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Zhang W, Cai Q, Lin M, Tian R, Jin S, Qin Y, Lu X. Diagnostic potential of myocardial early systolic lengthening for patients with suspected non-ST-segment elevation acute coronary syndrome. BMC Cardiovasc Disord 2023; 23:364. [PMID: 37468828 DOI: 10.1186/s12872-023-03364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND During early systole, ischemic myocardium with reduced active force experiences early systolic lengthening (ESL). This study aimed to explore the diagnostic potential of myocardial ESL in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF). METHODS Overall, 195 suspected NSTE-ACS patients with normal wall motion and LVEF, who underwent speckle tracking echocardiography (STE) before coronary angiography, were included in this study. Patients were stratified into the coronary artery disease (CAD) group when there was ≥ 50% stenosis in at least one major coronary artery. The CAD patients were further stratified into the significant (≥ 70% reduction of vessel diameter) stenosis group or the nonsignificant stenosis group. Myocardial strain parameters, including global longitudinal strain (GLS), duration of early systolic lengthening (DESL), early systolic index (ESI), and post-systolic index (PSI), were analyzed using STE and compared between groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic accuracy. Logistic regression analysis was conducted to establish the independent and incremental determinants for the presence of significant coronary stenosis. RESULTS The DESL and ESI values were higher in patients with CAD than those without CAD. In addition, CAD patients with significant coronary stenosis had higher DESL and ESI than those without significant coronary stenosis. The ROC analysis revealed that ESI was superior to PSI for identifying patients with CAD, and further superior to GLS and PSI for predicting significant coronary stenosis. Moreover, ESI could independently and incrementally predict significant coronary stenosis in patients with CAD. CONCLUSIONS The myocardial ESI is of great value for the diagnosis and risk stratification of clinically suspected NSTE-ACS patients with normal LVEF and wall motion.
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Affiliation(s)
- Wanwei Zhang
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qizhe Cai
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Mingming Lin
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Runyu Tian
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Shan Jin
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yunyun Qin
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Xiuzhang Lu
- Department of Ultrasound Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
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Early systolic lengthening: a niche within strain imaging with prognostic value in cardiovascular disease. Int J Cardiovasc Imaging 2021; 38:169-170. [PMID: 34932176 DOI: 10.1007/s10554-021-02500-z] [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: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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Myocardial early systolic lengthening predicts mid-term outcomes in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2021; 38:161-168. [PMID: 34846619 DOI: 10.1007/s10554-021-02484-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
In this study, we investigated whether early systolic lengthening (ESL) which reflects subclinical ischemia and other echocardiographic and clinic parameters predict primary outcome [appropriate ICD shock, cardiovascular mortality and ventricular tachycardia (VT) or fibrillation] in patients with hypertrophic cardiomyopathy (HCM). 202 Patients with HCM (68% male, mean age 48 ± 13.9 years) were included in the study. Patients' clinical, electrocardiographic, 2D classic and speckle tracking echocardiography (STE) data were collected. ESL was defined as time from onset of the Q wave on ECG (onset of the R wave if the Q wave was absent) to maximum myocardial systolic lengthening. Patients were divided into two groups as occurrence or absence of primary outcome during 5 years follow up. During the follow-up period of 5 years (mean follow-up duration, 45.9 ± 10.8 months), 31 patients (15%) developed primary outcome [appropriate ICD shock 22 (11%), cardiovascular death 6 (3%), VT/VF 3(1.5%)]. Higher HCM Risk SCD score, longer ESL, and decreased global longitudinal peak strain (GLPS) were observed in patients with primary outcome. A Cox regression analysis, ESL, GLPS and HCM Risk SCD score were found to be independent predictors of occurrence of primary outcome. In ROC curve analysis, ESL > 53.5 msn could discriminate between groups with and without a primary outcome (AUC 0.768, 80% sensitivity and 60% specificity, CI 95% 0.666-0.871). ESL were found to be predictive for primary outcome in patients with HCM. Readily measurable ESL could be helpful to distinguish patients at high risk who could optimally benefit from ICD therapy.
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Brainin P. Myocardial Postsystolic Shortening and Early Systolic Lengthening: Current Status and Future Directions. Diagnostics (Basel) 2021; 11:diagnostics11081428. [PMID: 34441362 PMCID: PMC8393947 DOI: 10.3390/diagnostics11081428] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
The concept of paradoxical myocardial deformation, commonly referred to as postsystolic shortening and early systolic lengthening, was originally described in the 1970s when assessed by invasive cardiac methods, such as ventriculograms, in patients with ischemia and animal experimental models. Today, novel tissue-based imaging technology has revealed that these phenomena occur far more frequently than first described. This article defines these deformational patterns, summarizes current knowledge about their existence and highlights the clinical potential associated with their understanding.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, DK-2900 Gentofte, Denmark
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Brainin P, Biering-Sørensen SR, Møgelvang R, Jensen JS, Biering-Sørensen T. Duration of early systolic lengthening: prognostic potential in the general population. Eur Heart J Cardiovasc Imaging 2021; 21:1283-1290. [PMID: 31628809 DOI: 10.1093/ehjci/jez262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND When the left ventricle pressure rises during early systole, myocardial fibres with reduced contractility tend to stretch instead of shortening. This interval is known as duration of early systolic lengthening (DESL). We sought to investigate if DESL provides prognostic information on cardiovascular events. METHODS AND RESULTS In this prospective study we included 1210 participants from a low-risk general population who underwent speckle tracking echocardiography (men 41%, mean age 56 years, SD 16). Primary endpoints were incident heart failure (HF), myocardial infarction (MI), and cardiovascular death (CVD). We defined DESL as time from onset of Q-wave on the electrocardiogram to peak positive systolic strain. In addition, we assessed the ratio between DESL and duration of cardiac systole, DESLsystole.During median follow-up of 16 years, 90 (7%) developed HF, 50 (4%) MI, and 70 (6%) experienced CVD. Both DESL [hazard ratio (HR) 1.58 95%CI 1.16-2.15, P = 0.004 per 10 ms increase] and DESLsystole (HR 1.74 95%CI 1.24-2.47, P = 0.001 per 1% increase) were predictors of HF. Similarly, DESL (HR 1.40 95%CI 1.09-1.78, P = 0.007 per 10 ms increase) and DESLsystole (HR 1.58 95%CI 1.01-2.49, P = 0.047 per 1% increase) were predictors of MI. No associations were found with CVD. After adjusting for clinical and echocardiographic parameters, the associations remained significant. DESLsystole was superior to systolic echocardiographic parameters for predicting HF (P = 0.012). CONCLUSION DESL and the novel index of DESLsystole provide independent and novel prognostic information on the risk of HF and MI in the general population. Evaluation of DESL should be explored in future echocardiographic studies.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark
| | - Sofie Reumert Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
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Brainin P, Haahr-Pedersen S, Olsen FJ, Holm AE, Fritz-Hansen T, Jespersen T, Gislason G, Biering-Sørensen T. Early Systolic Lengthening in Patients With ST-Segment-Elevation Myocardial Infarction: A Novel Predictor of Cardiovascular Events. J Am Heart Assoc 2020; 9:e013835. [PMID: 31973603 PMCID: PMC7033900 DOI: 10.1161/jaha.119.013835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early systolic lengthening (ESL) may occur in ischemic myocardial segments with reduced contractile force. We sought to evaluate the prognostic potential of ESL in patients with ST‐segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods and Results We prospectively enrolled 373 patients with ST‐segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. All patients underwent a speckle tracking echocardiographic examination a median of 2 days (interquartile range, 1–3 days) after the percutaneous coronary intervention. We assessed a novel viability index, the ESL index, defined as follows: [−100×(peak positive systolic strain/peak negative strain in cardiac cycle)]. We also calculated ESL duration, defined as time from onset of QRS complex on the ECG to time of peak positive systolic strain. Both parameters were averaged from 18 myocardial segments. During a median follow‐up of 5.3 years (interquartile range, 2.5–6.0 years), 145 (39%) experienced major adverse cardiovascular events, a composite of incident heart failure, new myocardial infarction, and all‐cause mortality. The ESL index and ESL duration were significantly increased in culprit lesion areas (6.7±6.2% versus 5.0±4.1% and 43±33 ms versus 33±24 ms, respectively; P<0.001 for both). In Cox proportional hazard models, the ESL index (hazard ratio, 1.27 per 1% increase; 95% CI, 1.13–1.43; P<0.001) and ESL duration (hazard ratio, 1.49 per 1‐ms increase; 95% CI, 1.15–1.92; P=0.002) yielded prognostic information on major adverse cardiovascular events. Both associations remained significant after adjusting for clinical, echocardiographic, and invasive confounders. Conclusions Assessment of ESL after primary percutaneous coronary intervention in patients with ST‐segment–elevation myocardial infarction yields independent and significant prognostic information on the future risk of cardiovascular events.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Sune Haahr-Pedersen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Flemming Javier Olsen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Anna Engell Holm
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences University of Copenhagen Denmark
| | - Gunnar Gislason
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,Department of Biomedical Sciences University of Copenhagen Denmark
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How to Define End-Diastole and End-Systole? JACC Cardiovasc Imaging 2015; 8:148-57. [DOI: 10.1016/j.jcmg.2014.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/09/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022]
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Zahid W, Eek CH, Remme EW, Skulstad H, Fosse E, Edvardsen T. Early systolic lengthening may identify minimal myocardial damage in patients with non-ST-elevation acute coronary syndrome. Eur Heart J Cardiovasc Imaging 2014; 15:1152-60. [DOI: 10.1093/ehjci/jeu101] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aase SA, Björk-Ingul C, Thorstensen A, Torp H, Støylen A. Aortic Valve Closure: Relation to Tissue Velocities by Doppler and Speckle Tracking in Patients with Infarction and at High Heart Rates. Echocardiography 2010; 27:363-9. [PMID: 20331696 DOI: 10.1111/j.1540-8175.2009.01025.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Svein A Aase
- Department of Circulation and Medical Imaging, NTNU, NO-7489 Trondheim, Norway.
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