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Ma X, Chen Z, Song Y, Wang J, Yang S, Yu S, Dong Z, Chen X, Wu S, Gao Y, Dai Y, Zhang S, Fan X, Hua W, Chen K, Zhao S. CMR feature tracking-based left atrial mechanics predicts response to cardiac resynchronization therapy and adverse outcomes. Heart Rhythm 2024; 21:1354-1362. [PMID: 38493992 DOI: 10.1016/j.hrthm.2024.03.028] [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: 11/21/2023] [Revised: 02/25/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established therapy for advanced heart failure (HF) with prolonged QRS duration. However, 30% of patients have shown no benefit from the treatment. OBJECTIVE This study aimed to examine the value of left atrial (LA) mechanics by cardiac magnetic resonance (CMR) to predict response to CRT and clinical outcomes. METHODS A total of 163 CRT recipients with preimplantation CMR examination were retrospectively recruited. CMR feature tracking was used to evaluate LA size and function. The end points include (1) improvement of at least 5% in left ventricular ejection fraction combined with a reduction of at least 1 New York Heart Association functional class at 6-month follow-up and (2) any all-cause death or HF hospitalization during follow-up. RESULTS Overall, 82 (50.3%) were CRT responders. CRT nonresponders had larger LA and worse LA reservoir and booster pump function than did responders (P < .001 for all). LA structural (maximum volume index < 47 mL/m2) and functional (booster pump strain > 8.5%) criteria were incremental to traditional indicators in detecting CRT response (χ2, 40.83 vs 9.98; P < .001). During follow-up (median 41 months), survival free from death or HF hospitalization increased with the number of positive LA criteria (log-rank, P < .001). After adjustment for clinical confounders, the absence of the 2 criteria remained associated with a considerably increased risk of death or HF hospitalization (adjusted hazard ratio 6.2; 95% confidence interval 2.15-17.88; P = .001). CONCLUSION The preprocedure LA mechanics evaluated using CMR may be useful to predict response to CRT and improve risk stratification in CRT recipients.
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Affiliation(s)
- Xuan Ma
- MR 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, China
| | - Zhongli Chen
- Arrhythmia 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, China
| | - Yanyan Song
- MR 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, China
| | - Jiaxin Wang
- MR 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, China
| | - Shujuan Yang
- MR 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, China
| | - Shiqin Yu
- MR 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, China
| | - Zhixiang Dong
- MR 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, China
| | - Xiuyu Chen
- MR 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, China
| | - Sijin Wu
- Arrhythmia 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, China
| | - Yuan Gao
- Arrhythmia 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, China
| | - Yan Dai
- Arrhythmia 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, China
| | - Shu Zhang
- Arrhythmia 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, China
| | - Xiaohan Fan
- Arrhythmia 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, China
| | - Wei Hua
- Arrhythmia 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, China
| | - Keping Chen
- Arrhythmia 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, China
| | - Shihua Zhao
- MR 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, China.
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Zhang M, Li Z, Wang Y, Chen L, Ren Y, Wu Y, Wang J, Lu Y. Left atrial and ventricular longitudinal strain by cardiac magnetic resonance feature tracking improves prognostic stratification of patients with ST-segment elevation myocardial infarction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03174-z. [PMID: 38985217 DOI: 10.1007/s10554-024-03174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/22/2024] [Indexed: 07/11/2024]
Abstract
We aimed to investigate the predictive value of left atrium (LA) and left ventricle (LV) longitudinal strain derived by CMR-FT early after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients with STEMI who received pPCI and completed CMR within the following week were enrolled. LA and LV longitudinal strain parameters were derived from cine CMR by FT; conventional CMR indexes were also performed. The primary endpoint was the occurrence of major cardiovascular adverse events (MACE), defined as a composite of death, reinfarction, and congestive heart failure (HF). 276 participants (median age, 57 years, IQR, 48-66 years; 85% men) were included in this study. CMR was usually completed on the 5 (IQR,4-7) days after pPCI. During a median follow-up of 16 months, MACE occurred in 35 (12.7%) participants. Multivariable Cox regression analysis showed that LA conduit strain (HR 0.91, 95%CI: 0.84, 0.98, p = 0.013) and LV global longitudinal strain (HR 1.17, 95%CI: 1.03, 1.34, p = 0.016) remained independently associated with MACE. Participants with impaired LA conduit strain (≤ 12.8%) and LV global longitudinal strain (> -13.1%) had a higher risk of MACE than those with preserved. Longitudinal strain of LA and LV could provide independent prognostic information in STEMI patients, and comprehensive assessment of Left atrial and ventricular longitudinal strain significantly improved the prognosis.
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Affiliation(s)
- Min Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Zhi Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Yiwen Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Lei Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Yanfei Ren
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Yixuan Wu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Jiali Wang
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China.
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Larsen BS, Biering-Sørensen T, Olsen FJ. Ischemic stroke and the emerging role of left atrial function. Expert Rev Cardiovasc Ther 2024; 22:289-300. [PMID: 38943632 DOI: 10.1080/14779072.2024.2370814] [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: 02/11/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Ischemic stroke is a leading cause of morbidity and mortality worldwide. Emerging evidence suggests that left atrial (LA) dysfunction could play a role in the pathophysiology of ischemic stroke, as a possible contributor and as a predictive biomarker. AREAS COVERED This narrative review details the intricate relationship between LA function, atrial fibrillation (AF), and ischemic stroke. We discuss imaging techniques used to assess LA function, the mechanisms by which impaired LA function may contribute to stroke, and its potential as a prognostic marker of stroke. EXPERT OPINION There is a lack of evidence-based treatments of LA dysfunction in both primary and secondary stroke prevention. This is partly due to the lack of a practical clinical definition and unanswered questions concerning the clinical implications of LA dysfunction in patients without AF. Until such questions are resolved, addressing well-known cardiovascular risk factors, like hypertension and obesity, should be prioritized for preventing AF and ischemic stroke. These risk factors are closely tied to atrial remodeling, emphasizing the importance of targeting primary modifiable factors for preventing future morbidity and mortality.
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Affiliation(s)
- Bjørn Strøier Larsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
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Spencer L, Wright L, Foulkes SJ, Rowe SJ, Dillon HT, Climie R, Bigaran A, Janssens K, Mitchell A, Wallace I, Lindqvist A, Burnham L, Prior DL, Howden EJ, La Gerche A. Characterizing the influence of cardiorespiratory fitness on left atrial size and function in the general population. Am J Physiol Heart Circ Physiol 2024; 326:H1269-H1278. [PMID: 38457351 DOI: 10.1152/ajpheart.00422.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/10/2024]
Abstract
Increased left atrial (LA) size and reduced LA function have been associated with heart failure and atrial fibrillation (AF) in at-risk populations. However, atrial remodeling has also been associated with exercise training and the relationship between fitness, LA size, and function has not been defined across the fitness spectrum. In a cross-sectional study of 559 ostensibly healthy participants, comprising 304 males (mean age, 46 ± 20 yr) and 255 females (mean age, 47 ± 15 yr), we sought to define the relationship between cardiorespiratory fitness (CRF), LA size, and function. We also aimed to interrogate sex differences in atrial factors influencing CRF. Echocardiographic measures included biplane measures of LA volumes indexed to body surface area (LAVi) and atrial deformation using two-dimensional speckle tracking. CRF was measured as peak oxygen consumption (V̇o2peak) during cardiopulmonary exercise testing (CPET). Using multivariable regression, age, sex, weight, and LAVi (P < 0.001 for all) predicted V̇o2peak (P < 0.001, R2 = 0.66 for combined model). After accounting for these variables, heart rate reserve added strength to the model (P < 0.001, R2 = 0.74) but LA strain parameters did not predict V̇o2peak. These findings add important nuance to the perception that LA size is a marker of cardiac pathology. LA size should be considered in the context of fitness, and it is likely that the adverse prognostic associations of increased LA size may be confined to those with LA enlargement and low fitness.NEW & NOTEWORTHY Left atrial (LA) structure better predicts cardiorespiratory fitness (CRF) than LA function. LA function adds little statistical value to predictive models of peak oxygen uptake (V̇o2peak) in healthy individuals, suggesting limited discriminatory for CRF once LA size is factored. In the wider population of ostensibly healthy individuals, the association between increased LA volume and higher CRF provides an important counter to the association between atrial enlargement and heart failure symptoms in those with cardiac pathology.
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Affiliation(s)
- Luke Spencer
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Stephanie J Rowe
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kristel Janssens
- St Vincent's Institute, Fitzroy, Victoria, Australia
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Amy Mitchell
- St Vincent's Institute, Fitzroy, Victoria, Australia
| | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Lauren Burnham
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David L Prior
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Erin J Howden
- University of Melbourne, Parkville, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Victor Chang Cardiac Research Centre, Darlinghurst, New South Wales, Australia
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Nguyen MB, Venet M, Fan CPS, Dragulescu A, Rusin CG, Mertens LL, Mital S, Villemain O. Modeling the Relationship Between Diastolic Phenotype and Outcomes in Pediatric Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2024; 37:508-517.e3. [PMID: 38097053 DOI: 10.1016/j.echo.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Pediatric hypertrophic cardiomyopathy (HCM) is associated with adverse events. The contribution of diastolic dysfunction to adverse events is poorly understood. The aim of this study was to explore the association between diastolic phenotype and outcomes in pediatric patients with HCM. METHODS Children <18 years of age with diagnosed with HCM were included. Diastolic function parameters were measured from the first echocardiogram at the time of diagnosis, including Doppler flow velocities, tissue Doppler velocities, and left atrial volume and function. Using principal-component analysis, key features in echocardiographic parameters were identified. The principal components were regressed to freedom from major adverse cardiac events (MACE), defined as implantable cardioverter-defibrillator insertion, myectomy, aborted sudden cardiac death, transplantation, need for mechanical circulatory support, and death. RESULTS Variables that estimate left ventricular filling pressures were highly collinear and associated with MACE (hazard ratio, 0.86; 95% CI, 0.75-1.00), though this was no longer significant after controlling for left ventricular thickness and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with outcomes in the covariate-adjusted model (hazard ratio, 0.69; 95% CI, 0.5-0.94). The covariate-adjusted model had an Akaike information criterion of 213, an adjusted R2 value of 0.78, and a concordance index of 0.82 for association with MACE. CONCLUSION Echocardiographic parameters of diastolic dysfunction were associated with MACE in this population study, in combination with the severity of left ventricular hypertrophy and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with adverse events. Additional study of diastolic function parameters adjusted for patient size could facilitate the prediction of adverse events in pediatric patients with HCM.
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Affiliation(s)
- Minh B Nguyen
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas; Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Maelys Venet
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Craig G Rusin
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
| | - Luc L Mertens
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Olivier Villemain
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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6
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Zhao Y, Song Y, Mu X. Application of left atrial strain derived from cardiac magnetic resonance feature tracking to predict cardiovascular disease: A comprehensive review. Heliyon 2024; 10:e27911. [PMID: 38560271 PMCID: PMC10979159 DOI: 10.1016/j.heliyon.2024.e27911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
The structural and functional changes of the left atrium (LA)are important for maintaining the filling of the left ventricle (LV), whether the hemodynamics is stable or not, and are valuable for evaluating LV diastolic dysfunction and grading the severity. Studies over the past decade have shown that LA structural alterations are linked to several cardiovascular disorders, and LA enlargement has been identified as a strong predictor of several cardiovascular diseases. However, LA structural or volumetric abnormalities are commonly seen in the advanced stages of disease and do not adequately represent functional changes throughout the cardiac cycle. In recent years, LA strain obtained using cardiac magnetic resonance feature tracking (CMR-FT)technology has been shown to provide early monitoring of LA tension damage while also comprehensively reflecting LA functional changes in three phases, providing deeper insights into cardiovascular disease risk, prognosis of cardiovascular disease, and evaluation of therapeutic efficacy. When compared to the ultrasound speckle tracking approach, the CMR-FT technique provides improved spatial resolution, repeatability, and reproducibility. We report a comprehensive review of the most recent studies on CMR-LA strain in the past five years, including normal reference values, early detection of disease, incremental diagnosis, improvement of risk stratification, assessment of the value of atrial-ventricular hemodynamics and coupled injury, major adverse cardiovascular events and prognostic value, as well as future research perspectives and current limitations, aiming at providing an objective reference for the further exploration of the value of the application of CMR-LA strain in various cardiac disorders.
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Affiliation(s)
- Yetong Zhao
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
- Department of Graduate School, Dalian Medical University, Dalian, 116000, PR China
| | - Yang Song
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
| | - Xiaolin Mu
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian, 116033, PR China
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McAree D, Hauck A, Arzu J, Carr M, Acevedo J, Patel AB, Husain N. Clinical Predictors of Subacute Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Pediatr Cardiol 2024; 45:876-887. [PMID: 36260103 PMCID: PMC9580417 DOI: 10.1007/s00246-022-03021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) often involves a post-viral myocarditis and associated left ventricular dysfunction. We aimed to assess myocardial function by strain echocardiography after hospital discharge and to identify risk factors for subacute myocardial dysfunction. We conducted a retrospective single-center study of MIS-C patients admitted between 03/2020 and 03/2021. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-ventricular circumferential strain (CS), and left atrial strain (LAS) were measured on echocardiograms performed 3-10 weeks after discharge and compared with controls. Among 60 MIS-C patients, hypotension (65%), ICU admission (57%), and vasopressor support (45%) were common, with no mortality. LVEF was abnormal (< 55%) in 29% during hospitalization but only 4% at follow-up. Follow-up strain abnormalities were prevalent (GLS abnormal in 13%, 4C-LS in 18%, CS in 16%, LAS in 5%). Hypotension, ICU admission, ICU and hospital length of stay, and any LVEF < 55% during hospitalization were factors associated with lower strain at follow-up. Higher peak C-reactive protein (CRP) was associated with hypotension, ICU admission, total ICU days, and with lower follow-up GLS (r = - 0.55; p = 0.01) and CS (r = 0.41; p = 0.02). Peak CRP < 18 mg/dL had negative predictive values of 100% and 88% for normal follow-up GLS and CS, respectively. A subset of MIS-C patients demonstrate subclinical systolic and diastolic function abnormalities at subacute follow-up. Peak CRP during hospitalization may be a useful marker for outpatient cardiac risk stratification. MIS-C patients with hypotension, ICU admission, any LVEF < 55% during hospitalization, or a peak CRP > 18 mg/dL may warrant closer monitoring than those without these risk factors.
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Affiliation(s)
- Daniel McAree
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Amanda Hauck
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Jennifer Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Michael Carr
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Jennifer Acevedo
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Ami B. Patel
- Department of Infectious Diseases, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Nazia Husain
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
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Sillett C, Razeghi O, Lee AWC, Solis Lemus JA, Roney C, Mannina C, de Vere F, Ananthan K, Ennis DB, Haberland U, Xu H, Young A, Rinaldi CA, Rajani R, Niederer SA. A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation. Front Cardiovasc Med 2024; 11:1359715. [PMID: 38596691 PMCID: PMC11002108 DOI: 10.3389/fcvm.2024.1359715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background A reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied. Aim The aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated. Methods A cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively. Results It was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03). Conclusion RGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.
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Affiliation(s)
- Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Angela W. C. Lee
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Caroline Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Felicity de Vere
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kiruthika Ananthan
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA, United States
| | | | - Hao Xu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster: Digital Twins, The Alan Turing Institute, London, United Kingdom
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Pambianchi G, Marchitelli L, Cundari G, Ruoli L, Conia L, Catalano C, Galea N. Takotsubo syndrome: left atrial and ventricular myocardial strain impairment in the subacute and convalescent phases assessed by CMR. Eur Radiol Exp 2024; 8:34. [PMID: 38413432 PMCID: PMC10899127 DOI: 10.1186/s41747-024-00423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique. METHODS We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30 days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7 days) and 31 during the convalescence (cTTS, 8-30 days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls. RESULTS All patients were women (mean age 63 years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670). CONCLUSIONS LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery. RELEVANCE STATEMENT Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies. KEY POINTS • In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS.
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Affiliation(s)
- Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Letizia Ruoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy.
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Gillebert TC, Smiseth OA. Left atrial reservoir strain in prognosis of heart failure and time for getting terminology straight. Eur Heart J Cardiovasc Imaging 2024; 25:325-327. [PMID: 37966264 DOI: 10.1093/ehjci/jead311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Thierry C Gillebert
- Department of Cardiology, Ghent University and Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
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11
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Pawar SG, Saravanan PB, Gulati S, Pati S, Joshi M, Salam A, Khan N. Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors. Dis Mon 2024; 70:101675. [PMID: 38262769 DOI: 10.1016/j.disamonth.2024.101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Heart failure (HF) with normal ejection fraction - the isolated diastolic heart failure, depicts increasing prevalence and health care burden in recent times. Having less mortality rate compared to systolic heart failure but high morbidity, it is evolving as a major cardiac concern. With increasing clinical use of Left atrial volume (LAV) quantitation in clinical settings, LAV has emerged as an important independent predictor of cardiovascular outcome in HF with normal ejection fraction. This article is intended to review the diastolic and systolic heart failure, their association with left atrial volume, in depth study of Left atrial function dynamics with determinants of various functional and structural changes.
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Affiliation(s)
| | | | | | | | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Ajal Salam
- Government Medical College, Kottayam, Kerala, India
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
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12
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Lindner JR. Opportunities and Challenges of Murine Atrial Strain Imaging. Circ Cardiovasc Imaging 2023; 16:e015976. [PMID: 37795598 DOI: 10.1161/circimaging.123.015976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Jonathan R Lindner
- Division of Cardiovascular Medicine, Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville
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13
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Nemtsova V, Burkard T, Vischer AS. Hypertensive Heart Disease: A Narrative Review Series-Part 2: Macrostructural and Functional Abnormalities. J Clin Med 2023; 12:5723. [PMID: 37685790 PMCID: PMC10488346 DOI: 10.3390/jcm12175723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Hypertensive heart disease (HHD) remains a major global public health concern despite the implementation of new approaches for the management of hypertensive patients. The pathological changes occurring during HHD are complex and involve the development of structural and functional cardiac abnormalities. HHD describes a broad spectrum ranging from uncontrolled hypertension and asymptomatic left ventricular hypertrophy (LVH), either a concentric or an eccentric pattern, to the final development of clinical heart failure. Pressure-overload-induced LVH is recognised as the most important predictor of heart failure and sudden death and is associated with an increased risk of cardiac arrhythmias. Cardiac arrhythmias are considered to be one of the most important comorbidities affecting hypertensive patients. This is the second part of a three-part set of review articles. Here, we focus on the macrostructural and functional abnormalities associated with chronic high pressure, their involvement in HHD pathophysiology, and their role in the progression and prognosis of HHD.
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Affiliation(s)
- Valeriya Nemtsova
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Internal Diseases and Family Medicine Department, Educational and Scientific Medical Institute, National Technical University “Kharkiv Polytechnic Institute”, 61002 Kharkiv, Ukraine
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Annina S. Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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14
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Lopez-Candales A, Asif T, Sawalha K, Norgard NB. Heart Failure with Preserved Left Ventricular Ejection Fraction: A Complex Conundrum Simply Not Limited to Diastolic Dysfunction. Cardiovasc Ther 2023; 2023:1552826. [PMID: 37496726 PMCID: PMC10368509 DOI: 10.1155/2023/1552826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023] Open
Abstract
Over the last two decades, the changing paradigm of heart failure with preserved ejection fraction (HFpEF) has transformed our understanding not only of the pathophysiology of this clinical entity but also the diagnostic and therapeutic approaches aimed at treating this complex patient population. No longer HFpEF should be seen as simply left ventricular diastolic dysfunction but as a group of that in addition of having small and thick left ventricles with abnormal diastolic filling patterns as their main pathophysiologic abnormality; they also have whole host of different abnormalities. In fact, this heterogeneous clinical entity embodies numerous mechanisms and is linked to multiorgan dysfunction, with hypertension and obesity playing a major role. Although we have gained an enormous amount of understanding not only on the causes but also the downstream effects of HFpEF, there is still much to be learned before we can fully comprehend this complex clinical entity. It is the main intention of this review to synthesize the most recent attributes, mechanism, diagnostic tools, and most useful therapeutic alternatives to be considered when evaluating patients either complaining of dyspnea on exertion as well as exercise intolerance or those recently admitted with HF symptoms but with normal LVEF in the absence of any other valvular abnormalities.
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Affiliation(s)
- Angel Lopez-Candales
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Talal Asif
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Khalid Sawalha
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - Nicholas B. Norgard
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
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15
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Jiang X, Yan Y, Yang Z, Wen M, Long Y, Fu B, Jiang J. Diagnostic accuracy of left atrial function and strain for differentiating between acute and chronic myocardial infarction. BMC Cardiovasc Disord 2023; 23:218. [PMID: 37118657 PMCID: PMC10148459 DOI: 10.1186/s12872-023-03254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The cardiac magnetic resonance tissue tracking (CMR-TT) technique was used to obtain left atrial strain and strain rate in patients with myocardial infarction (MI) and to evaluate the utility of this technique in the quantitative assessment of myocardial infarction for distinguishing acute from chronic myocardial infarction. METHODS We retrospectively analyzed 36 consecutive patients with acute myocardial infarction (AMI) and 29 patients with chronic myocardial infarction (CMI) who underwent CMR and 30 controls. Left atrial (LA) and ventricular functions were quantified by volumetric, and CMR-TT derived strain analysis from long and short left ventricular view cines. Receiver Operating Characteristics (ROC) analysis was used to determine the diagnostic accuracy of CMR-TT strain parameters for discriminating between acute and chronic myocardial infarction. RESULTS AMI and CMI participants had impaired LA reservoir function, conduit function and LA booster pump dysfunction compared to the controls. LA strain was more sensitive than LV global strain for the assessment of the MI stage. Peak late-negative SR yielded the best areas under the ROC curve (AUC) of 0.879, showing differentiation between acute and chronic myocardial infarction of all the LA strain parameters obtained. The highest significant differences between chronic myocardial infarction and normal myocardium were also found in the LV strain (p < 0.001) and LA functional parameters (p < 0.001), but there was no difference between AMI and normals. CONCLUSIONS CMR-TT-derived LA strain is a potential and robust tool in demonstrating impaired LA mechanics and quantifying LA dynamics, which have high sensitivity and specificity in the differential diagnosis of acute versus chronic myocardial infarction. Their use is thus worth popularizing in clinical application.
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Affiliation(s)
- Xiaofeng Jiang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Yi Yan
- Department of Pain, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhi Yang
- The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Miao Wen
- The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Yitian Long
- The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Bing Fu
- The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
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16
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Thellier N, Altes A, Layec J, Castel AL, Delelis F, Hubert T, Outerryck F, Appert L, Tribouilloy C, Maréchaux S. Impact of left atrial and diastolic ventricular dysfunction on mortality in patients with aortic stenosis. Arch Cardiovasc Dis 2023; 116:126-135. [PMID: 36739188 DOI: 10.1016/j.acvd.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is common in severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF≥50%). AIM To determine the impact of American Society of Echocardiography/European Association of Cardiovascular Imaging-recommended DD grading and left atrial strain on mortality in a cohort of patients with severe AS and preserved LVEF. METHODS We studied patients with severe AS (aortic valve area indexed<0.6 cm2/m2 and/or aortic valve area<1cm2), LVEF≥50% and no or mild AS-related symptoms. The endpoint was all-cause mortality. RESULTS A total of 387 patients (median age 76years; 53% women) were studied. During a median follow-up of 57 (interquartile range 37; 83) months, 158 patients died. After adjustment for prognostic factors, patients with grade II or III DD had an increased mortality risk versus patients with grade I DD (adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.11-2.38; P=0.013; aHR 4.73, 95% CI 2.49-8.99; P<0.001; respectively). Adding peak atrial longitudinal strain (PALS)≤14% to a multivariable model including DD grade improved predictive performance, with better global model fit, reclassification and discrimination. Patients with grade III DD or grade II DD+PALS≤14% displayed an increased mortality risk versus patients with grade I DD+PALS>14% (aHR 4.17, 95% CI 2.46-7.06; P<0.0001). Those with grade I DD+PALS≤14% or grade II DD+PALS>14% were at intermediate risk (aHR 1.63, 95% CI 1.07-2.49; P=0.024). CONCLUSIONS Our results demonstrate the strong relationship between DD and mortality in patients with severe AS and preserved LVEF. Patients with grade III or grade II DD and impaired PALS are at very high risk. These data demonstrate the importance of a comprehensive assessment of diastolic function in patients with severe AS.
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Affiliation(s)
- Nicolas Thellier
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Alexandre Altes
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Jeremy Layec
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Anne Laure Castel
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - François Delelis
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Tiffany Hubert
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - François Outerryck
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Ludovic Appert
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Christophe Tribouilloy
- Centre Hospitalier Universitaire d'Amiens, 80054 Amiens, France; EA 7517 MP3CV, Jules Verne University of Picardie, 80054 Amiens, France
| | - Sylvestre Maréchaux
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France; EA 7517 MP3CV, Jules Verne University of Picardie, 80054 Amiens, France.
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17
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Ozden O, Unlu S, Kilic DI, Sherif SA, Opan S, Kemal HS, Ozmen E, Tuner H, Bingol G, Barutcu A, Nasifov M, Bakan S, Goktekin O. [The association between cardiac mr feature tracking strain and myocardial late gadolinium enhancement in patients with hypertrophic cardiomyopathy]. KARDIOLOGIIA 2023; 63:52-58. [PMID: 36880144 DOI: 10.18087/cardio.2023.2.n2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 03/08/2023]
Abstract
Aim Hypertrophic cardiomyopathy (HCM) is a relatively common, heritable cardiomyopathy, and cardiac magnetic resonance (CMR) studies have been performed previously to evaluate different aspects of the disease. However, a comprehensive study, including all four cardiac chambers and analysis of left atrial (LA) function, is missing in the literature. The aim of this retrospective study was to analyze CMR-feature tracking (CMR-FT) strain parameters and atrial function of HCM patients and to investigate the association of these parameters with the amount of myocardial late gadolinium enhancement (LGE).Material and Methods In this retrospective, cross-sectional study, we analyzed the CMR images (CMRI) of 58 consecutive patients, who from February 2020 to September 2022 were diagnosed with HCM at our tertiary cardiovascular center. Patients who were younger than 18 yrs or who had moderate or severe valvular heart disease, significant coronary artery disease, previous myocardial infarction, suboptimal image quality, or with contraindication to CMR were excluded. CMRI was performed at 1.5 T with a scanner, and all scans were assessed by an experienced cardiologist and then re-assessed by an experienced radiologist. SSFP 2-, 3- and 4‑chamber, short axis views were obtained and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were measured. LGE images were obtained using a PSIR sequence. Native T1 and T2 mapping and post-contrast T1 map sequences were performed and each patient's myocardial extracellular volume (ECV) was calculated. LA volume index (LAVI), LA ejection fraction (LAEF), LA coupling index (LACI) were calculated. The complete CMR analysis of each patient was performed with CVI 42 software (Circle CVi, Calgary, Canada), off-line.Results The patients were divided into two groups, HCM with LGE (n=37, 64 %) and HCM without LGE (n=21, 36 %). The average patient age in the HCM patients with LGE was 50.8±14 yrs and 47±12.9 yrs in the HCM patients without LGE. Maximum LV wall thickness and basal antero-septum thickness were significantly higher in the HCM with LGE group compared to the HCM without LGE group (14.8±3.5 mm vs 20.3±6.5 mm (p<0.001), 14.2±3.2 mm vs 17.3±6.1 mm (p=0.015), respectively). LGE was 21.9±31.7 g and 15.7±13.4 % in the HCM with LGE group. LA area (22.2±6.1 vs 28.8±11.2 cm2; p=0.015) and LAVI (28.9±10.2 vs 45.6±23.1; p-0.004) were significantly higher in the HCM with LGE group. LACI was doubled in the HCM with LGE group (0.2±0.1 vs 0.4±0.2; p<0.001). LA strain (30.4±13.2 vs 21.3±16.2; p-0.04) and LV strain (15.2±3 vs 12.2±4.5; p=0.012) were significantly decreased in the HCM with LGE group.Conclusion This study sheds light on the CMR-FT differences between HCM with and without LGE. We found a greater burden of LA volume but significantly lower LA and LV strain in the LGE patients. These findings highlight further the LA and LV remodeling in HCM. Impaired LA function appears to have physiological significance, being associated with greater LGE. While our CMR-FT findings support the progressive nature of HCM, beginning with sarcomere dysfunction to eventual fibrosis, further studies are needed to validate these results in larger cohorts and to evaluate their clinical relevance.
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Affiliation(s)
| | | | | | - Sara Abu Sherif
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust
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Chen Y, Zhao W, Zhang N, Liu J, Liu D, Sun Z, Xu L, Wen Z. Prognostic Significance of Cardiac Magnetic Resonance in Left Atrial and Biventricular Strain Analysis during the Follow-Up of Suspected Myocarditis. J Clin Med 2023; 12:jcm12020457. [PMID: 36675386 PMCID: PMC9862408 DOI: 10.3390/jcm12020457] [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: 11/03/2022] [Revised: 12/09/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
To assess the variation in left atrial (LA) and biventricular strain and its prognostic value in the course of suspected myocarditis, this retrospective study included 55 patients with clinically suspected myocarditis who underwent cardiac magnetic resonance (CMR) examinations at baseline and follow-up periods. Cine images were used for feature tracking analysis. Paired Student's t test, McNemar's test, and Cox proportional hazard regression were used for statistical analysis. The LA total emptying fraction was the only functional index that showed a statistically significant improvement. The initial LA peak's late negative strain rate (SRa) was the only parameter with a significant predictive power of major adverse cardiac events under univariable (hazard ratio [HR] 2.396, 95% confidence interval [CI] 1.044-5.498, p = 0.039) and multivariable Cox survival analysis when adjusted by LA strain parameters (HR 5.072, 95% CI 1.478-17.404, p = 0.010), LA strain and functional parameters (HR 7.197, 95% CI 1.679-30.846, p = 0.008), and LA and biventricular strain and functional parameters (HR 10.389, 95% CI 2.250-47.977, p = 0.003). Thus, our findings indicate that CMR strain is useful for monitoring LA and ventricular function in suspected myocarditis, that LA function may recover preceding ventricular function changes, and that LA strain may serve as an incremental tool to predict adverse outcomes.
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Affiliation(s)
- Yan Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
| | - Wenjing Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
| | - Dongting Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6102, Australia
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
- Correspondence: (L.X.); (Z.W.)
| | - Zhaoying Wen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing 100029, China
- Correspondence: (L.X.); (Z.W.)
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19
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Nagueh SF. Noninvasive Measurement of Left Atrial Stiffness in Patients With Heart Failure and Preserved Ejection Fraction. JACC. CARDIOVASCULAR IMAGING 2022; 16:446-449. [PMID: 36752446 DOI: 10.1016/j.jcmg.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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20
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Hu HH. Editorial for "Cardiac MRI Left Atrial Strain Associated With New-Onset Atrial Fibrillation in Patients With ST-Segment Elevation Myocardial Infarction". J Magn Reson Imaging 2022. [PMID: 36250625 DOI: 10.1002/jmri.28493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Houchun Harry Hu
- Department of Radiology, Section of Radiological Science, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, 80045, USA
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21
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The relationship between left atrial and left ventricular remodeling: A dangerous liaison. Int J Cardiol 2022; 366:65-66. [PMID: 35803399 DOI: 10.1016/j.ijcard.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022]
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22
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Xie WH, Chen LJ, Hu LW, Ouyang RZ, Guo C, Sun AM, Wang Q, Qiu HS, Zhang YQ, Zhang H, Fu QH, Zhong YM. Cardiac Computed Tomography-Derived Left Atrial Strain and Volume in Pediatric Patients With Congenital Heart Disease: A Comparative Analysis With Transthoracic Echocardiography. Front Cardiovasc Med 2022; 9:870014. [PMID: 35795359 PMCID: PMC9251122 DOI: 10.3389/fcvm.2022.870014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed at exploring the feasibility and reproducibility of CCT for the measurement of Left Atrial (LA) strain and volume compared with transthoracic echocardiography (TTE) in pediatric patients with congenital heart disease (CHD). Materials and Methods The present study included 43 postoperative patients with CHD (7.39 ± 3.64 years, 56% male) who underwent clinically indicated CCT, and all patients underwent additional TTE on the same day. LA strain and volume parameters were measured by dedicated software. The correlation and agreement of LA strain and volume parameters were assessed using Pearson’s correlation coefficient and Bland-Altman analysis. Intra-class correlation coefficients (ICC) were used to assess CCT intra-observer and inter-observer reproducibility. Results All strain parameters of CCT were lower compared to TTE (reservoir strain: 28.37 ± 6.92 vs. 32.15 ± 8.15, respectively; conduit strain: 21.33 ± 6.46 vs. 24.23 ± 7.75, respectively; booster strain: 7.04 ± 2.74 vs. 7.92 ± 3.56). While the volume parameters of CCT were higher compared to TTE (LAV: 29.60 ± 19.01 vs. 25.66 ± 17.60, respectively; LAVi: 30.36 ± 22.31 vs. 28.63 ± 19.25, respectively). Both LA strain and volume measurements showed good correlation and agreement between the two modalities (r = 0.63–0.87, p < 0.001). CT-derived LA strain and volume measurements showed good intra- and inter-observer reproducibility using prototype software (ICC = 0.78–0.96). Conclusions CCT was feasible for measuring LA strain and volume with good correlation and high reproducibility as compared with TTE. As a complementary modality, CCT can regard as an accepted method in the evaluation of LA function in pediatric patients with CHD
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Affiliation(s)
- Wei-Hui Xie
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Wei Hu
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong-Zhen Ouyang
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Guo
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ai-Min Sun
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Wang
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hai-Sheng Qiu
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Zhang
- Department of Cardiovascular Thoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi-Hua Fu
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Qi-Hua Fu,
| | - Yu-Min Zhong
- Department of Radiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Yu-Min Zhong,
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Zhou H, An DA, Ni Z, Xu J, Zhou Y, Fang W, Lu R, Ying L, Huang J, Yao Q, Li D, Hu J, Chen B, Shen J, Jin H, Wei Y, Ouchi E, Xu L, Wu LM, Mou S. Incremental diagnostic value of CMR-derived LA strain and strain rate in dialysis patients with HFpEF. Eur J Radiol 2022; 151:110285. [DOI: 10.1016/j.ejrad.2022.110285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
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Cau R, Bassareo P, Suri JS, Pontone G, Saba L. The emerging role of atrial strain assessed by cardiac MRI in different cardiovascular settings: an up-to-date review. Eur Radiol 2022; 32:4384-4394. [PMID: 35451607 PMCID: PMC9213357 DOI: 10.1007/s00330-022-08598-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Abstract
The left atrium (LA) has a crucial function in maintaining left ventricular filling, which is responsible for about one-third of all cardiac filling. A growing body of evidence shows that LA is involved in several cardiovascular diseases from a clinical and prognostic standpoint. LA enlargement has been recognized as a predictor of the outcomes of many diseases. However, LA enlargement itself does not explain the whole LA's function during the cardiac cycle. For this reason, the recently proposed assessment of atrial strain at advanced cardiac magnetic resonance (CMR) enables the usual limitations of the sole LA volumetric measurement to be overcome. Moreover, the left atrial strain impairment might allow several cardiovascular diseases to be detected at an earlier stage. While traditional CMR has a central role in assessing LA volume and, through cine sequences, a marginal role in evaluating LA function, feature tracking at advanced CMR (CMR-FT) has been increasingly confirmed as a feasible and reproducible technique for assessing LA function through strain. In comparison to atrial function evaluations via speckle tracking echocardiography, CMR-FT has a higher spatial resolution, larger field of view, and better reproducibility. In this literature review on atrial strain analysis, we describe the strengths, limitations, recent applications, and promising developments of studying atrial function using CMR-FT in clinical practice. KEY POINTS: • The left atrium has a crucial function in maintaining left ventricular filling; left atrial size has been recognized as a predictor of the outcomes of many diseases. • Left atrial strain has been confirmed as a marker of atrial functional status and demonstrated to be a sensitive tool in the subclinical phase of a disease. • A comprehensive evaluation of the three phases of atrial function by CMR-FT demonstrates an impairment before the onset of atrial enlargement, thus helping clinicians in their decision-making and improving patient outcomes.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy
| | - Pierpaolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Jasjit S Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint(tm), Roseville, CA, USA
| | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, 09045, Cagliari, Italy.
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25
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Tanasa A, Tapoi L, Ureche C, Sascau R, Statescu C, Covic A. Left atrial strain: A novel "biomarker" for chronic kidney disease patients? Echocardiography 2021; 38:2077-2082. [PMID: 34820890 DOI: 10.1111/echo.15259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/04/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022] Open
Abstract
Cardiovascular disease and chronic kidney disease are frequently inter-connected and this association leads to an exponential growth of cardiovascular risk. This risk is currently underestimated by the existing algorithms and there is a constant need for new markers to predict adverse outcomes in this special population. In general population left atrial strain has emerged as an important tool for both the diagnosis and prognostic stratification, but data regarding its role in chronic kidney disease patients is scarce. The purpose of this review is to summarize the current evidence regarding this matter. Left atrial size and function mirror the duration and severity of increased left ventricular filling pressures. Increased left atrial volume index and impaired left atrial strain parameters are independent predictors for adverse cardiovascular events. Left atrial strain is impaired before changes in volume appear, thus being able to predict both diastolic and systolic function in chronic kidney disease patients. Finally, left atrial strain can identify renal patients with impaired exercise capacity and this could have clinical applications in the rehabilitation of this patients.
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Affiliation(s)
- Ana Tanasa
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laura Tapoi
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Carina Ureche
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Sascau
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Statescu
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C.I. Parhon" University Hospital, Iasi, Romania
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26
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Serezhina EK, Obrezan AG. [Significance of the echocardiographic evaluation of left atrial myocardial strain for early diagnosis of heart failure with preserved ejection fraction]. KARDIOLOGIIA 2021; 61:68-75. [PMID: 34549696 DOI: 10.18087/cardio.2021.8.n1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 06/13/2023]
Abstract
This systematic review is based on 19 studies from Elsevier, PubMed, Embase, and Scopus databases, which were found by the following keywords: LA strain (left atrial strain), STE (speckle tracking echocardiography), HF (heart failure), and HFpEF (heart failure with preserved ejection fraction). The review focuses on results and conclusions of studies on using the 2D echocardiographic evaluation of left atrial (LA) myocardial strain for early diagnosis of HFpEF in routine clinical practice. Analysis of the studies included into this review showed a significant decline of all LA functions in patients with HFpEF. Also, multiple studies have reported associations between decreased indexes of LA strain and old age, atrial fibrillation, left ventricular hypertrophy, left and right ventricular systolic dysfunction, and LV diastolic dysfunction. Thus, the review indicates significant possibilities of using indexes of LA strain in evaluation of early stages of both systolic and diastolic myocardial dysfunction. Notably, LA functional systolic and diastolic indexes are not sufficiently studied despite their growing significance for diagnosis and prognosis of patients with HFpEF. For this reason, in addition to existing models for risk stratification in this disease, including clinical characteristics and/or echocardiographic data, future studies should focus on these parameters.
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Affiliation(s)
- E K Serezhina
- ООО International Medical Center "SOGAZ", Saint Petersburg, Russia
| | - A G Obrezan
- ООО International Medical Center "SOGAZ", Saint Petersburg, Russia
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27
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Tomlinson S, Scalia GM, Appadurai V, Edwards N, Savage M, Lam AKY, Chan J. Left atrial reservoir strain provides incremental value to left atrial volume index for evaluation of left ventricular filling pressure. Echocardiography 2021; 38:1503-1513. [PMID: 34355811 DOI: 10.1111/echo.15157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/22/2021] [Accepted: 07/06/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Left atrial analysis is employed in diastolic assessment with left atrial volume index (LAVI) incorporated in the 2016 ASE/EACVI diastology guideline algorithm. LAVI has sub-optimal correlation with invasive left ventricular filling pressure (LVFP) and incorporation of left atrial reservoir strain (LASr) may improve diastolic assessment. METHODS A cross-sectional prospective study of 139 patients was undertaken with all patients undergoing transthoracic echocardiography immediately prior to cardiac catheterization with invasive evaluation of LVFP. LASr by speckle tracking echocardiography and conventional echocardiographic parameters were assessed in relation to invasive LVFP. Modification of the 2016 guideline algorithm was performed with incorporation of LASr in place of LAVI (LASr ≤23% indicating elevated LVFP). Accuracy of the modified and conventional algorithm were assessed for predicting invasive LVFP. RESULTS The mean age was 63±12 years with 27% female. LASr demonstrated superior correlation and receiver operator characteristic for predicting LVFP than LAVI (LASr: r -.46 (p < 0.01), AUC: .82 vs LAVI: r .19 (p 0.02), AUC: .66). LASr of ≤23% was the optimal cut-off for discriminating elevated LVFP (sensitivity 80%, specificity 77%). Modification of the 2016 algorithm with incorporation of LASr in place of LAVI reclassified 12% of the patient cohort and improved concordance of echocardiographic and invasive LVFP assessment (modified algorithm κ .47 vs 2016 algorithm κ: .33). No patients were incorrectly reclassified by modified algorithm assessment. CONCLUSIONS LASr better predicts invasive LVFP than LAVI. Modification of the 2016 guideline algorithm with incorporation of LASr in place of LAVI improves accuracy of echocardiographic assessment of LVFP.
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Affiliation(s)
- Stephen Tomlinson
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Gregory M Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Vinesh Appadurai
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Natalie Edwards
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michael Savage
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Alfred K-Y Lam
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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28
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Chen YC, Voskoboinik A, Gerche AL, Marwick TH, McMullen JR. Prevention of Pathological Atrial Remodeling and Atrial Fibrillation: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2846-2864. [PMID: 34082914 DOI: 10.1016/j.jacc.2021.04.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
Atrial enlargement in response to pathological stimuli (e.g., hypertension, mitral valve disease) and physiological stimuli (exercise, pregnancy) can be comparable in magnitude, but the diseased enlarged atria is associated with complications such as atrial fibrillation (AF), whereas physiological atrial enlargement is not. Pathological atrial enlargement and AF is also observed in a small percentage of athletes undergoing extreme/intense endurance sport and pregnant women with preeclampsia. Differences between physiological and pathological atrial enlargement and underlying mechanisms are poorly understood. This review describes human and animal studies characterizing atrial enlargement under physiological and pathological conditions and highlights key knowledge gaps and clinical challenges, including: 1) the limited ability of atria to reverse remodel; and 2) distinguishing physiological and pathological enlargement via imaging/biomarkers. Finally, this review discusses how targeting distinct molecular mechanisms underlying physiological and pathological atrial enlargement could provide new therapeutic and diagnostic strategies for preventing or reversing atrial enlargement and AF.
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Affiliation(s)
- Yi Ching Chen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Heart Center, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia.
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29
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Eberhardt C, Schwarzwald CC. Quantification of left atrial contractile function using two-dimensional speckle tracking echocardiography in horses after conversion of atrial fibrillation to sinus rhythm. J Vet Cardiol 2021; 35:108-120. [PMID: 33940552 DOI: 10.1016/j.jvc.2021.03.004] [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: 07/07/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES In horses, persistent atrial dysfunction is a prognostic indicator of recurrence of atrial fibrillation (AF). The objective of this study was to quantify left atrial (LA) contractile function in Warmblood horses after successful cardioversion of AF to sinus rhythm, using standard two-dimensional echocardiography (2DE) and two-dimensional speckle tracking (2DST) analyses, and to provide proof-of-concept for use of 2DST to detect LA contractile dysfunction in horses. ANIMALS, MATERIALS, AND METHODS Nineteen Warmblood horses with AF and successful transvenous electrical cardioversion (TVEC) or medical cardioversion using quinidine sulfate (QS) were included. Echocardiography was performed at 24 hr, 72 hr, and 1-6 months after cardioversion. Conventional 2DE-derived indices of LA size and function and global longitudinal strain (SL) and longitudinal strain rate (SRL) during LA contractile function were measured to detect differences in LA size and function over time and between treatment modalities. The association between 2DE-derived indices and global SL and SRL, respectively, and the agreement of the variables to detect LA dysfunction were assessed. RESULTS Global SL and SRL, as well as active LA fractional area change (FAC) identified cases with LA dysfunction after TVEC and QS cardioversion and proved useful to demonstrate LA functional recovery over time. Agreement between active LA FAC and SL and SRL, respectively, to diagnose atrial dysfunction was substantial to fair at 24 hr after cardioversion and decreased with time. CONCLUSION This study shows that 2DST is useful to quantify LA contractile dysfunction in horses after cardioversion of AF.
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Affiliation(s)
- C Eberhardt
- University of Zurich, Vetsuisse Faculty, Equine Department, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - C C Schwarzwald
- University of Zurich, Vetsuisse Faculty, Equine Department, Winterthurerstrasse 260, 8057, Zurich, Switzerland
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30
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García-Izquierdo E, Moñivas-Palomero V, Forteza A, Martín-López C, Torres-Sanabria M, Cia-Mendioroz X, Olivo-Rodríguez C, Navarro-Rico S, Sánchez-Gómez A, Mirelis JG, Cavero MA, Mingo-Santos S. Left atrial strain in the assessment of diastolic function: providing new insights into primary myocardial dysfunction in Marfan syndrome. Int J Cardiovasc Imaging 2021; 37:2735-2745. [PMID: 33871735 DOI: 10.1007/s10554-021-02247-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 01/28/2023]
Abstract
Previous studies using conventional echocardiographic measurements have reported subclinical left ventricular (LV) diastolic abnormalities in patients with Marfan syndrome (MFS). Left atrial (LA) strain allows an accurate categorization of LV diastolic dysfunction. We aimed to characterize LV myocardial performance in a cohort of MFS patients using STE-derived measurements (LV and LA strain) along with conventional echocardiographic parameters. We studied 127 adult patients with MFS (no prior cardiac surgery or significant valvular regurgitation) and 38 healthy controls. We performed detailed echocardiograms and selected left atrial reservoir strain (LASr) as a surrogate of impaired relaxation. Additionally, we searched for possible determinants of LASr in patients with MFS, with a special focus on the elastic properties of the aorta. In spite of lower E-wave, septal and lateral e' velocities and average E/e' ratio in MFS patients, all participants had normal diastolic function according to current guidelines. MFS patients exhibited reduced LV global longitudinal strain (19.3 ± 2.6 vs 21.6 ± 2.1%, p < 0.001) and reduced LASr (32.9 ± 8.5 vs 43.3 ± 7.8%, p < 0.001) compared to controls. In the MFS cohort, we found weak significant (p < 0.05) correlations between LASr and certain parameters: E/A ratio (R = 0.258), E wave (R = 0.226), aortic distensibility (R = 0.222), stiffness index (R = - 0.216), LV ejection fraction (R = 0.214), lateral e' (R = 0.210), LV end-systolic volume index (R = - 0.210), LV global longitudinal strain (R = 0.201), septal e' (R = 0.185). After multivariate analysis, only LV end-systolic volume index and E/A ratio maintained a weak independent association with LASr (R = - 0.220; p = 0.017 and R = 0.199; p = 0.046, respectively). In conclusion, LASr is reduced in patients with MFS, which may represent an early stage of LV diastolic dysfunction. LASr is not determined by the elastic properties of the aorta, suggesting that impaired myocardial relaxation is a primary condition in MFS.
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Affiliation(s)
- Eusebio García-Izquierdo
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain.
| | - Vanessa Moñivas-Palomero
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Carlos Martín-López
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Mario Torres-Sanabria
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Xabier Cia-Mendioroz
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Consuelo Olivo-Rodríguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Sara Navarro-Rico
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Andrés Sánchez-Gómez
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Jesús G Mirelis
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Miguel A Cavero
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Susana Mingo-Santos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
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Hadadi M, Mohseni-Badalabadi R, Hosseinsabet A. Assessment of the ability of the CHA 2DS 2-VASc scoring system to grade left atrial function by 2D speckle-tracking echocardiography. BMC Cardiovasc Disord 2021; 21:94. [PMID: 33593290 PMCID: PMC7885434 DOI: 10.1186/s12872-021-01908-8] [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: 10/08/2020] [Accepted: 01/28/2021] [Indexed: 12/22/2022] Open
Abstract
Background The CHA2DS2-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHA2DS2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG). Methods This cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHA2DS2-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed. Results LA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s−1 vs 2.9 ± 0.6 s−1 vs 2.9 ± 0.6 s−1, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1–12.5]% vs 12.9 [9.4–15.1]% vs 11.5 [9.1–13.8]%, correspondingly; P < 0.001 and 2.1 [1.6–2.7] s−1 vs 2.8 [2.4–3.6] s−1 vs 2.6 [2.2–3.0] s−1, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31–71.43) and 8.05 (1.08–60.16), respectively; P = 0.026 and P = 0.042, respectively). Conclusions LA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay.
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Affiliation(s)
- Marjan Hadadi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, Islamic Republic of Iran
| | - Reza Mohseni-Badalabadi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, Islamic Republic of Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, Islamic Republic of Iran.
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Laufer-Perl M, Arias O, Dorfman SS, Baruch G, Rothschild E, Beer G, Hasson SP, Arbel Y, Rozenbaum Z, Topilsky Y, Kapusta L. Left Atrial Strain changes in patients with breast cancer during anthracycline therapy. Int J Cardiol 2021; 330:238-244. [PMID: 33581179 DOI: 10.1016/j.ijcard.2021.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/25/2021] [Accepted: 02/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiotoxicity has become a significant adverse effect of cancer therapy, with Anthracyclines (ANT) in particular. There is a crucial need for new imaging techniques for the early subclinical detection of cardiotoxic effect. We aimed to evaluate left atrial strain (LAS) changes during ANT therapy and to assess the correlation between LAS and the routine echocardiographic diastolic parameters. METHODS AND RESULTS Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). All female patients with breast cancer, planned for ANT therapy were included. All patients underwent serial echocardiography exams including baseline LAS (before chemotherapy, T1) and shortly after the completion of ANT therapy (T3). LAS was assessed in 3 phases: Reservoir (LASr), Conduit (LASc) and Pump (LASp). Significant reduction in LASr was determined by either a relative reduction of >10% or an absolute value of <35%. From September 2016 to June 2019, 40 patients were evaluated with a mean Doxorubicin (type of ANT) dose of 237±13.24mg/m2. At T3, significant reduction in LASr was observed among 50% of the patients with a mean LASr reduction from 40.15 ± 6.83% to 36.04 ± 7.73% (p < 0.001). LASc showed significant reduction as well (p < 0.004) as opposed to LASp (p=0.076). Both LASr and LASc showed significant correlation to the routine diastolic parameters. CONCLUSIONS LASr and LASc reduction are frequent and occur early in the course of ANT therapy, showing significant correlation to the routine echocardiographic diastolic parameters, which may imply a role in the detection of early cardiotoxicity.
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Affiliation(s)
- Michal Laufer-Perl
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orly Arias
- Department of Internal medicine B, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Svetlana Sirota Dorfman
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Guy Baruch
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ehud Rothschild
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gil Beer
- Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Peleg Hasson
- Department of Oncology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zach Rozenbaum
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Livia Kapusta
- Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
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Marwick TH, Chandrashekhar Y. Left Atrial Strain. JACC Cardiovasc Imaging 2020; 13:2278-2279. [DOI: 10.1016/j.jcmg.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Szilveszter B, Nagy AI, Vattay B, Apor A, Kolossváry M, Bartykowszki A, Simon J, Drobni ZD, Tóth A, Suhai FI, Merkely B, Maurovich-Horvat P. Left ventricular and atrial strain imaging with cardiac computed tomography: Validation against echocardiography. J Cardiovasc Comput Tomogr 2020; 14:363-369. [DOI: 10.1016/j.jcct.2019.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/07/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022]
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Exercise behavior of degenerative mitral stenosis. Int J Cardiovasc Imaging 2020; 36:1845-1853. [PMID: 32458290 DOI: 10.1007/s10554-020-01898-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
Mitral annular calcification (MAC) is increasingly encountered, particularly among the elderly and those with chronic kidney disease, and is often associated with a transvalvular gradient. In contrast to rheumatic mitral stenosis relatively little is known about mitral stenosis due to MAC. We aimed to clarify whether exercise limitation in this group is primarily due to valvular obstruction or ventricular dysfunction resulting from multiple comorbidities. 20 patients with severe MAC (bulky calcium deposits which restricted leaflet motion) were submitted to supine bicycle exercise, measuring Doppler and echocardiographic parameters at baseline and during exercise. They were compared 1:1 to subjects matched for age, sex, and left ventricular wall thickness. At baseline MAC subjects had higher mean mitral valve gradients (MVG) than comparison subjects (7.5 ± 3.8 vs 1.6 ± 0.8 mm Hg, p < 0.0001), along with larger indexed left atrial volumes (54.4 ± 14.9 vs 34.0 ± 11.7 mL, p < 0.0001) and reduced left atrial strains (reservoir, conduit, and booster pump). With exercise MAC subjects reached higher levels of MVG (17.3 ± 8.4 vs 5.5 ± 2.5 mm Hg, p < 0.0001), and pulmonary artery systolic pressure (estimated from tricuspid regurgitant jet [TR] velocity) and displayed a moderate correlation between ΔMVG and ΔTR velocity (r2 = 0.57). MAC subjects whose exercise MVG was ≥ 15 mm Hg all had a peak pulmonary artery systolic pressure > 60 mm Hg. MAC subjects also had relative chronotropic incompetence. Patients with severe MAC and a transvalvular gradient experience large increases in MVG and pulmonary pressure with exercise, similar to what has been described in rheumatic mitral stenosis. MAC may be an under-recognized cause of dyspnea and exercise intolerance in older patients.
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Cameli M, Pastore MC, Henein MY, Mondillo S. The left atrium and the right ventricle: two supporting chambers to the failing left ventricle. Heart Fail Rev 2020; 24:661-669. [PMID: 31025236 DOI: 10.1007/s10741-019-09791-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) is mainly caused by left ventricular (LV) impairment of function, hence detailed assessment of its structure and function is a clinical priority. The frequent involvement of the left atrium (LA) and the right ventricle (RV) in the overall cardiac performance has recently gained significant interest with specific markers predicting exercise intolerance and prognosis being proposed. The LA and RV are not anatomically separated from the LV, while the LA controls the inlet the RV shares the interventricular septum with the LV. Likewise, the function of the two chambers is not entirely independent from that of the LV, with the LA enlarging to accommodate any rise in filling pressures, which could get transferred to the RV via the pulmonary circulation. In the absence of pulmonary disease, LA and RV function may become impaired in patients with moderate-severe LV disease and raised filling pressures. These changes can often occur irrespective of the severity of systolic dysfunction, thus highlighting the important need for critical assessment of the function of the two chambers. This review evaluates the pivotal role of the left atrium and right ventricle in the management of HF patients based on the available evidence.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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Left atrial strain in left ventricular diastolic dysfunction: have we finally found the missing piece of the puzzle? Heart Fail Rev 2019; 25:409-417. [DOI: 10.1007/s10741-019-09889-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hiebert JB, Vacek J, Shah Z, Rahman F, Pierce JD. Use of speckle tracking to assess heart failure with preserved ejection fraction. J Cardiol 2019; 74:397-402. [PMID: 31303358 PMCID: PMC6764910 DOI: 10.1016/j.jjcc.2019.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) currently represents approximately 50% of heart failure (HF) cases in the USA and is increasingly recognized as a leading cause of morbidity and mortality. Recent data suggest that the prevalence of HFpEF relative to HF with reduced ejection fraction (HFrEF) is increasing at a rate of 1% per year. With an aging population and increasing risk factors such as hypertension, obesity, and diabetes mellitus, HFpEF will soon be the most prevalent HF phenotype. Two-dimensional speckle-tracking echocardiography (STE) has been used to diagnose HFpEF specifically by focusing on the longitudinal systolic function of the left ventricle (LV). Yet there are many patients with HFpEF in whom there are no differences in LV global longitudinal systolic strain, but there are changes in left atrial function and structure. There are several proposed pathophysiological mechanisms for HFpEF such as endothelial dysfunction, interactions among proteins, signaling pathways, and myocardial bioenergetics. Yet only one specific therapy, mineralocorticoid receptor antagonist, spironolactone, is recommended as a treatment for patients with HFpEF. However, spironolactone does not address many of the pathophysiologic changes that occur in HFpEF, thus new novel therapeutic agents are needed. With the limited available therapies, clinicians should use STE to assess for the presence of this syndrome in their patients to provide effective diagnosis and management.
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Affiliation(s)
- John B Hiebert
- University of Kansas, School of Nursing, Kansas City, KS, USA
| | - James Vacek
- Clinical Cardiology and Cardiovascular Research, Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, KS, USA
| | - Zubair Shah
- The University of Kansas Health System, Kansas City, KS, USA
| | - Faith Rahman
- University of Kansas, School of Nursing, Kansas City, KS, USA.
| | - Janet D Pierce
- Department of Molecular and Integrative Physiology, University of Kansas, School of Nursing, Kansas City, KS, USA
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Durmaz E, Ikitimur B, Kilickiran Avci B, Atıcı A, Yurtseven E, Tokdil H, Ebren C, Polat F, Karaca O, Karadag B, Ongen Z. The clinical significance of premature atrial contractions: How frequent should they become predictive of new-onset atrial fibrillation. Ann Noninvasive Electrocardiol 2019; 25:e12718. [PMID: 31603280 PMCID: PMC7358836 DOI: 10.1111/anec.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background Although previous studies reported frequent premature atrial contractions(fPACs) increased the risk of adverse cardiovascular outcomes, especially atrial fibrillation(AF), there is a substantial inconsistency between reports concerning the definition of fPAC. In this study, we aimed to investigate the relationship between fPAC and cardiovascular outcomes, especially AF. We further searched for a cutoff value of fPAC for prediction of AF. Methods We retrospectively analyzed the ambulatory 24‐hr Holter monitoring records and 392 patients included. Frequent PAC was defined as more than 720 PAC/24 hr as used for frequent ventricular premature beats. Patients’ baseline characteristics, echocardiographic variables and medical history were recorded. Results There were 189 patients with fPAC and 203 patients without fPAC. Patients with fPAC had more comorbidities in terms of hypertension, diabetes mellitus, coronary artery disease and congestive heart failure. CHA2DS2‐VaSc was higher in patients with fPAC. Mean follow‐up duration was 31 months, and the number of patients with new‐onset AF during follow‐up was significantly higher in fPAC group (22% vs. 5%, p < .001). fPAC was significantly and independently associated with new‐onset AF and predicted AF with a cutoff value of 3,459 PAC/24 hr, and the risk of AF was 11‐fold higher than those with <3,000 PAC/24 hr. In addition, an increased CHA2DS2‐VaSc score was also associated with new‐onset atrial fibrillation. Conclusion In our study, we have demonstrated that fPAC is significantly associated with new‐onset AF, and this association is the strongest among those patients who have more than 3,000 PAC in 24 hr.
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Affiliation(s)
- Eser Durmaz
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Baris Ikitimur
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burcak Kilickiran Avci
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Adem Atıcı
- Cardiology Department, Goztepe Research and Training Hospital, Istabul, Turkey
| | - Ece Yurtseven
- Cardiology Department, Koc University Hospital, Istanbul, Turkey
| | - Hasan Tokdil
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cansu Ebren
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fuat Polat
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Orhan Karaca
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilgehan Karadag
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeki Ongen
- Cardiology Department, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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40
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Utilidad del “speckle tracking” en pacientes no oncológicos. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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41
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Left Atrial Strain Performance and its Application in Clinical Practice. JACC Cardiovasc Imaging 2019; 12:1093-1101. [DOI: 10.1016/j.jcmg.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/01/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022]
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Abstract
Left atrial size and function parameters are associated with adverse outcomes in multiple disease states, including heart failure with reduced and preserved ejection fraction. Recent data suggest that phasic left atrial function and left atrial stain measurements also hold prognostic information. Three-dimensional echocardiography provides more accurate and reproducible quantification of left atrial volumes than 2-dimensional echocardiography when compared with cardiac magnetic resonance reference standards. Greater accessibility to these advanced imaging techniques allows for the integration of these parameters into routine clinical practice.
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Affiliation(s)
- Kalie Y Kebed
- Section of Cardiology, University of Chicago Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9067, DCAM 5502, Chicago, IL 60637, USA
| | - Karima Addetia
- Section of Cardiology, University of Chicago Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9067, DCAM 5504, Chicago, IL 60637, USA
| | - Roberto M Lang
- Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, Heart & Vascular Center, University of Chicago Medicine, The University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA.
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Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8979407. [PMID: 30627581 PMCID: PMC6304576 DOI: 10.1155/2018/8979407] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull's-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.
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