) with STEMI. Patients underwent an echocardiographic examination a median of two days after pPCI. By echocardiography, transmitral early filling velocity (E) was measured by pulsed-wave Doppler, and early diastolic strain rate (SRe) was measured by speckle tracking of the left ventricle. E was indexed to SRe and the early myocardial relaxation velocity (e') to obtain the E/SRe and E/e', respectively. The endpoint was new-onset AF. During follow-up (median 5.6 years, IQR: 5.0-6.1 years), 23 (6%) of the 369 patients developed AF. In unadjusted analyses, both E/SRe and E/e' were significantly associated with AF [E/SRe: HR = 1.06; (1.03-1.10); p < 0.001, per 10 increase] and [E/e': HR = 1.11 (1.05-1.17); p < 0.001, per 1 increase] and had equal Harrell's C-statistic of 0.71. However, only E/SRe remained an independent predictor after multivariable adjustments for clinical and echocardiographic parameters [E/SRe: HR = 1.06 (1.00-1.11); p = 0.044, per 10 increase]. E/SRe was further significantly associated with AF in patients with E/e' < 14 HR = 1.09 (1.01-1.17); p = 0.030, per 10 increase), also after multivariable adjustments. E/SRe is an independent predictor of AF in STEMI patients, even in subjects with seemingly normal filling pressure.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Thomas Fritz Hansen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lassen MCH, Skaarup KG, Johansen ND, Olsen FJ, Qasim AN, Jensen GB, Schnohr P, Møgelvang R, Biering-Sørensen T. Normal Values and Reference Ranges for the Ratio of Transmitral Early Filling Velocity to Early Diastolic Strain Rate: The Copenhagen City Heart Study. J Am Soc Echocardiogr 2023; 36:1204-1212. [PMID: 37390909 DOI: 10.1016/j.echo.2023.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has recently emerged as a measure of left ventricular filling pressure. Reference values are needed for this new parameter for it to be used clinically. METHODS Healthy participants from a prospective general population study, the Fifth Copenhagen City Heart Study, were assessed to establish reference values for E/e'sr derived from two-dimensional speckle-tracking echocardiography. The prevalence of abnormal E/e'sr was assessed in participants with cardiovascular risk factors or specific diseases. RESULTS The population comprised 1,623 healthy participants (median age, 45; interquartile range, 32-56; 61% female). The upper reference limit for E/e'sr in the population was 79.6 cm. Following multivariable adjustment, male participants exhibited significantly higher E/e'sr than female participants (upper reference limit for male participants, 83.7 cm; for female participants, 76.5 cm). For both sexes, E/e'sr increased in a curvilinear fashion with age such that the largest increases in E/e'sr were observed in participants >45 years. In the entire CCHS5 population with E/e'sr available (n = 3,902), increasing age, body mass index, systolic blood pressure, male sex, estimated glomerular filtration rate, and diabetes were associated with E/e'sr (all P < .05). Total cholesterol was associated with a less steep increase in E/e'sr. Abnormal E/e'sr was seldomly observed in participants with normal diastolic function but became more frequent in participants with increasing grades of diastolic dysfunction (normal, mild, moderate, severe [abnormal E/e'sr for each grade: 4.4% vs 20.0% vs 16.2% vs 55.6%, respectively]). CONCLUSION The E/e'sr differs between sexes and is age dependent such that E/e'sr increases with advancing age. Therefore, we established sex- and age-stratified reference values for E/e'sr.
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Affiliation(s)
| | | | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | - Atif N Qasim
- Division of Cardiology, UCSF Medical Center, University of California San Francisco, San Francisco, California
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark; The Copenhagen City Heart Study, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Wei L, Dong JX, Jin LX, He J, Zhao CX, Kong LC, An DAL, Ding S, Yang F, Yang YN, Yan FH, Xiu JC, Wang HW, Ge H, Pu J. Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction. LA RADIOLOGIA MEDICA 2023; 128:1372-1385. [PMID: 37640898 DOI: 10.1007/s11547-023-01700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The prognostic role of diastolic dysfunction measured by the circumferential peak early diastolic strain rate (PEDSR) on ST-elevation myocardial infarction (STEMI) is not completely established. OBJECTIVES We aimed to investigate the prognostic value of diastolic function by measuring PEDSR within 1 week after STEMI. METHODS The cardiac magnetic resonance (CMR) pictures of 420 subjects from a clinical registry study (NCT03768453) were analyzed and the composite major adverse cardiac events (MACEs) were followed up. RESULTS The PEDSR of patients was significantly lower compared with that of control subjects (P < 0.001). Within the median follow-up period of 52 months, PEDSR of patients who experienced MACEs deceased more significantly than that of patients without MACEs (P < 0.001). After adjusting with clinical or CMR indexes, per 0.1/s reduction of PEDSR increased the risks of MACEs to 1.402 or 1.376 fold and the risk of left ventricular (LV) remodeling to 1.503 or 1.369 fold. When PEDSR divided by best cutoff point, significantly higher risk of MACEs (P < 0.001) and more remarkable LV remodeling (P < 0.001) occurred in patients with PEDSR ≤ 0.485/s. Moreover, when adding the PEDSR to the conventional prognostic factors such as LV ejection fraction and infarction size, better prognostic risk classification models were created. Finally, aging, tobacco use, remarkable LV remodeling, and a low LV ejection fraction were factors related with the reduction of PEDSR. CONCLUSIONS Diastolic dysfunction has an important prognostic effect on patients with STEMI. Measurement of the PEDSR in the acute phase could serve as an effective index to predict the long-term risk of MACEs and cardiac remodeling.
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Affiliation(s)
- Lai Wei
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Xun Dong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Xing Jin
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen-Xu Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling-Cong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Ao-Lei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Ning Yang
- The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China
| | - Fu-Hua Yan
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Cheng Xiu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hu-Wen Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Abbasi MA, Bruno G, Di Stefano C, Garcia Bello L, Laack NN, Corbin KS, Whitaker TJ, Pellikka PA, Mutter RW, Villarraga HR. Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study. J Cardiovasc Dev Dis 2023; 10:418. [PMID: 37887865 PMCID: PMC10607871 DOI: 10.3390/jcdd10100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27-79] vs. 217 [120-596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.
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Affiliation(s)
| | - Giulia Bruno
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Cristina Di Stefano
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Laura Garcia Bello
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pharmacology, Mayo Clinic, Rochester, MN 55905, USA
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Shabani M, Ostovaneh MR, Ma X, Ambale Venkatesh B, Wu CO, Chahal H, Bakhshi H, McClelland RL, Liu K, Shea SJ, Burke G, Post WS, Watson KE, Folsom AR, Bluemke DA, Lima JAC. Pre-diagnostic predictors of mortality in patients with heart failure: The multi-ethnic study of atherosclerosis. Front Cardiovasc Med 2022; 9:1024031. [PMID: 36620619 PMCID: PMC9812565 DOI: 10.3389/fcvm.2022.1024031] [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: 08/20/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background There are multiple predictive factors for cardiovascular (CV) mortality measured at, or after heart failure (HF) diagnosis. However, the predictive role of long-term exposure to these predictors prior to HF diagnosis is unknown. Objectives We aim to identify predictive factors of CV mortality in participants with HF, using cumulative exposure to risk factors before HF development. Methods Participants of Multi-Ethnic Study of Atherosclerosis (MESA) with incident HF were included. We used stepwise Akaike Information Criterion to select CV mortality predictors among clinical, biochemical, and imaging markers collected prior to HF. Using the AUC of B-spline-corrected curves, we estimated cumulative exposure to predictive factors from baseline to the last exam before HF. The prognostic performance for CV mortality after HF was evaluated using competing risk regression with non-CV mortality as the competing risk. Results Overall, 375 participants had new HF events (42.9% female, mean age: 74). Over an average follow-up of 4.7 years, there was no difference in the hazard of CV death for HF with reduced versus preserved ejection fraction (HR = 1.27, p = 0.23). The selected predictors of CV mortality in models with the least prediction error were age, cardiac arrest, myocardial infarction, and diabetes, QRS duration, HDL, cumulative exposure to total cholesterol and glucose, NT-proBNP, left ventricular mass, and statin use. The AUC of the models were 0.72 when including the latest exposure to predictive factors and 0.79 when including cumulative prior exposure to predictive factors (p = 0.20). Conclusion In HF patients, besides age and diagnosed diabetes or CVD, prior lipid profile, NT-proBNP, LV mass, and QRS duration available at the diagnosis time strongly predict CV mortality. Implementing cumulative exposure to cholesterol and glucose, instead of latest measures, improves predictive accuracy for HF mortality, though not reaching statistical significance.
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Affiliation(s)
- Mahsima Shabani
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Mohammad R. Ostovaneh
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, United States
| | | | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Harjit Chahal
- Medstar Heart and Vascular Institute, Washington, DC, United States
| | - Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Inova Heart and Vascular Institute, Falls Church, VA, United States
| | - Robyn L. McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Steven J. Shea
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, United States,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC, United States
| | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karol E. Watson
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - João A. C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiology, Johns Hopkins University, Baltimore, MD, United States,*Correspondence: João A. C. Lima,
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9
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Chamberlain R, Edwards NFA, Scalia GM, Chan J. Novel left and right ventricular strain analysis to detect subclinical myocardial dysfunction in cardiac allograft rejection. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1077-1088. [PMID: 34936051 DOI: 10.1007/s10554-021-02486-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Early detection of acute cellular rejection (ACR) by echocardiography shows potential clinical benefit as ACR remains a significant contributor to morbidity and mortality. This retrospective, longitudinal study sought to investigate the use of novel left (LV) and right ventricular (RV) strain analysis to detect biopsy proven ACR. 46 heart transplant patients (Mean age 46 ± 16 years) with biopsy proven ACR were grouped according to biopsy results: 1R-ACR (n = 36) and 2R-ACR (n = 10). Serial two-dimensional transthoracic echocardiography with strain analysis was performed. Echocardiographic parameters were serially measured: (1) rejection free period (0R-ACR); (2) pre-ACR period (pre-ACR); (3) during ACR (1R-ACR or 2R-ACR) and (4) post-ACR (Post-ACR). Significant reductions for LV Global Longitudinal Strain (LV GLS) and LV Early diastolic Strain rate (LV ESr) were observed between 0R-ACR and pre-ACR (LV GLS 0R-ACR: 17.3% vs Pre-2R ACR: 15.4%, p = 0.016; LV ESr 0R-ACR: 1.00/s vs Pre-2R ACR: 0.74/s, p = 0.007) with LV ESr demonstrating the highest sensitivity (92%) and specificity (81%) to predict ACR. LV ESr and the E/LV ESr ratio were significantly different (p = 0.0001; p = 0.016) during pre-1R ACR period vs 0R whereas LV GLS showed no significant differences for grade 1R-ACR. Diastolic mechanical dispersion showed significant increases in dispersion during ACR for the 1R-ACR group and early significant increases pre-2R ACR. Systolic and diastolic RV strain parameters showed a similar trend for both ACR groups. Systolic and diastolic strain parameters can detect myocardial dysfunction before biopsy confirmed 2R-ACR. Early diastolic strain rate parameters are most sensitive detecting subclinical myocardial dysfunction pre-ACR. Novel strain parameters are potentially useful clinical tool for prediction of early ACR in heart transplant.
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Affiliation(s)
- Robert Chamberlain
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Natalie F A Edwards
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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10
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Fukamachi D, Yamada A, Ohgaku A, Koyama Y, Fujito H, Arai R, Ebuchi Y, Migita S, Morikawa T, Monden M, Takei N, Tamaki T, Kojima K, Akutsu N, Murata N, Saito Y, Kitano D, Sudo M, Okumura Y. Protective effect of the Impella on the left ventricular function after acute broad anterior wall ST elevation myocardial infarctions with cardiogenic shock: cardiovascular magnetic resonance imaging strain analysis. BMC Cardiovasc Disord 2022; 22:201. [PMID: 35484492 PMCID: PMC9052554 DOI: 10.1186/s12872-022-02632-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical efficacy of the Impella for high-risk percutaneous coronary intervention (PCI) and cardiogenic shock remains under debate. We thus sought to investigate the protective effects on the heart with the Impella's early use pre-PCI using cardiac magnetic resonance imaging (CMRI). METHODS We retrospectively evaluated the difference in the subacute phase CMR imaging results (19 ± 9 days after admission) between patients undergoing an Impella (n = 7) or not (non-Impella group: n = 18 [12 intra-aortic balloon pumps (1 plus veno-arterial extracorporeal membrane oxygenation) and 6 no mechanical circulation systems]) in broad anterior ST-elevation myocardial infarction (STEMI) cases. A mechanical circulation system was implanted pre-PCI. RESULTS No differences were found in the door-to-balloon time, peak creatine kinase, and hospital admission days between the Impella and non-Impella groups; however, the CMRI-derived left ventricular ejection fraction was significantly greater (45 ± 13% vs. 34 ± 7.6%, P = 0.034) and end-diastolic and systolic volumes smaller in the Impella group (149 ± 29 vs. 187 ± 41 mL, P = 0.006: 80 ± 29 vs. 121 ± 40 mL, P = 0.012). Although the global longitudinal peak strain did not differ, the global radial (GRS) and circumferential peak strain (GCS) were significantly higher in the IMPELLA than non-IMPELLA group. Greater systolic and diastolic strain rates (SRs) in the Impella than non-Impella group were observed in non-infarcted rather than infarcted areas. CONCLUSIONS Early implantation of an Impella before PCIs for STEMIs sub-acutely prevented cardiac dysfunction through preserving the GRS, GCS, and systolic and diastolic SRs in the remote myocardium. This study provided mechanistic insight into understanding the usefulness of the Impella to prevent future heart failure.
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Affiliation(s)
- Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Akimasa Yamada
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akihito Ohgaku
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yutaka Koyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hidesato Fujito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Riku Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasunari Ebuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Suguru Migita
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tomoyuki Morikawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masaki Monden
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Norio Takei
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takehiro Tamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Keisuke Kojima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naotaka Akutsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Mitsumasa Sudo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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11
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Lassen MCH, Lindberg S, Olsen FJ, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Møgelvang R, Biering-Sørensen T. Early diastolic strain rate in relation to long term prognosis following isolated coronary artery bypass grafting. Int J Cardiol 2021; 345:137-142. [PMID: 34688721 DOI: 10.1016/j.ijcard.2021.10.022] [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: 06/30/2021] [Revised: 09/15/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ratio of early mitral inflow velocity to early diastolic strain rate (E/e'sr) is a novel echocardiographic measure to estimate early left ventricular (LV) filling pressure. We hypothesize that E/e'sr is a predictor of outcome following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e'. METHODS & RESULTS Consecutive patients undergoing isolated CABG at Gentofte Hospital (n = 652) were included. The mean age of the study population was 67 ± 9 years, 84% were male, mean LVEF was 50 ± 11%. Prior to surgery, all patients underwent an extensive echocardiographic examination. The outcome was all-cause mortality. During follow-up (median 3.8 years [IQR: 2.7; 4.9 years]), a total of 73 (11.2%) died. Both E/e' and E/e'sr were significant predictors in univariable models. In a multivariable model, E/e'sr remained an independent predictor of outcome (HR:1.05 [1.01-1.10], p = 0.049, per 10 cm increase) whereas E/e' did not (HR:1.05 [0.99-1.11], p = 0.053, per 1-unit increase). The relationship between E/e'sr, and the outcome was significantly modified by GLS (p for interaction = 0.043). In the multivariable model, E/e'sr was still significantly associated with the outcome in patients with high GLS (≥13.6%) (HR:1.18 [1.02-1.36], p = 0.029) but not in patients with low GLS (HR 1.04 CI95%: [0.99-1.10], p = 0.14). E/e' was not a significant predictor of all-cause mortality after multivariable adjustment in neither of the groups. E/e'sr improved net reclassification with 33% when added to EuroSCOREII. CONCLUSION Following CABG, preoperative E/e'sr is an independent predictor of all-cause mortality, especially in patients with preserved systolic function and superior to E/e'.
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Affiliation(s)
- Mats C H Lassen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.
| | - Søren Lindberg
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Flemming J Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Southern Denmark, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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12
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Bharadwaj S, Prasad S, Almekkawy M. An Upgraded Siamese Neural Network for Motion Tracking in Ultrasound Image Sequences. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3515-3527. [PMID: 34232873 DOI: 10.1109/tuffc.2021.3095299] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Deep learning is heavily being borrowed to solve problems in medical imaging applications, and Siamese neural networks are the front runners of motion tracking. In this article, we propose to upgrade one such Siamese architecture-based neural network for robust and accurate landmark tracking in ultrasound images to improve the quality of image-guided radiation therapy. Although several researchers have improved the Siamese architecture-based networks with sophisticated detection modules and by incorporating transfer learning, the inherent assumptions of the constant position model and the missing motion model remain unaddressed limitations. In our proposed model, we overcome these limitations by introducing two modules into the original architecture. We employ a reference template update to resolve the constant position model and a linear Kalman filter (LKF) to address the missing motion model. Moreover, we demonstrate that the proposed architecture provides promising results without transfer learning. The proposed model was submitted to an open challenge organized by MICCAI and was evaluated exhaustively on the Liver US Tracking (CLUST) 2D dataset. Experimental results proved that the proposed model tracked the landmarks with promising accuracy. Furthermore, we also induced synthetic occlusions to perform a qualitative analysis of the proposed approach. The evaluations were performed on the training set of the CLUST 2D dataset. The proposed method outperformed the original Siamese architecture by a significant margin.
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13
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Lassen MCH, Qasim A, Webber A, Gao Y, Biering-Sørensen T, Park M. The effect of kidney transplantation on left ventricular remodeling and global diastolic strain rate in end-stage renal disease. Echocardiography 2021; 38:1879-1886. [PMID: 34713484 DOI: 10.1111/echo.15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diastolic dysfunction is an early marker of cardiac pathology in end-stage kidney disease (ESKD) patients. The ratio of transmitral filling velocity (E) to early diastolic strain rate (E/e'sr) is a novel non-invasive marker of early left ventricular (LV) filling pressure obtained using two-dimensional speckle tracking echocardiography (2DSTE). METHODS In a prospective cohort of kidney transplant (KTX) recipients with echocardiograms performed pre-transplant we obtained repeat echocardiograms at 6 months following transplant. All echocardiograms were analyzed using 2DSTE where E/e'sr and global longitudinal strain were obtained. Paired tests were used to assess changes to cardiac structure and function following KTX. RESULTS A total of 33 patients were included in the study (mean age was 46.6 ± 13.7 years and 42% were males). The primary causes of ESKD in the cohort were glomerular disease (33%), hypertension (30%), and polycystic kidney disease (12%). The median (IQR) time spent on dialysis was 5.4 years [2.9, 7.7 years]. A reverse remodeling of the LV was observed following KTX as LV mass decreased (189.2 ± 57.5 g vs 171.1 ± 56.8 g, P = 0.014). LV filling pressure decreased as assessed by E/e'sr (103.7 ± 51.1 cm vs 72.6 ± 35.5 cm, P = 0.009). E to early diastolic mitral annular tissue velocity (E/e') did not change following KTX (9.9 ± 4.5 vs 10.3 ± 4.1, P = 0.54). Additionally, both LV internal diastolic and systolic diameter decreased significantly. CONCLUSION Reverse cardiac remodeling following KTX was observed as improvements in LV mass and LV dimensions. LV filling pressure improved as assessed by E/e'sr decreased following KTX, whereas E/e' did not change.
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Affiliation(s)
| | - Atif Qasim
- Division of Cardiology, San Francisco (UCSF), University of California, San Francisco, California, USA
| | - Allison Webber
- Department of Medicine, Division of Nephrology, San Francisco (UCSF), University of California, San Francisco, California, USA
| | - Ying Gao
- Department of Medicine, Division of Nephrology, San Francisco (UCSF), University of California, San Francisco, California, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Meyeon Park
- Department of Medicine, Division of Nephrology, San Francisco (UCSF), University of California, San Francisco, California, USA
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14
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Kamel H, Bartz TM, Longstreth WT, Elkind MSV, Gottdiener J, Kizer JR, Gardin JM, Kim J, Shah S. Cardiac mechanics and incident ischemic stroke: the Cardiovascular Health Study. Sci Rep 2021; 11:17358. [PMID: 34462469 PMCID: PMC8405795 DOI: 10.1038/s41598-021-96702-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Recent evidence indicates that our understanding of the relationship between cardiac function and ischemic stroke remains incomplete. The Cardiovascular Health Study enrolled community-dwelling adults ≥ 65 years old. We included participants with speckle-tracking data from digitized baseline study echocardiograms. Exposures were left atrial reservoir strain (primary), left ventricular longitudinal strain, left ventricular early diastolic strain rate, septal e’ velocity, and lateral e’ velocity. The primary outcome was incident ischemic stroke. Cox proportional hazards models were adjusted for demographics, image quality, and risk factors including left ventricular ejection fraction and incident atrial fibrillation. Among 4,000 participants in our analysis, lower (worse) left atrial reservoir strain was associated with incident ischemic stroke (HR per SD absolute decrease, 1.14; 95% CI 1.04–25). All secondary exposure variables were significantly associated with the outcome. Left atrial reservoir strain was associated with cardioembolic stroke (HR per SD absolute decrease, 1.42; 95% CI 1.21–1.67) and cardioembolic stroke related to incident atrial fibrillation (HR per SD absolute decrease, 1.60; 1.32–1.95). Myocardial dysfunction that can ultimately lead to stroke may be identifiable at an early stage. This highlights opportunities to identify cerebrovascular risk earlier and improve stroke prevention via therapies for early myocardial dysfunction.
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Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, New York, NY, USA. .,Division of Neurocritical Care, Weill Cornell Medicine, 420 East 70th St, LH-413, New York, NY, 10021, USA.
| | - Traci M Bartz
- Departments of Biostatistics, University of Washington, Seattle, WA, USA
| | - W T Longstreth
- Departments of Neurology, University of Washington, Seattle, WA, USA.,Departments of Medicine, University of Washington, Seattle, WA, USA.,Departments of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - John Gottdiener
- Division of Cardiology, University of Maryland, Baltimore, MD, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Julius M Gardin
- Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | - Sanjiv Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Harrington JK, Ferraro AM, Colan SD, Sleeper LA, Lu M, Adar A, Powell AJ, Levy PT, Harrild DM. Normal Left Ventricular Systolic and Diastolic Strain Rate Values in Children Derived from Two-Dimensional Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2021; 34:1303-1315.e3. [PMID: 34325008 DOI: 10.1016/j.echo.2021.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Strain rate (SR) parameters derived from two-dimensional speckle-tracking echocardiography have prognostic value in children with heart disease. Routine use is hindered by a lack of normative data. The aim of this study was to determine reference values and Z scores for left ventricular systolic and diastolic SR in a large cohort of healthy children. METHODS Echocardiograms from 577 subjects ≤18 years of age (mean age, 9.6 ± 5.6 years; range, 1 day to 18.0 years; 46% female) with structurally and functionally normal hearts were retrospectively included. Left ventricular longitudinal and circumferential systolic and early and late diastolic SR were measured using two-dimensional speckle-tracking echocardiography from the apical four-chamber and short-axis mid-papillary views. Associations with age and body surface area were assessed using Spearman correlation and generalized additive modeling. The relationship between systolic SR and wall stress (afterload) was examined. Analyses were conducted with and without correction for heart rate. Multivariable linear regression modeling was used to identify independent factors associated with the SR parameters. Z score equations were derived from a selected best-fit parametric model. RESULTS All SR parameters differed significantly by age group. The magnitude of all SR values decreased with increasing age and body surface area. Systolic SR magnitude was inversely related to wall stress in children ≤7 years of age but not did not vary significantly in the older age groups. All relationships were maintained after heart rate correction. SR measurements had very good or excellent agreement. CONCLUSION Longitudinal and circumferential systolic and diastolic SR parameters are presented from a large cohort of healthy children using two-dimensional speckle-tracking echocardiography from the Philips platform. SR values differ significantly by age and body surface area. These results suggest that the myocardium becomes less sensitive to afterload with maturity. Z score equations based on age are presented, which should promote further clinical and research use.
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Affiliation(s)
- Jamie K Harrington
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alessandra M Ferraro
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Adi Adar
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Philip T Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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16
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Zhou D, Zhou Y, Tang S, Feng Y. Correlation of left ventricular longitudinal strain and E/e' ratio in primary hypertension patients. Clin Exp Hypertens 2021; 43:653-660. [PMID: 34096414 DOI: 10.1080/10641963.2021.1937201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: The aim of this study is to explore and compare the relationships of both global longitudinal strain (GLS) and strain (SR) with E/e' ratio in a population of asymptomatic patients with systemic hypertension.Methods: Retrospectively included 210 cases of essential hypertension patients. Dynamic images were analyzed for left ventricular myocardial systolic global longitudinal strain (GLS), left ventricular longitudinal peak systolic strain rate (SRs), early diastolic peak strain rate (SRe), late diastolic peak strain rate (SRa). According to the 2012 baseline E/e' ratio, the population was divided into three groups, group A (E/e'<8), group B (8 ≤ E/e'≤14), and group C (E/e'>14).Results: Systolic function parameters left ventricular ejection fraction (LVEF) remained at normal rage and no different, but patients with elevated E/e' ratio had significantly lower GLS, lower early diastolic strain rate(SRe), lower ratio of early diastolic strain rate to late diastolic strain rate (SRe/a) and higher E/SRe. Positive relationships were observed between GLS, E/SRe and E/e' ratio, inverse relationships were observed between SRe, SRe/a and E/e' ratio. E/SRe >0.73 had a sensitivity of 87.7% and a specificity of 38.2% for predicting an elevated E/e' ratio (E/e'>14). In multivariable analysis, IVS-e' <7 cm/s showed almost 2.5-fold increased risk for decreased GLS (OR 2.48[95% CI 1.36-4.53]; p = 003).Conclusions: Our current study demonstrated that hypertensive patients with preserved LVEF and elevated E/e' ratio have systolic and diastolic abnormalities in longitudinal directions as detected by speckle imaging. E/SRe correlates well with E/e' and predicted elevated left ventricular filling pressure.
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Affiliation(s)
- Dan Zhou
- Guangdong General Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital, Zhuhai, China
| | - Yingling Zhou
- Guangdong General Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital, Zhuhai, China
| | - Songtao Tang
- Community Health Center of Liaobu County, Dongguan, Guangdong, China
| | - Yingqing Feng
- The First Affiliated Hospital of South China University of Technology, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Hypertension Research Laboratory, Guangzhou, China
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17
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Skaarup KG, Lassen MCH, Marott JL, Biering-Sørensen SR, Johansen ND, Modin D, Jørgensen PG, Jensen GB, Schnohr P, Prescott E, Søgaard P, Møgelvang R, Biering-Sørensen T. Diastolic function assessed with speckle tracking over a decade and its prognostic value: The Copenhagen City Heart Study. Echocardiography 2021; 38:964-973. [PMID: 33998050 DOI: 10.1111/echo.15083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) may be a more accurate measure of LV filling pressure then ratio of early filling pressure to early tissue velocity. The aim of the study was to investigate the impact of age, sex, obesity, smoking, hypertension, hypercholesterolemia, diabetes, physical activity level, socioeconomic, and psychosocial status on E/e'sr over a decade. Additionally, the predictive value of ΔE/e'sr on future major adverse cardiovascular events (MACE) has never been explored. METHOD The study included 623 participants from the general population, who participated in the 4th and 5th Copenhagen City Heart Study (CCHS4 and CCHS5). Examinations were median 10 years apart. MACE was the composite endpoint of heart failure, myocardial infarction, and all-cause death. RESULTS Follow-up time was median 5.7 years, and 43 (7%) experienced MACE. Mean age was 51 ± 14 years, and 43% were male. Mean ΔE/e'sr was 2.1 ± 23.0 cm. After multivariable adjustment for demographic, clinical, and biochemistry variables, high age (stand. β-coef. = .24, P < .001) and mean arterial blood pressure (MAP) (stand. β-coef. = .17, P < .001) were significantly associated with an accelerated increase in E/e'sr In multivariable Cox regression, E/e'sr at CCHS5 and ΔE/e'sr were independent predictors of MACE (HR = 1.20, 95% CI [1.01; 1.42] per 10 cm increase for both). ΔE/e'sr did only provide incremental prognostic value to change in left atrial volume index of the conventional diastolic measurements. CONCLUSION In the general population, age and MAP were predictors of an accelerated increase in E/e'sr over a decade. E/e'sr at CCHS5 and ΔE/e'sr were independent predictors of future MACE.
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Affiliation(s)
| | | | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Niklas Dyrby Johansen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Daniel Modin
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.,The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Eva Prescott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Cardiovascular Research Unit, University of Southern Denmark, Odense, Denmark.,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark.,The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Barros Filho ACL, Moreira HT, Dias BP, Ribeiro FFF, Tanaka DM, Schmidt A, Maciel BC, Simões MV, Marin-Neto JA, Romano MMD. Feasibility and reference intervals assessed by conventional and speckle-tracking echocardiography in normal hamsters. Physiol Rep 2021; 9:e14776. [PMID: 33650789 PMCID: PMC7923569 DOI: 10.14814/phy2.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to determine feasibility, reference intervals, and reproducibility of left ventricular ejection fraction (LVEF) and speckle-tracking echocardiography (STE) in adult Syrian hamsters. BACKGROUND Syrian hamster is an experimental model for several heart diseases. Echocardiography allows the evaluation of structure and function with bidimensional conventional techniques and STE. However, there is no data regarding reference values for bidimensional LVEF and myocardial strain in hamsters. METHODS A total of 135 female Syrian hamsters were anesthetized and studied with a small animal dedicated echocardiography system. Echocardiography measurements were obtained from M-mode and B-mode images. Feasibility and 95% reference intervals were obtained for LVEF using three different approaches: LVEF_Teichholz (from M-mode linear measurements), LVEF_BMode (from area-length method), and LVEF_ STE (from strain), and for global longitudinal (GLS), circumferential (GCS), and radial (GRS) endocardial strain. Reproducibility was assessed as intra-class correlation coefficients. RESULTS Feasibility of LVEF and endocardial strain was high (95% in FEVE_Teichholz, 93% in the LVEF_BMode, 84% in the LVEF_STE, 84% from PSLAX, and 80% from PSSAX). Values of LVEF_Teichholz were significantly higher than values of LVEF_BMode, and LVEF_STE-derived methods (59.0 ± 5.8, 53.8 ± 4.7, 46.3 ± 5.7, p < 0.0001). The 95% reference intervals for GLS, GCS, and GRS were respectively -13.6(-7.5;-20.4)%, -20.5 ± 3.1%, and + 34,7 ± 7.0%. Intra-class correlation coefficients were 0.49 - 0.91 for LVEF measurements, 0.73 - 0.92 for STE, with better results for LVEF_Teichholz and GLS. CONCLUSIONS Evaluation of LVEF by several methods and STE parameters is feasible in hamsters. Reference intervals for LVEF and STE obtained for this experimental animal model can be applied at future research.
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Affiliation(s)
- Antonio C L Barros Filho
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Henrique T Moreira
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Beatriz P Dias
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Fernando F F Ribeiro
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Denise M Tanaka
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - André Schmidt
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Benedito C Maciel
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Marcus V Simões
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - José A Marin-Neto
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
| | - Minna M D Romano
- Cardiology Center of the Medical School of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil
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19
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Nordén ES, Bendiksen BA, Andresen H, Bergo KK, Espe EK, Hasic A, Hauge-Iversen IM, Veras I, Hussain RI, Sjaastad I, Christensen G, Cataliotti A. Sacubitril/valsartan ameliorates cardiac hypertrophy and preserves diastolic function in cardiac pressure overload. ESC Heart Fail 2021; 8:918-927. [PMID: 33497525 PMCID: PMC8006657 DOI: 10.1002/ehf2.13177] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/15/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Sacubitril/valsartan (sac/val) has shown superior effect compared with blockade of the renin–angiotensin–aldosterone system in heart failure with reduced ejection fraction. We aimed to investigate effects of sac/val compared with valsartan in a pressure overload model of heart failure with preserved ejection fraction (HFpEF). Methods and results Sprague–Dawley rats underwent aortic banding or sham (n = 16) surgery and were randomized to sac/val (n = 28), valsartan (n = 29), or vehicle (n = 26) treatment for 8 weeks. Sac/val reduced left ventricular weight by 11% compared with vehicle (P = 0.01) and 9% compared with valsartan alone (P = 0.04). Only valsartan reduced blood pressure compared with sham (P = 0.02). Longitudinal early diastolic strain rate was preserved in sac/val compared with sham, while it was reduced by 23% in vehicle (P = 0.03) and 24% in valsartan (P = 0.02). Diastolic dysfunction, measured by E/e'SR, increased by 68% in vehicle (P < 0.01) and 80% in valsartan alone (P < 0.001), while sac/val showed no increase. Neither sac/val nor valsartan prevented interstitial fibrosis. Although ejection fraction was preserved, we observed mild systolic dysfunction, with vehicle showing a 28% decrease in longitudinal strain (P < 0.01). Neither sac/val nor valsartan treatment improved this dysfunction. Conclusions In a model of HFpEF induced by cardiac pressure overload, sac/val reduced hypertrophy compared with valsartan alone and ameliorated diastolic dysfunction. These effects were independent of blood pressure. Early systolic dysfunction was not affected, supporting the notion that sac/val has the largest potential in conditions characterized by reduced ejection fraction. Observed anti‐hypertrophic effects in preserved ejection fraction implicate potential benefit of sac/val in the clinical setting of hypertrophic remodelling and impaired diastolic function.
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Affiliation(s)
- Einar Sjaastad Nordén
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department for Health Sciences, Bjørknes University College, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Bård Andre Bendiksen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department for Health Sciences, Bjørknes University College, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Henriette Andresen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kaja Knudsen Bergo
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Emil Knut Espe
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department for Health Sciences, Bjørknes University College, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Almira Hasic
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Ida Marie Hauge-Iversen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Ioanni Veras
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | | | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department for Health Sciences, Bjørknes University College, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Alessandro Cataliotti
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
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20
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Ovchinnikov AG, Ageev FT, Alekhin MN, Belenkov YN, Vasyuk YA, Galyavich AS, Gilyarevskiy SR, Lopatin YM, Mareev VY, Mareev YV, Mitkov VV, Potekhina AV, Prostakova TS, Rybakova MK, Saidova MA, Khadzegova AB, Chernov MY, Yuschuk EN, Boytsov SA. [The role of diastolic transthoracic stress echocardiography with incremental workload in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. Expert consensus developed under the auspices of the National Medical Research Center of Cardiology, Society of Experts in Heart Failure (SEHF), and Russian Association of Experts in Ultrasound Diagnosis in Medicine (REUDM)]. ACTA ACUST UNITED AC 2021; 60:48-63. [PMID: 33522468 DOI: 10.18087/cardio.2020.12.n1219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.
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Affiliation(s)
- A G Ovchinnikov
- National medical research center of cardiology, Moscow A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - F T Ageev
- National medical research center of cardiology, Moscow, Russia
| | - M N Alekhin
- Central State Medical Academy of the Presidential Administration of Russian Federation, Moscow, Russia
| | - Yu N Belenkov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Yu A Vasyuk
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - S R Gilyarevskiy
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Y M Lopatin
- Volgograd State Medical University, Volgograd, Russia Volgograd regional clinical cardiology center, Volgograd, Russia
| | - V Yu Mareev
- Lomonosov Moscow State University, Moscow, Russia
| | - Yu V Mareev
- National Research Center for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | - V V Mitkov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Potekhina
- National medical research center of cardiology, Moscow, Russia
| | - T S Prostakova
- National medical research center of cardiology, Moscow, Russia
| | - M K Rybakova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M A Saidova
- National medical research center of cardiology, Moscow, Russia
| | - A B Khadzegova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Chernov
- N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia
| | - E N Yuschuk
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S A Boytsov
- National medical research center of cardiology, Moscow, Russia
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21
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Colak A, Muderrisoglu H, Pirat B, Eroglu S, Aydinalp A, Sezgin A, Sade LE. Longitudinal Strain and Strain Rate for Estimating Left Ventricular Filling Pressure in Heart Transplant Recipients. Am J Cardiol 2020; 137:63-70. [PMID: 32998008 DOI: 10.1016/j.amjcard.2020.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 02/04/2023]
Abstract
Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic, and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pretransplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared with pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8 ± 4.3 mm Hg (range: 4 to 25 mm Hg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e'), were different between studies with normal (n = 47) and elevated PCWP (n = 27). Area Under Curve for GLS (0.932*), E/e'SR (0.849*), and systolic SR (0.848*) (*p <0.0001) were more accurate than traditional parameters for predicting PCWP>12 mm Hg. GLS, systolic SR and E/e'SR remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e' was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e'SR tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e'SR provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP.
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22
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Lassen MCH, Jensen MT, Biering-Sørensen T, Møgelvang R, Fritz-Hansen T, Vilsbøll T, Rossing P, Jørgensen PG. Prognostic value of ratio of transmitral early filling velocity to early diastolic strain rate in patients with Type 2 diabetes. Eur Heart J Cardiovasc Imaging 2020; 20:1171-1178. [PMID: 31329838 DOI: 10.1093/ehjci/jez075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS The ratio of early mitral inflow velocity to global diastolic strain rate (E/e'sr) has recently emerged as a novel measure of left ventricular filling pressure. E/e'sr has in previous studies demonstrated to have good prognostic value in various patient populations. The aim of this study is to investigate the prognostic value of E/e'sr in a large cohort of patients with Type 2 diabetes in relation to cardiovascular morbidity and mortality. METHODS AND RESULTS In this prospective study, 848 Type 2 diabetic patients (mean age 63.6 ± 10.3 years, 64.7% male) underwent comprehensive echocardiographic examination including 2D speckle tracking in which E/e'sr along with novel and conventional echocardiographic variables were obtained. During follow-up (median: 4.8 years, interquartile range: 4.0-5.3), 122 (14.1%) met the composite outcome of cardiovascular disease, hospitalization, and mortality. Both E/e'sr and E/e' were significantly associated with the outcome [E/e'sr: hazard ratio (HR) 1.07, 95% confidence interval (CI): 1.05-1.10; P < 0.001, per 0.10 m increase] and (E/e': HR 1.07, 95% CI: 1.05-1.10; P = 0.001, per 1 unit increase). E/e'sr remained an independent predictor after multivariable adjustment for demographical, clinical, and echocardiographic parameters (HR 1.06, 95% CI: 1.01-1.12; P = 0.032, per 10 cm increase). The same was true for E/e' (HR 1.09, 95% CI: 1.04-1.14; P < 0.001, per 1 unit increase). Additionally, E/e'sr provided incremental prognostic information beyond the UK 'Prospective Diabetes Study risk engine' 0.72 (0.68-0.77) vs. 0.74 (0.70-79), P = 0.040. CONCLUSION In patients with Type 2 diabetes, E/e'sr provides independent and incremental prognostic information regarding cardiovascular morbidity and mortality.
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Affiliation(s)
- Mats Christian Højbjerg Lassen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Tina Vilsbøll
- Steno Diabetes Center, Copenhagen, Niels Steensens vej 2, Gentofte, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, København N, Denmark
| | - Peter Rossing
- Steno Diabetes Center, Copenhagen, Niels Steensens vej 2, Gentofte, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, København N, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
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23
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Longitudinal diastolic strain slope as an early sign for systolic dysfunction among patients with active cancer. Clin Res Cardiol 2020; 110:569-578. [PMID: 33219853 DOI: 10.1007/s00392-020-01776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diastolic dysfunction is a common finding in patients receiving cancer therapy. This study evaluated the correlation of diastolic strain slope (Dss) with routine echocardiography diastolic parameters and its role in early detection of systolic dysfunction and cardiovascular (CV) mortality within this population. METHODS Data were collected from the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling adult patient receiving cancer therapy. All patients performed at least three echocardiography exams (T1, T2, T3), including left ventricle Global Longitudinal Strain (LV GLS) and Dss. Systolic dysfunction was determined by either LV GLS relative reduction of ≥ 15% or LV ejection fraction reduction > 10% to < 53%. Dss was assessed as the early lengthening rate, measured by the diastolic slope (delta%/sec). RESULTS Among 144 patients, 114 (79.2%) were female with a mean age of 57.31 ± 14.3 years. Dss was significantly correlated with e' average. Mid segment Dss change between T1 and T2 showed significant association to systolic dysfunction development (Odds Ratio (OR) = 1.04 [1.01,1.06]. p = 0.036). In multivariate prediction, Dss increase was a significant predictor for the development of systolic dysfunction (OR = 1.06 [1.03,1.1], P < 0.001).An 8% increase in Dss between T1 and T2 was associated with a trend in increased CV mortality (HR = 3.4 [0.77,15.4], p = 0.085). CONCLUSIONS This study is the first to use the novel measurement of Dss in patients treated with cancer therapies and to show significant correlation between routine diastolic dysfunction parameters and Dss. Changes in the mid segment were found to have significant independent early predictive value for systolic dysfunction development in univariate and multivariate analyses.
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24
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Hochstadt A, Arnold J, Rosen R, Sherez C, Sherez J, Mor L, Derakhshesh M, Moshkovits Y, Merdler I, Arbel Y, Kapusta L, Rozenbaum Z, Topilsky Y, Laufer-Perl M. Diastolic strain time as predictor for systolic dysfunction among patients with active breast cancer. Echocardiography 2020; 37:1890-1896. [PMID: 32686871 DOI: 10.1111/echo.14791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of diastolic strain time (Dst) with the routine echocardiography diastolic parameters and estimated its role in the early detection of cardiotoxicity among patients with active breast cancer. METHODS Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy, were included. Echocardiography, including global longitudinal systolic strain (GLS) and Dst, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity was determined by GLS relative reduction of ≥15%. Dst was assessed as the time measured (ms) of the myocardium lengthening during diastole. RESULTS Among 69 patients, 67 (97.1%) were females with a mean age of 52 ± 13 years. Dst was significantly associated with the routine diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3. Both in a univariate and a multivariate analyses, the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (P < .04). CONCLUSIONS Among breast cancer patients, Dst showed high correlation to the routine diastolic echocardiography parameters. Change in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.
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Affiliation(s)
- Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Arnold
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Rosen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Sherez
- University of Naples, Federico ll, Naples, Italy
| | - Jack Sherez
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Livia Kapusta
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Pediatrics Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Relationship between right and left ventricular diastolic dysfunction assessed by 2-dimensional speckle-tracking echocardiography in adults with repaired tetralogy of Fallot. Int J Cardiovasc Imaging 2020; 37:569-576. [PMID: 33006716 PMCID: PMC8702514 DOI: 10.1007/s10554-020-02045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
Several studies have reported a correlation between right ventricular (RV) and left ventricular (LV) systolic dysfunction in adults with repaired tetralogy of Fallot (TOF). However, data are lacking regarding the relationship between RV and LV diastolic dysfunction assessed by 2-dimensional speckle-tracking echocardiography. We studied 69 adults with repaired TOF (mean age 34 years, 61% male) who had been regularly followed up and had routinely undergone echocardiography. In addition to conventional echocardiography, global longitudinal strain (GLS) and early diastolic strain rate (SRe) of both ventricles were assessed using 2-dimensional speckle-tracking echocardiography. Results were compared with 30 age- and sex-matched controls. RV and LV GLS were decreased in TOF patients compared with controls (− 18.4 ± 3.3% vs. −23.5 ± 4.2%, p < 0.001 and − 16.0 ± 3.8% vs. −20.0 ± 3.0%, p < 0.001, respectively). RV and LV SRe were also decreased in TOF patients compared with controls (1.22 ± 0.34 sec− 1 vs. 1.47 ± 0.41 sec− 1, p = 0.003 and 1.29 ± 0.42 sec− 1 vs. 1.63 ± 0.42 sec− 1, p < 0.001, respectively). A correlation between RV and LV SRe was found in TOF patients (r = 0.43, p < 0.001) as well as between RV and LV GLS (r = 0.45, p < 0.001). Two-dimensional speckle-tracking echocardiography reveals subclinical RV and LV diastolic dysfunction in adults with repaired TOF. A correlation is observed between RV and LV diastolic dysfunction as well as between RV and LV systolic dysfunction.
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Nazir SA, Shetye AM, Khan JN, Singh A, Arnold JR, Squire I, McCann GP. Inter-study repeatability of circumferential strain and diastolic strain rate by CMR tagging, feature tracking and tissue tracking in ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2020; 36:1133-1146. [PMID: 32152811 PMCID: PMC7228913 DOI: 10.1007/s10554-020-01806-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Strain assessment allows accurate evaluation of myocardial function and mechanics in ST-segment elevation myocardial infarction (STEMI). Strain using cardiovascular magnetic resonance (CMR) has traditionally been assessed with tagging but limitations of this technique have led to more widespread use of alternative methods, which may be more robust. We compared the inter-study repeatability of circumferential global peak-systolic strain (Ecc) and peak-early diastolic strain rate (PEDSR) derived by tagging with values obtained using novel cine-based software: Feature Tracking (FT) (TomTec, Germany) and Tissue Tracking (TT) (Circle cvi42, Canada) in patients following STEMI. Twenty male patients (mean age 56 ± 10 years, mean infarct size 13.7 ± 7.1% of left ventricular mass) were randomised to undergo CMR 1-5 days post-STEMI at 1.5 T or 3.0 T, repeated after ten minutes at the same field strength. Ecc and PEDSR were assessed using tagging, FT and TT. Inter-study repeatability was evaluated using Bland-Altman analyses, coefficients of variation (CoV) and intra-class correlation coefficient (ICC). Ecc (%) was significantly lower with tagging than with FT or TT at 1.5 T (- 9.5 ± 3.3 vs. - 17.5 ± 3.8 vs. -15.5 ± 5.2, respectively, p < 0.001) and 3.0 T (- 13.1 ± 1.8 vs. - 19.4 ± 2.9 vs. - 17.3 ± 2.1, respectively, p = 0.001). This was similar for PEDSR (.s-1): 1.5 T (0.6 ± 0.2 vs. 1.5 ± 0.4 vs. 1.0 ± 0.4, for tagging, FT and TT respectively, p < 0.001) and 3.0 T (0.6 ± 0.2 vs. 1.5 ± 0.3 vs. 0.9 ± 0.3, respectively, p < 0.001). Inter-study repeatability for Ecc at 1.5 T was good for tagging and excellent for FT and TT: CoV 16.7%, 6.38%, and 8.65%, respectively. Repeatability for Ecc at 3.0 T was good for all three techniques: CoV 14.4%, 11.2%, and 13.0%, respectively. However, repeatability of PEDSR was generally lower than that for Ecc at 1.5 T (CoV 15.1%, 13.1%, and 34.0% for tagging, FT and TT, respectively) and 3.0 T (CoV 23.0%, 18.6%, and 26.2%, respectively). Following STEMI, Ecc and PEDSR are higher when measured with FT and TT than with tagging. Inter-study repeatability of Ecc is good for tagging, excellent for FT and TT at 1.5 T, and good for all three methods at 3.0 T. The repeatability of PEDSR is good to moderate at 1.5 T and moderate at 3.0 T. Cine-based methods to assess Ecc following STEMI may be preferable to tagging.
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Affiliation(s)
- Sheraz A. Nazir
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Abhishek M. Shetye
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Jamal N. Khan
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Jayanth R. Arnold
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
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Early diastolic strain rate by two-dimensional speckle tracking echocardiography is a predictor of coronary artery disease and cardiovascular events in stable angina pectoris. Int J Cardiovasc Imaging 2020; 36:1249-1260. [PMID: 32405734 DOI: 10.1007/s10554-020-01822-8] [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: 11/19/2019] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
This study aimed to clarify the diagnostic and prognostic potential of strain rate in patients with suspected stable angina pectoris (SAP). Strain rate by 2-dimensional speckle tracking echocardiography (2DSTE) has been suggested to be able to diagnose coronary artery disease (CAD) and predict cardiovascular events in various patient groups. Prospectively enrolled patients (n = 296) with suspected SAP, no previous cardiac disease, and normal left ventricular ejection fraction were examined by 2DSTE, exercise ECG, and coronary angiography. Obstructive CAD was defined as stenosis ≥ 70% in ≥ 1 coronary artery on coronary angiography (n = 107). Major adverse cardiac events (MACE) included myocardial infarction, heart failure, atrial fibrillation, and stroke. In multivariable analysis adjusted for baseline data, conventional echocardiography, and Duke score, early diastolic strain rate (SRe) was independently associated with significant CAD with a 1.35 increased risk of having CAD per 0.1 decrease in SRe (OR = 1.35, 95% CI 1.03-1.76, P = 0.027). Peak velocity of early diastolic filling (E)/SRe was not associated with significant CAD (OR = 1.14, 95% CI 0.81-1.62, P = 0.445). MACE occurred in 34 patients (12%) during follow-up (median 3.5 years) and both SRe (HR 1.26, 95% CI (1.07-1.49), P = 0.006) and E/SRe (HR 1.24, 95% CI (1.04-1.47), P = 0.017) were independent predictors after multivariable adjustment. In patients with suspected SAP, SRe by 2DSTE was independently associated with presence of CAD. In addition, SRe and E/SRe provided independent and incremental prognostic value for predicting future MACE.
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The clinical application of the ratio of transmitral early filling velocity to early diastolic strain rate: a systematic review and meta-analysis. J Echocardiogr 2020; 18:94-104. [DOI: 10.1007/s12574-020-00466-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
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Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance. Eur Radiol 2020; 30:3672-3683. [PMID: 32107604 DOI: 10.1007/s00330-020-06744-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches. METHODS The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASRs), early diastole (FLASRe), and atrial contraction (FLASRa) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance. RESULTS FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASRe (0.96, 90%, and 94%). CONCLUSIONS The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis. KEY POINTS • Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
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Nagueh SF. Left Ventricular Diastolic Function. JACC Cardiovasc Imaging 2020; 13:228-244. [DOI: 10.1016/j.jcmg.2018.10.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022]
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Tsai WC, Lee WH, Wu PY, Huang JC, Chen YC, Chen SC, Hsu PC, Lee CS, Lin TH, Voon WC, Su HM. Ratio of Transmitral E Wave Velocity to Left Atrial Strain as a Useful Predictor of Total and Cardiovascular Mortality in Hemodialysis Patients. J Clin Med 2019; 9:jcm9010085. [PMID: 31905735 PMCID: PMC7019944 DOI: 10.3390/jcm9010085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 01/20/2023] Open
Abstract
The ratio of transmitral E-wave velocity (E) to a left ventricular diastolic parameter is reported to be well correlated with left ventricular filling pressure and is useful in the prediction of mortality. Left atrial (LA) strain has been demonstrated to be associated with left ventricular diastolic function. The aim of the study is to examine the ability of E/LA strain in predicting total and cardiovascular mortality in hemodialysis (HD) patients. In 197 routine HD patients, global LA strain during the reservoir phase was estimated by taking the average of longitudinal strain data obtained from the apical four-chamber and two chamber views by two-dimensional speckle tracking echocardiography. Twenty-nine total mortality and 14 cardiovascular mortality were documented during the 2.7 ± 0.6-year follow-up. After adjusting age, comorbidities, albumin, E/early diastolic mitral annular velocity (Ea), and LA strain, increased E/LA strain (hazard ratio (HR) = 1.191, 95% confidence interval (CI) = 1.072-1.324, p = 0.001) was still associated with increased total mortality. After adjusting age, comorbidities, albumin, E/Ea, left ventricular ejection fraction, and LA strain, increased E/LA strain (HR = 1.195, 95% CI = 1.041-1.372, p = 0.011) was still associated with increased cardiovascular mortality. In conclusion, E/LA strain is a useful parameter in the prediction of total and cardiovascular mortality in HD patients. Hence, E/LA strain deserves to be calculated in HD patients for better survival prediction.
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Affiliation(s)
- Wei-Chung Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.-C.T.); (W.-H.L.); (J.-C.H.)
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (C.-S.L.); (T.-H.L.); (W.-C.V.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Wen-Hsien Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.-C.T.); (W.-H.L.); (J.-C.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan; (P.-Y.W.); (Y.-C.C.)
| | - Pei-Yu Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan; (P.-Y.W.); (Y.-C.C.)
| | - Jiun-Chi Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (W.-C.T.); (W.-H.L.); (J.-C.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan; (P.-Y.W.); (Y.-C.C.)
| | - Ying-Chih Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan; (P.-Y.W.); (Y.-C.C.)
| | - Szu-Chia Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan; (P.-Y.W.); (Y.-C.C.)
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (C.-S.L.); (T.-H.L.); (W.-C.V.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (C.-S.L.); (T.-H.L.); (W.-C.V.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (C.-S.L.); (T.-H.L.); (W.-C.V.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (P.-C.H.); (C.-S.L.); (T.-H.L.); (W.-C.V.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Ho-Ming Su
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan; (P.-Y.W.); (Y.-C.C.)
- Correspondence: ; Tel.: +886-7-8036783-3441; Fax: +886-7-8063346
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Chamberlain R, Scalia GM, Shiino K, Platts DG, Sabapathy S, Chan J. Diastolic strain imaging: a new non-invasive tool to detect subclinical myocardial dysfunction in early cardiac allograft rejection. Int J Cardiovasc Imaging 2019; 36:317-323. [PMID: 31720881 DOI: 10.1007/s10554-019-01725-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022]
Abstract
Acute cellular rejection (ACR) remains a significant contributor to increased morbidity and mortality in heart transplant recipients. Early detection of ACR by non-invasive imaging is of potential clinical benefit. This study sought to investigate the use of non-invasive early global diastolic strain rate (GDSRe) and global longitudinal strain (GLS) in the detection of biopsy proven ACR. We retrospectively analysed 31 heart transplant patients (Mean age 52 ± 14 years) with biopsy proven ACR who underwent serial transthoracic echocardiographic examination and 2D strain analysis. Traditional echocardiographic systolic and diastolic parameters and novel systolic and diastolic strain imaging were measured during (1) early rejection free period (0R); (2) pre-rejection period (pre-1R); and (3) grade 1R acute cellular rejection (1R-ACR). GDSRe was significantly reduced (p = 0.0001) during the pre-rejection period (pre-1R) (0.74/s) when compared with 0R (0.97/s). GLS was only significantly reduced during 1R-ACR (17.7%), p = 0.001 but could not detect pre-1R (19.9%). Global diastolic strain rate at isovolumic relaxation showed no significant differences between any of the rejection periods. Traditional systolic and diastolic indices showed no significant differences. In conclusion, early global diastolic strain rate is the most sensitive parameter to detect subclinical myocardial dysfunction during early periods of pre-1R prior to biopsy confirmed 1R-ACR. GDSRe is a potential new tool for non-invasive screening of early post-transplant cardiac allograft rejection.
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Affiliation(s)
- Robert Chamberlain
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Kenji Shiino
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Department of Cardiology, Fujita-Health University, Nagoya, Japan
| | - David G Platts
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Surendran Sabapathy
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Morbach C, Walter BN, Breunig M, Liu D, Tiffe T, Wagner M, Gelbrich G, Heuschmann PU, Störk S. Speckle tracking derived reference values of myocardial deformation and impact of cardiovascular risk factors - Results from the population-based STAAB cohort study. PLoS One 2019; 14:e0221888. [PMID: 31513619 PMCID: PMC6742365 DOI: 10.1371/journal.pone.0221888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/17/2019] [Indexed: 01/19/2023] Open
Abstract
AIMS We aimed to provide reference values for speckle-tracking derived systolic and diastolic myocardial deformation markers, and to determine their relation with age, sex, and cardiovascular risk factors. METHODS AND RESULTS The Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study recruited a representative sample of the population of Würzburg, Germany, aged 30-79 years. In a sample of 1818 participants (52% female, mean age 54±12 years) global longitudinal peak systolic strain (GL-PSS, n = 1218), systolic (GL-SSR, n = 1506), and early (GL-EDSR, n = 1506) and late diastolic strain rates (GL-LDSR, n = 1500) were derived from 2D speckle tracking analysis. From a subgroup of 323 individuals without any cardiovascular risk factor, sex- and age-specific reference values were computed. GL-PSS, GL-SSR, and GL-EDSR were associated with sex, GL-EDSR decreased and GL-LDSR increased with age. In the total sample, dyslipidemia was associated with altered GL-PSS, GL-SSR, and GL-EDSR in women but not in men, whereas obesity was associated with less favorable GL-PSS and GL-EDSR in either sex. Hypertension impacted more adversely on systolic and diastolic myocardial deformation in women compared to men (all p<0.01). CONCLUSION The female myocardium appeared more vulnerable to high blood pressure and dyslipidemia when compared to men, while obesity was associated with adverse myocardial deformation in either sex. The reference values for echocardiographic myocardial deformation provided for a non-diseased population and their here reported associations with cardiovascular risk factors will inform future observational and intervention studies regarding i) effect sizes and power calculation, ii) cross-study comparisons, and iii) categorization of myocardial deformation in specific patient groups.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
| | - Bettina N. Walter
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Margret Breunig
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
| | - Dan Liu
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
| | - Theresa Tiffe
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter U. Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
- * E-mail:
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Ratio of Early Mitral Inflow Velocity to the Global Diastolic Strain Rate and Global Left Ventricular Longitudinal Systolic Strain Predict Overall Mortality and Major Adverse Cardiovascular Events in Hemodialysis Patients. DISEASE MARKERS 2019; 2019:7512805. [PMID: 31583030 PMCID: PMC6748193 DOI: 10.1155/2019/7512805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 01/15/2023]
Abstract
Background The ratio of early mitral inflow velocity to the global diastolic strain rate (E/E'sr) and global longitudinal systolic strain (GLS) of the left ventricle (LV) are emerging indices of diastolic and systolic functions, respectively, for the LV. Their prognostic significance in the prediction of mortality and cardiovascular (CV) outcomes remains underexplored in hemodialysis (HD) patients. Methods This prospective study included 190 maintenance HD patients. The E/E'sr ratio and GLS were assessed using two-dimensional speckle tracking echocardiography. The clinical outcomes included overall mortality, CV mortality, and major adverse cardiovascular events (MACE). The associations between the E/E'sr ratio, GLS, and clinical outcomes were evaluated using multivariate Cox regression analysis. The incremental values of the E/E'sr ratio and GLS in outcome prediction were assessed by χ 2 changes in Cox models. Results Over a median follow-up period of 3.7 years, there were 35 overall deaths, 16 CV deaths, and 45 MACE. Impaired diastolic function with a higher E/E'sr ratio was associated with overall mortality (HR, 1.484; 95% CI, 1.201-1.834; p < 0.001), CV mortality (HR, 1.584; 95% CI, 1.058-2.371; p = 0.025), and MACE (HR, 1.205; 95% CI, 1.040-1.397; p = 0.013) in multivariate adjusted Cox analysis. Worsening GLS was associated with overall mortality (HR, 1.276; 95% CI, 1.101-1.480; p = 0.001), CV mortality (HR, 1.513; 95% CI, 1.088-2.104; p = 0.014), and MACE (HR, 1.214; 95% CI, 1.103-1.337; p < 0.001). The E/E'sr ratio and GLS had better outcome prediction than the E to early diastolic mitral annular velocity (E/E') ratio and left ventricular ejection fraction (LVEF). Moreover, adding the E/E'sr ratio and GLS to Cox models containing relevant clinical and conventional echocardiographic parameters improved the prediction of overall mortality (p < 0.001), CV mortality (p < 0.001), and MACE (p < 0.001). Conclusion The E/E'sr ratio and GLS, as emerging indices of LV diastolic and systolic functions, significantly predict mortality and CV outcomes and outperform conventional echocardiographic parameters in outcome prediction in HD patients.
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Cardiac function assessed by myocardial deformation in adult polycystic kidney disease patients. BMC Nephrol 2019; 20:324. [PMID: 31419965 PMCID: PMC6697983 DOI: 10.1186/s12882-019-1500-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 07/29/2019] [Indexed: 01/19/2023] Open
Abstract
Background Patients with autosomal dominant polycystic kidney disease (ADPKD) have an increased risk of cardiovascular morbidity and mortality. Impaired left ventricular (LV) global longitudinal strain (GLS) can be a sign of subclinical cardiac dysfunction even in patients with otherwise preserved ejection fraction (EF). Transmitral early filling velocity to early diastolic strain rate (E/SRe) is a novel measure of LV filling pressure, which is often affected early in cardiac disease. Methods A total of 110 ADPKD patients not on dialysis were included in this prospective study. All patients underwent an extensive echocardiographic examination including two-dimensional speckle tracking. GLS and strain rates were measured. The distribution of GLS and E/SRe was determined and patient characteristics were compared by median levels of GLS (− 17.8%) and E/SRe (91.4 cm). Twenty healthy participants were included as control group. Results There was a significantly worse GLS in the ADPKD patients (mean: − 17.8 ± 2.5%) compared to the healthy controls (mean: − 21.9 ± 1.9%), p < 0.001. The same was true for E/SRe (mean: 10.0 ± 0.3 cm) compared to the control group (mean: 6.5 ± 0.3 cm), p < 0.001. In simple logistic regression, male gender (OR: 4.74 [2.10–10.71], p < 0.001), fasting glucose (odds ratio (OR) 1.05 [1.01–1.10], p = 0.024), htTKV (OR: 1.07 [1.01–1.13], p = 0.013), HDL cholesterol (OR: 0.97 [0.94, 0.996], p = 0.025), triglycerides (OR: 1.01 [1.00–1.02], p = 0.039), hemoglobin (OR: 1.50 [1.11–2.04], p = 0.009), and β-blocker use (OR: 1.07 [1.01, 1.13], p = 0.013) were all associated with higher GLS. After multivariate logistic regression with backward model selection, only male gender (OR: 5.78 [2.27–14.71], p < 0.001) and β-blocker use (OR: 14.00 [1.60, 122.51], p = 0.017) remained significant. In simple logistic regression models, BMI (OR: 1.11 [1.02–1.20], p = 0.015), systolic blood pressure (OR: 1.03 [1.00–1.06], p = 0.027) and β-blocker use (OR: 17.12 [2.15–136.20], p = 0.007) were associated with higher E/SRe - a novel measure of left ventricular filling pressure. After backward elimination, only β-blocker use (OR: 17.22 [2.16, 137.14], p = 0.007) remained significant. Conclusion Higher GLS and E/SRe are common in ADPKD patients, even in patients with preserved eGFR and normal left ventricular EF. GLS and E/SRe may aid in cardiovascular risk stratification in patients with ADPKD as they represent early markers of cardiac dysfunction. Electronic supplementary material The online version of this article (10.1186/s12882-019-1500-1) contains supplementary material, which is available to authorized users.
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Echocardiographic predictors of all-cause mortality in patients with left ventricular ejection fraction >35%: Value of guideline based assessment of diastolic dysfunction. IJC HEART & VASCULATURE 2019; 24:100407. [PMID: 31428670 PMCID: PMC6692060 DOI: 10.1016/j.ijcha.2019.100407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 01/28/2023]
Abstract
Background Recent data suggests that the majority of cardiac deaths in patients with heart failure occur in patients with a left ventricular ejection fraction (LVEF) >35%. This study sought to determine the value of guideline based assessment of diastolic dysfunction in predicting all-cause mortality in patients with a first-ever myocardial infarction (MI) with an LVEF >35%. Methods A retrospective single centre study involving 383 patients with a first-ever MI (STEMI or NSTEMI) with LVEF >35% was performed. Clinical, angiographic and echocardiographic data were obtained from prospectively maintained institutional databases. Outcomes data were obtained from national death registry. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined was grade 2/3 diastolic dysfunction according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Results At a median follow up of 2 years, there were 32 deaths. On Cox proportional hazards multivariate analysis incorporating significant clinical variables (age, chronic kidney disease and extent of coronary artery disease), significant DD (HR 2.57, 95%CI 1.16–5.68, p = 0.020) and left ventricular end-diastolic volume index (HR 1.03, 1.04–1.07, p = 0.021) were the only independent echocardiographic predictors of all-cause mortality. Intermodel comparisons using model χ2 and Harrel's-C confirmed incremental value of DD. In the subgroup with LVEF 36–55% (n = 176), significant DD was the only independent echocardiographic predictor (HR 3.56, 95%CI 2.46–9.09, p = 0.006). Conclusions The presence of significant DD identifies patients with LVEF >35% following MI who are at a higher risk of all-cause mortality, and who may benefit from further risk stratification and treatment. The majority of deaths in heart failure patients occur in patients with LVEF>35%. Diastolic dysfunction identifies elevated risk of death in patients with LVEF>35%. Diastolic dysfunction thus identifies patients for further risk stratification.
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Lassen MCH, Sengeløv M, Qasim A, Jørgensen PG, Bruun NE, Olsen FJ, Fritz-Hansen T, Gislason G, Biering-Sørensen T. Ratio of Transmitral Early Filling Velocity to Early Diastolic Strain Rate Predicts All-Cause Mortality in Heart Failure with Reduced Ejection Fraction. J Card Fail 2019; 25:877-885. [PMID: 31336135 DOI: 10.1016/j.cardfail.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/13/2019] [Accepted: 07/05/2019] [Indexed: 12/31/2022]
Abstract
AIMS The ratio of early mitral inflow velocity to global diastolic strain rate (E/e'sr) has recently emerged as a novel measure of left ventricular (LV) filling pressure. This new measure has demonstrated to have prognostic value superior to E/e'. This study aimed to investigate the prognostic value of E/e'sr in a large cohort of patients with heart failure with reduced ejection fraction (HFrEF) in relation to all-cause mortality. METHODS We retrospectively studied 897 HFrEF (mean age 66 ± 12 years, 73% male, 59% ischemic cardiomyopathy) patients who underwent speckle tracking echocardiography where E/e'sr along with novel and conventional echocardiographic parameters were obtained. The primary endpoint was defined as all-cause mortality. RESULTS During follow-up (median: 40 months IQR: 22-57), 137 (15.3%) patients died. Both E/e'sr and E/e' were significantly associated with mortality (E/e'sr: HR 1.03 95%CI [1.02-1.04], p<0.001, per 0.10m increase) and (E/e': HR 1.04 95%CI [1.02-1.06], p = 0.001, per 1unit increase). E/e'sr remained an independent predictor in a multivariable model after adjusting for age, gender, mean arterial pressure, heart rate, BMI, total cholesterol, diabetes mellitus, ischemic cardiomyopathy, LVEF, LVIDd, LVMI, LAVI, TAPSE and LV-GLS (HR 1.02 95%CI [1.01-1.03], p = 0.007) whereas E/e' did not (HR 1.01 95%CI [0.98-1.04], p = 0.57). Furthermore, E/e'sr provided incremental prognostic information beyond a model including known risk factors: age, gender, total cholesterol, mean arterial pressure, heart rate, BMI, smoking status and E/e' (Harrell's C-statistics: 0.72 (0.68-0.77) vs 0.70 (0.66-0.75), p = 0.047). CONCLUSIONS In HFrEF patients, E/e'sr provides independent and incremental prognostic information regarding all-cause mortality superior to E/e'.
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Affiliation(s)
- Mats Christian Højbjerg Lassen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Division of Cardiology, University of California, San Francisco UCSF.
| | - Morten Sengeløv
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Atif Qasim
- Division of Cardiology, University of California, San Francisco UCSF
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Niels Eske Bruun
- Clinical Institute of Copenhagen and Aalborg Universities, Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen
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Liu BY, Wu WC, Zeng QX, Liu ZH, Niu LL, Tian Y, Cheng XL, Luo Q, Zhao ZH, An CH, Huang L, Wang H, He JG, Xiong CM. EXPRESS: Left ventricular early diastolic strain rate detected by two-dimensional speckle tracking echocardiography and disease severity in pre-capillary pulmonary hypertension. Pulm Circ 2019; 9:2045894019865158. [PMID: 31267820 PMCID: PMC8826283 DOI: 10.1177/2045894019865158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022] Open
Abstract
We investigated and compared the correlations between two-dimensional speckle tracking echocardiography detected left ventricular peak early diastolic strain rates (global: left ventricular global peak early diastolic strain rate; septum: left ventricular peak early diastolic strain rate of septum; free wall: left ventricular peak early diastolic strain rate of free wall) and disease severity in pre-capillary pulmonary hypertension. Seventy-four pre-capillary pulmonary hypertension patients (23 males and 51 females, 35 ± 13 years) and thirty healthy controls were consecutively recruited for two-dimensional speckle tracking echocardiography analyses in our study. Medical records of pre-capillary pulmonary hypertension patients were reviewed to capture clinical data; risk assessments were performed based on the 2015 ESC Guidelines. Compared with healthy controls, left ventricular global peak early diastolic strain rate was lower in pre-capillary pulmonary hypertension patients (1.11 ± 0.60 s−1 versus 1.47 ± 0.45 s−1, P = 0.001), especially that of the septum (1.13 ± 0.58 s−1 versus 1.68 ± 0.46 s−1, P<0.001). Linear correlation analyses showed significant but weak correlations between left ventricle diastolic parameters and peak oxygen consumption, N-terminal pro-brain natriuretic peptide, and conventional echocardiographic right ventricle parameters: E/E′, tricuspid annular plane systolic excursion, S′, and fractional area change. No or weak correlations were observed between left ventricle diastolic parameters and hemodynamics. Multivariate logistic regression analyses showed left ventricular global peak early diastolic strain rate (OR: 0.304; 95%CI: 0.101–0.911) and left ventricular peak early diastolic strain rate of septum (OR: 0.252; 95%CI: 0.075–0.848) independently predict intermediate–high risk of pulmonary hypertension patients, even adjusted by age, gender, and body mass index. Receive operating characteristic curves showed that all the three models had the capacity to predict intermediate–high risk of pulmonary hypertension patients, and the model including left ventricular peak early diastolic strain rate of septum showed the strongest predictive capacity (area under the curve = 0.76, 95%CI: 0.59–0.93). Two-dimensional speckle tracking echocardiography detected left ventricle diastolic function parameters are significantly correlated with clinical data and can independently predict intermediate–high risk in pre-capillary pulmonary hypertension patients; the dysfunction of interventricular septum may make major contribution.
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Affiliation(s)
- Bing-yang Liu
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei-chun Wu
- Department of Echocardiography, State
Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, People's Republic of China
| | - Qi-xian Zeng
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhi-hong Liu
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Li-li Niu
- Department of Echocardiography, State
Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, People's Republic of China
| | - Yue Tian
- Department of Echocardiography, State
Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, People's Republic of China
| | - Xiao-ling Cheng
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qin Luo
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhi-hui Zhao
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chen-hong An
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Li Huang
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State
Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, People's Republic of China
| | - Jian-guo He
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chang-ming Xiong
- Department of Cardiology, Pulmonary
Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Çelik SF. Early Impairment Left Ventricular Mechanics in Children With Mitral Valve Prolapse. Am J Cardiol 2019; 123:1992-1998. [PMID: 30961911 DOI: 10.1016/j.amjcard.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/05/2019] [Accepted: 03/08/2019] [Indexed: 02/02/2023]
Abstract
Early impairment of left ventricular (LV) function has been reported in some inherited connective tissue diseases such as Marfan syndrome or rheumatic heart disease in pediatric patients. However, there is no study about cardiac strain in pediatric patients with primary mitral valve prolapse (MVP). The aim of this study was to evaluate the LV functions in pediatric patients with primary MVP, mild or moderate mitral regurgitation (MR), and normal LV ejection fraction. The study group included 72 consecutive patients (40 female, mean age: 13.1 ± 5.2 with primary MVP who had mild or moderate MR, and normal systolic function (LV ejection fraction ≥60%) were compared with 40 healthy children using conventional echocardiography, tissue Doppler imaging, and 2-dimensional speckle tracking echocardiography. Patients were divided into subgroups according to the MR severity: mild (n:34), and moderate (n:38) and leaflet thickness: classical (n: 40), and nonclassical (n: 32). The children with MR had significantly lower values for global early diastolic strain rate ([SRe] patients: 1.40 ± 0.25 vs controls: 1.62 ± 0.54; p = 0.001), and E/SRe (patients: 72.7 ± 5.6 vs controls: 62.1 ± 4.9; p <0.04) when compared with the control group. In subgroup analysis, SRe (mild: 1.49 ± 0.38 vs moderate: 1.32 ± 0.31; p <0.001) was lower in MVP patients with moderate MR compared to mild MR, and E/SRe (mild: 69.4 ± 5.1 vs moderate: 75.1 ± 6.4; p <0.001) value was higher in MVP patients with moderate MR compared to mild MR. Diatolic strain parameters, SRe, and E/SRe are more sensitive markers of early subtle myocardial injury in pediatric patients with primary MVP.
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Affiliation(s)
- Serkan F Çelik
- Department of Pediatrics, Division of Pediatric Cardiology, Adnan Menderes University Hospital, Aydın, Turkey.
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40
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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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Lassen MC, Skaarup KG, Iversen AZ, Jørgensen PG, Olsen FJ, Galatius S, Biering-Sørensen T. Ratio of Transmitral Early Filling Velocity to Early Diastolic Strain Rate as a Predictor of Cardiovascular Morbidity and Mortality Following Acute Coronary Syndrome. Am J Cardiol 2019; 123:1776-1782. [PMID: 30952381 DOI: 10.1016/j.amjcard.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 11/24/2022]
Abstract
The ratio of early mitral inflow velocity (E) to early diastolic strain rate (E/e'sr) is a significant predictor of cardiac outcomes in various patient populations. This study aims to evaluate the predictive value of E/e'sr for heart failure, acute myocardial infarction, and death due to cardiovascular disease following acute coronary syndrome (ACS). In total, 432 ACS patients underwent echocardiography following percutaneous coronary intervention. The end point was the composite of heart failure, acute myocardial infarction, and death due to cardiovascular disease. Median follow-up was 4.4 (interquartile range 0.2 to 6.3) years. During the follow-up period, 199 (46.1%) met the composite outcome. Mean value of E/e'sr in patients was 0.70 ± 0.37 m. In univariable Cox regression, E/e'sr was a predictor of the composite outcome (hazard ratio [HR] 1.05 95% confidence interval [CI] 1.03 to 1.07, p <0.001, per 0.10 m increase). After multivariable adjustment for demographic and clinical parameters, E/e'sr remained an independent predictor (HR 1.03; 95% CI 1.01 to 1.06; p = 0.013, per 0.10 m increase). Global longitudinal strain (GLS) modified the relation between E/e'sr and outcome (p value for interaction = 0.011). In ACS patients with a relatively preserved systolic function assessed by GLS (GLS ≥ 13.2%), E/e'sr showed to be a significant predictor (HR 1.20; 95% CI 1.06 to 1.36; p = 0.005, per 0.10 m increase). In contrast, E/e'sr was not a significant predictor in ACS patients with impaired systolic function (GLS < 13.2%; HR 1.02; 95% CI 0.99 to 1.04; p = 0.28). In conclusion, E/e'sr provides important prognostic information regarding cardiovascular morbidity and mortality in ACS patients. However, E/e'sr was not an independent predictor over that of echocardiographic parameters. Furthermore, E/e'sr is a stronger prognosticator in patients with relatively preserved systolic function as opposed to patients with impaired systolic function.
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Nagueh SF, Chang SM, Nabi F, Shah DJ, Estep JD. Cardiac Imaging in Patients With Heart Failure and Preserved Ejection Fraction. Circ Cardiovasc Imaging 2019; 10:CIRCIMAGING.117.006547. [PMID: 28838962 DOI: 10.1161/circimaging.117.006547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Sherif F Nagueh
- From the Methodist DeBakey Heart and Vascular Center, Houston, TX; and Cardiovascular Imaging Institute Methodist Hospital, Houston, Texas.
| | - Su Min Chang
- From the Methodist DeBakey Heart and Vascular Center, Houston, TX; and Cardiovascular Imaging Institute Methodist Hospital, Houston, Texas
| | - Faisal Nabi
- From the Methodist DeBakey Heart and Vascular Center, Houston, TX; and Cardiovascular Imaging Institute Methodist Hospital, Houston, Texas
| | - Dipan J Shah
- From the Methodist DeBakey Heart and Vascular Center, Houston, TX; and Cardiovascular Imaging Institute Methodist Hospital, Houston, Texas
| | - Jerry D Estep
- From the Methodist DeBakey Heart and Vascular Center, Houston, TX; and Cardiovascular Imaging Institute Methodist Hospital, Houston, Texas
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Changes in left ventricular filling parameters before and after dialysis in patients with end stage renal disease. Int J Cardiovasc Imaging 2019; 35:1673-1681. [PMID: 31093896 DOI: 10.1007/s10554-019-01619-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate the grading of diastolic dysfunction (DD) in relation to hemodialysis in patients with end stage renal disease (ESRD) on hemodialysis (HD) Cardiovascular disease is prevalent in patients with ESRD and accounts for significant morbidity and mortality. Left ventricular hypertrophy (LVH) is common in ESRD but little is known about the impact of HD on currently recommended grading schemes for DD. Comprehensive echocardiographic data was obtained in consecutive patients with ESRD before (n = 247) and immediately after (n = 239) standard HD regimen. Grading of DD was performed according to current recommendations both pre- and post HD. Prior to HD, DD was classified as present in 83 patients (34%), indeterminate in 51 patients (21%) and absent in 113 patients (45%). Patients with DD at baseline compared to those without were older [67.3 years (13.1) vs. 63.2 (14.3), p = 0.037], were more likely to have diabetic- or hypertensive ESRD (43.4% vs. 35.4%, p = ns) and LVMi was significantly higher [119 g/cm2 (27.5) vs. 103 g/cm2 (24.3), p < 0.001]. After HD [mean HD time = 221 min (27.6), mean ultrafiltration volume = 2 L (1.1)], 39 patients (16%) exhibited sustained DD. These patients were older [69.4 years (14.5) vs. 65.0 years (13.9), p = 0.071], were more likely to have diabetic- or hypertensive ESRD (59% vs. 36%, p = 0.010). Myocardial adverse remodeling was more advanced with higher LVMi [127.4 g/m2 (27.5) vs. 106.5 g/m2 (25.3), p < 0.001], lower LVEF [44.7% (11.0) vs. 54.5% (8.7), p < 0.001] and more impaired GLS [- 13.4% (4.3) vs. - 15.8% (4.0), p = 0.006]. Echocardiographic evaluation of diastolic function in patients with ESRD on HD is critically dependent on timing relative to dialysis. The presence of sustained DD after volume unloading by HD identifies a population of patients with an adverse phenotype of blunted vascular response and severe cardiac remodeling.
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Gupta R, Gupta N, Yadav O, Yadav A, Doshi R. Exploring speckle‐tracking echocardiography for the assessment of diastolic function: A step in the right direction. Echocardiography 2019; 36:629-630. [DOI: 10.1111/echo.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Neelesh Gupta
- University of South Alabama Medical Center Mobile Alabama
| | - Ojus Yadav
- SSR Medical College Belle Rive Mauritius
| | - Anshul Yadav
- Mari State University Yoshkar‐Ola Russian Federation
| | - Rajkumar Doshi
- University of Nevada Reno School of Medicine Reno Nevada
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Mele D, Trevisan F, D'Andrea A, Luisi GA, Smarrazzo V, Pestelli G, Flamigni F, Ferrari R. Speckle Tracking Echocardiography in Non-ST-Segment Elevation Acute Coronary Syndromes. Curr Probl Cardiol 2019; 46:100418. [PMID: 31030854 DOI: 10.1016/j.cpcardiol.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 01/13/2023]
Abstract
Non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) are a group of clinical conditions characterized by acute myocardial ischemia. Conventional echocardiography is generally used to evaluate cardiac function using wall motion analysis and left ventricular ejection fraction but may be insufficient to explore all the complex features of NSTE-ACSs, which may vary substantially from patient to patient in terms of severity of ischemia and extent of involved myocardium. In the last years, speckle tracking echocardiography (STE) has become a widely available technique for the non-invasive assessment of cardiac function and has been repeatedly applied in the setting of NSTE-ACSs. In this review we summarize current evidence about the use of STE in patients with NSTE-ACSs, trying to underline advantages and limitations in comparison with conventional echocardiography for: diagnosis of NSTE-ACS, differential diagnosis, identification of high-risk patients, and prediction of outcome.
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Morris DA, Takeuchi M, Nakatani S, Otsuji Y, Belyavskiy E, Aravind Kumar R, Frydas A, Kropf M, Kraft R, Marquez E, Osmanoglou E, Krisper M, Köhncke C, Boldt LH, Haverkamp W, Tschöpe C, Edelmann F, Pieske B, Pieske-Kraigher E. Lower limit of normality and clinical relevance of left ventricular early diastolic strain rate for the detection of left ventricular diastolic dysfunction. Eur Heart J Cardiovasc Imaging 2019; 19:905-915. [PMID: 28977386 DOI: 10.1093/ehjci/jex185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022] Open
Abstract
Aims The aim of the present study was to determine the lower limit of normality and the clinical relevance of left ventricular (LV) early diastolic strain rate (LVSRe) for the detection of LV diastolic dysfunction (LVDD). Methods and results Using 2D speckle-tracking echocardiography, we analysed 377 healthy subjects and 475 patients with risk for LVDD with preserved LV ejection fraction (LVEF). The normal range of LVSRe analysing the healthy subjects was 1.56 ± 0.28 s-1, with a lower limit of normality at 1.00 s-1. Using this cut-off, LVSRe was able to detect high rates of LV diastolic alterations (rate 71.1%), which was significantly better than using indirect diastolic parameters such as left atrial volume index (LAVI) and tricuspid regurgitation velocity (TR) (rates 22.9% and 9.1%) and similar to annular mitral parameters such as lateral and septal e' velocity (rates 70.9% and 72.4%). In line, adding LVSRe to the current evaluation of LVDD increased significantly the rate of detection of LVDD (absolute rate of increase 18.9%; rate of detection of LVDD: from 14.3% to 33.2%, P < 0.01). Regarding the clinical relevance of LVSRe, patients with abnormal LVSRe (i.e. <1.00 s-1) had significantly worse New York Heart Association functional class and symptomatic status than those with normal LVSRe. In addition, in a retrospective post hoc analysis, we found that an abnormal LVSRe had a significant association with the risk of heart failure hospitalization at 2 years (odds ratio 5.0, 95% confidence interval 1.3-18.4), which was better than using conventional diastolic parameters such as septal and lateral e' velocity, LAVI and TR velocity. Conclusion The findings from this multicentre study provide important data regarding the normal range of LVSRe and highlight the potential clinical relevance of using this new diastolic parameter in the detection of LVDD in patients with preserved LVEF.
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Affiliation(s)
- Daniel A Morris
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Masaaki Takeuchi
- Department of Internal Medicine and Cardiology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu-shi, Fukuoka, 807-0804, Japan
| | - Satoshi Nakatani
- Department of Internal Medicine and Cardiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Yutaka Otsuji
- Department of Internal Medicine and Cardiology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu-shi, Fukuoka, 807-0804, Japan
| | - Evgeny Belyavskiy
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Radhakrishnan Aravind Kumar
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Athanasios Frydas
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Martin Kropf
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Robin Kraft
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Esteban Marquez
- Department of Radiology, Private Clinic of Radiology (Q-Diagnostica-Scanner Murcia), C/ Abenarabi, n° 3 Bajo - 30007 Murcia, Spain
| | - Engin Osmanoglou
- Department of Internal Medicine and Cardiology, Meoclinic, Quartier 206 - Friedrichstraße 7110117 Berlin, Germany
| | - Maximilian Krisper
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Clemens Köhncke
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Leif-Hendrik Boldt
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Wilhelm Haverkamp
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Carsten Tschöpe
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Oudenarder Straße 16, Berlin, Germany
| | - Frank Edelmann
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Oudenarder Straße 16, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Burkert Pieske
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Oudenarder Straße 16, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
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47
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Prasad SB, Lin AK, Guppy-Coles KB, Stanton T, Krishnasamy R, Whalley GA, Thomas L, Atherton JJ. Diastolic Dysfunction Assessed Using Contemporary Guidelines and Prognosis Following Myocardial Infarction. J Am Soc Echocardiogr 2018; 31:1127-1136. [DOI: 10.1016/j.echo.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/17/2022]
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48
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Prasad SB, Holland DJ, Atherton JJ. Diastolic stress echocardiography: from basic principles to clinical applications. Heart 2018; 104:1739-1748. [PMID: 30030333 DOI: 10.1136/heartjnl-2017-312323] [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: 04/17/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) looms as a major public heart challenge with increasing prevalence due to an ageing population. Diagnosis can be challenging due to non-specific symptomatology, low natriuretic peptide levels and equivocal diastology on resting echocardiography. Diastolic stress echocardiography represents a non-invasive option to refining the diagnosis in this subset of patients. Diastolic responses to exercise are most commonly measured with a non-invasive measure of left ventricular filling pressures (LVFP) estimated by the ratio of the early mitral inflow wave to early diastolic tissue velocity (E/e' ratio). This is measured pre- and post-exercise , and is highly feasible. An elevation of exercise E/e' >15 is classified as an abnormal response as per current guidelines. An alternative measure of exercise-related diastolic performance, the Diastolic Functional Reserve Index has also been proposed, but has not been as well studied as exercise E/e'. A number of studies have validated exercise E/e' as a measure of LVFP against invasively measured LVFP using simultaneous echocardiography-catheterisation studies. The independent prognostic value of exercise E/e' has also been well delineated in a number of studies. While diastolic stress echocardiography can be considered for all patients with suspected HFpEF, it is of particular value in patients with normal or equivocal diastolic indices on resting echocardiography.
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Affiliation(s)
- Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David J Holland
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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49
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Liu D, Oder D, Salinger T, Hu K, Müntze J, Weidemann F, Herrmann S, Ertl G, Wanner C, Frantz S, Störk S, Nordbeck P. Association and diagnostic utility of diastolic dysfunction and myocardial fibrosis in patients with Fabry disease. Open Heart 2018; 5:e000803. [PMID: 30018776 PMCID: PMC6045729 DOI: 10.1136/openhrt-2018-000803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/13/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives Current guidelines highlight important therapy implications of cardiac fibrosis in patients with Fabry disease (FD). However, association between morphological and functional impairments with cardiac fibrosis in hereditary cardiomyopathies remains elusive. We investigated the association between echocardiography-determined cardiac dysfunction and cardiac MRI (cMRI)-detected myocardial fibrosis (late gadolinium enhancement, LE) in patients with FD with preserved left ventricular ejection fraction (≥50%). Methods 146 patients with FD (aged 39±14 years, 57 men) were analysed, all receiving echocardiography and cMRI within a 1 week interval. Longitudinal systolic strain (LS_sys), strain rate (LSr_sys) and diastolic strain rate (LSr_E/LSr_A) were assessed using speckle-tracking imaging. Receiver operating characteristic (ROC) analysis was performed to identify the diagnostic performance of various markers for LE. Results LE was detected in 57 (39%) patients with FD. LV wall thickness, left atrial volume, septal E/e', diastolic dysfunction grade, global LS_sys and E/LSr_E, mid-lateral LS_sys and LSr_E, as well as N-terminal pro-brain natriuretic peptide were all associated with LE independent of age, sex, body mass index, New York Heart Association functional class and kidney function. In ROC curve analysis, septal E/e' performed best (area under the curve=0.86, 95% CI=0.79 to 0.92). Septal E/e'>14.8 was strongly associated with LE (specificity=97.8% and sensitivity=49.1%). In 9% of patients, localised LE was present even though no other cardiac or kidney abnormalities were detected. Conclusions Echocardiography-derived diastolic dysfunction is closely linked to LE in FD. Septal E/e' ratio is the best echocardiographic marker suggestive of LE. Diastolic dysfunction is not a prerequisite for LE in FD, since LE can be detected in the absence of measurable cardiac functional impairments. Trial registration number ClinicalTrials.gov Identifier (NCT03362164).
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Affiliation(s)
- Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Tim Salinger
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.,Medizinische Klinik I, Klinikum Vest, Recklinghausen, Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
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50
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Sun BJ, Park JH, Kim J, Choi JO, Lee JH, Shin MS, Kim MJ, Jung HO, Park JR, Sohn IS, Kim H, Kim HK, Cho GY, Park JS, Shim CY, Shin SH, Kim KH, Kim WS, Park SW. Normal reference values of diastolic strain rate in healthy individuals: Chronological trends and the comparison according to genders. Echocardiography 2018; 35:1533-1541. [PMID: 29920763 DOI: 10.1111/echo.14053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Recently, the diastolic strain rate (DSR) utilizing speckle-tracking echocardiography has been proposed as a novel parameter for left ventricular diastolic function. We aimed to present normal reference data for those in a large-sized, selected group of healthy individuals. METHODS The current study was a part of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL), a prospective nationwide survey from 23 centers in Korea. We analyzed 447 subjects (age 48 ± 15 years, 234 females) without any history of cardiovascular disease and presented the early and late DSRs (SRe and SRa , respectively) in a total and gender-/age-specified groups. RESULTS Among the total subjects, the mean SRe and SRa were 1.6 ± 0.4 S-1 and 0.8 ± 0.3 S-1 , respectively. With increasing age, there were significant trends of decreasing SRe and increasing SRa . Although both gender groups showed comparable age, the female group presented significantly higher SRe compared to male subjects with age of 20-59 years, which diminished after the age of 60 years. However, the SRa was comparable between genders in all age groups. On multiple linear regression, age showed independent associations with both SRe (β = -0.132, P = .010) and SRa (β = 0.440, P < .001), whereas gender did not show any association with SRe or SRa . CONCLUSION We present normal reference data of a novel parameter, DSR, in a large-sized selected group with healthy Korean subjects. Additionally, we present significant age-related changes both in SRe and SRa without the impact of their gender.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeongai Kim
- Cardiovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hae Ok Jung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Shik Kim
- Cardiovascular Center, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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