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Meloni A, Saba L, Positano V, Pistoia L, Campanella A, Spasiano A, Putti MC, Fotzi I, Cossu A, Corigliano E, Massa A, Keilberg P, Cademartiri F, Cau R. Global longitudinal strain by cardiac magnetic resonance is associated with cardiac iron and complications in beta-thalassemia major patients. Int J Cardiol 2024; 413:132319. [PMID: 38971535 DOI: 10.1016/j.ijcard.2024.132319] [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: 04/23/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in patients with β-thalassemia major (β-TM). METHOD We considered 266 β-TM patients (134 females, 37.08 ± 11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project and 80 healthy controls (50 females, mean age 39.77 ± 11.29 years). The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, the T2* technique for the assessment of myocardial iron overload, and late gadolinium enhancement (LGE) technique. RESULTS In comparison to the healthy control group, β-TM patients showed impaired GLS, GCS, and GRS values. Among β-TM patients, sex was identified as the sole independent determinant of all LV strain parameters. All LV strain parameters displayed a significant correlation with LV end-diastolic volume index, end-systolic volume index, mass index, and ejection fraction, and with the number of segments exhibiting LGE. Only GLS exhibited a significant correlation with global heart T2* values and the number of segments with T2* < 20 ms. Patients with cardiac complications exhibited significantly impaired GLS compared to those without cardiac complications. CONCLUSION In patients with β-TM, GLS, GCS, and GRS were impaired in comparison with control subjects. Among LV strain parameters, only GLS demonstrated a significant association with cardiac iron levels and complications.
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Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; U.O.C. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessandra Campanella
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Napoli, Italy
| | - Maria Caterina Putti
- Dipartimento della Salute della Donna e del Bambino, Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padova, Italy
| | - Ilaria Fotzi
- SOC Oncologia, Ematologia e Trapianto di Cellule Staminali Emopoietiche, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Antonella Cossu
- Ambulatorio Trasfusionale - Servizio Immunoematologia e Medicina Trasfusionale Dipartimento dei Servizi, Presidio Ospedaliero "San Francesco", Nuoro, Italy
| | | | - Antonella Massa
- Servizio Trasfusionale, Ospedale "Giovanni Paolo II", Olbia, Italy
| | - Petra Keilberg
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
| | - Riccardo Cau
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
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Frederiksen PH, Linde L, Gregers E, Udesen NLJ, Helgestad OK, Banke A, Dahl JS, Povlsen AL, Jensen LO, Larsen JP, Lassen J, Schmidt H, Ravn HB, Moller JE. Association between speckle tracking echocardiography and pressure-volume loops during cardiogenic shock development. Open Heart 2024; 11:e002512. [PMID: 38782543 PMCID: PMC11116883 DOI: 10.1136/openhrt-2023-002512] [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] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The relationship between speckle tracking assessed global longitudinal strain (GLS) and Doppler-based echocardiography with basic physiological markers of cardiac function derived from pressure-volume loops is poorly elucidated. OBJECTIVE We aimed to describe the association between LS and Doppler-based echocardiography and direct measurements of central haemodynamic parameters from conductance catheter-based pressure-volume loops in an animal model with increasing left ventricular (LV) dysfunction. METHODS 12 Danish landrace female pigs (75-80 kg) were used. All instrumentations were performed percutaneously, including the conductance catheter in the LV. Progressive LV dysfunction was induced by embolisation through the left main coronary artery with microspheres every 3 min until a >50% reduction in cardiac output (CO) or mixed venous saturation (SvO2), compared with baseline, or SvO2 <30%. Echocardiography was performed at baseline and 90 s after each injection. RESULTS With progressive LV dysfunction, mean CO decreased from 5.6±0.9 L/min to 2.1±0.9 L/min, and mean SvO2 deteriorated from 61.1±7.9% to 35.3±6.1%. Mean LS and LV outflow tract velocity time integral (LVOT VTI) declined from -13.8±3.0% to -6.1±2.0% and 16.9±2.6 cm to 7.8±1.8 cm, respectively. LS and LVOT VTI showed the strongest correlation to stroke work in unadjusted linear regression (r2=0.53 and r2=0.49, respectively). LS correlated significantly with stroke volume, end-systolic elastance, systolic blood pressure, ventriculo-arterial coupling and arterial elastance. CONCLUSION In an animal model of acute progressive LV dysfunction, echocardiographic and conductance catheter-based measurements changed significantly. LS and LVOT VTI displayed the earliest and the largest alterations with increased myocardial damage and both correlated strongest with stroke work.
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Affiliation(s)
- Peter Hartmund Frederiksen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
| | | | - Ole K Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | | | - Amalie L Povlsen
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jeppe P Larsen
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Jens Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Hanne Berg Ravn
- University of Southern Denmark, Odense, Denmark
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark
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Timóteo AT, Branco LM, Galrinho A, Rio P, Papoila AL, Alves M, Ferreira RC. Global left ventricular myocardial work index and medium-term adverse cardiovascular events after ST-elevation myocardial infarction. Int J Cardiol 2024; 399:131781. [PMID: 38218250 DOI: 10.1016/j.ijcard.2024.131781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Left ventricular global longitudinal strain (GLS) has incremental prognostic value over ejection fraction (EF) in patients with ST-segment-elevation myocardial infarction (STEMI), but it is also load dependent. It has been recently demonstrated that Myocardial work (MW), integrating blood pressure with GLS, predicts long-term all-cause mortality. We aimed to further explore the prognostic value of MW for cardiovascular endpoints in patients with STEMI. METHODS AND RESULTS Retrospective study of 200 consecutive patients admitted with a STEMI, mean age of 62 (SD 12) years, 79.5% males, that survived to discharge. Transthoracic echocardiography was performed before discharge (5 ± 3 days after admission). Mean follow-up was 790 days. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and unplanned cardiovascular admission (ACE). During follow-up, 26 patients had a ACE. In univariable Cox regression analysis, male gender, body mass index, GRACE risk score and Global Work Index (GWI) were selected to the multivariable analysis, in which, only GWI (per 100 mmHg% decrease: hazard ratio estimate 1.19, 95% confidence interval 1.07-1.34, p-value = 0.002) remained independently associated with ACE, with effective reclassification of non-events. The best GWI cut-off to predict ACE was ≤1165 mmHg% (Log-rank, p = 0.034). CONCLUSIONS LV GWI is independently associated with medium-term ACE. Nevertheless, prospective studies in a larger sample of patients are warranted to confirm this finding.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal.
| | - Luísa Moura Branco
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Galrinho
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- NOVA Medical School, Lisbon, Portugal; Center of Statistics and Its Applications (CEAUL), Lisbon, Portugal; Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Marta Alves
- NOVA Medical School, Lisbon, Portugal; Center of Statistics and Its Applications (CEAUL), Lisbon, Portugal; Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
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Dorobantu DM, Amir NH, Wadey CA, Sharma C, Stuart AG, Williams CA, Pieles GE. The Role of Speckle-Tracking Echocardiography in Predicting Mortality and Morbidity in Patients With Congenital Heart Disease: A Systematic Review and Meta-analysis. J Am Soc Echocardiogr 2024; 37:216-225. [PMID: 37972793 DOI: 10.1016/j.echo.2023.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Speckle-tracking echocardiography (STE) is now routinely included in cardiac evaluations, but its role in predicting mortality and morbidity in congenital heart disease (CHD) is not well described. We conducted a systematic review to evaluate the prognostic value of STE in patients with CHD. METHODS The EMBASE, Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to January 2023 for terms related to all CHD, STE, and prognosis. Meta-analysis of association of right ventricle and left ventricle strain (RV Sl and LV Sl, respectively) with major adverse cardiovascular events (MACEs) was performed in atrial switch transposition of the great arteries (asTGA)/congenitally corrected TGA (ccTGA), tetralogy of Fallot (ToF), and congenital aortic stenosis (cAS)/bicuspid aortic valve (BAV). P-value combination analysis was additionally performed for all CHD groups. RESULTS A total of 33 studies (30 cohorts, n = 8,619 patients, children, and adults) were included. Meta-analysis showed the following parameters as being associated with MACE: RV Sl in asTGA/ccTGA (hazard ratio [HR] = 1.1/%; CI, [1.03; 1.18]), RV Sl and LV Sl in ToF (HR = 1.14/%; CI, [1.03; 1.26] and HR = 1.14/%; CI, [1.08; 1.2], respectively), and LV Sl in cAS/BAV (HR = 1.19/%; CI, [1.15; 1.23]). The RV Sl and strain rate were associated with outcomes also in single ventricle/hypoplastic left heart syndrome (at all palliation stages except before Norwood stage 1) and LV Sl in Ebstein's anomaly. CONCLUSIONS This systematic review and meta-analysis showed that biventricular strain and strain rate were associated with outcomes in a variety of CHD, highlighting the need for updated recommendations on the use of STE in the current guidelines, specific to disease types.
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Affiliation(s)
- Dan M Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom; Department of Population and Translational Health Science, University of Bristol, Bristol, United Kingdom
| | - Nurul H Amir
- Department of Population and Translational Health Science, University of Bristol, Bristol, United Kingdom; Faculty of Sport Science and Recreation, Universiti Teknologi Majlis Amanah Rakyat, Arau, Malaysia
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom
| | - Chetanya Sharma
- Congenital Heart Unit, Bristol Heart Institute and Royal Hospital for Children, Bristol, United Kingdom
| | - A Graham Stuart
- Department of Population and Translational Health Science, University of Bristol, Bristol, United Kingdom; Congenital Heart Unit, Bristol Heart Institute and Royal Hospital for Children, Bristol, United Kingdom
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom.
| | - Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute and Royal Hospital for Children, Bristol, United Kingdom; Institute of Sport, Exercise and Health, University College London, London, United Kingdom; Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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5
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Kandels J, Metze M, Hagendorff A, Stöbe S. Prognostic Relevance of Global Myocardial Work Index in Patients with Moderate Aortic Valve Stenosis. J Clin Med 2023; 12:7694. [PMID: 38137763 PMCID: PMC10743712 DOI: 10.3390/jcm12247694] [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: 10/18/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was to evaluate the prognostic value of the GWI in patients with moderate AS. METHODS AND RESULTS In this prospective study, 103 patients with moderate AS (mean age 72 ± 10 years; male: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without an aortic valve replacement (AVR). After a median follow-up of 30 ± 5 months, 37 patients (36%) were referred for an AVR. Survival without an AVR was 96% at 12 months and 80% at 30 months (>1951 mmHg%) versus 96% and 68% (≤1951 mmHg%). A GWI ≤ 1951 mmHg% did not predict the need for an AVR (hazard ratio 1.31 (95% CI, 0.63-2.72), p = 0.49). Furthermore, there was no significant correlation between the mean GWI (1644 ± 448 mmHg%) and mean aortic valve pressure gradient (24.2 mmHg ± 6.2, p = 0.615) or effective aortic orifice area (1.24 cm2 ± 0.11, p = 0.678). There was no difference between the AVR and non-AVR groups in the occurrence of clinical symptoms. CONCLUSION In contrast to patients with severe AS, a GWI ≤ 1951 mmHg% did not predict the need for an AVR. Further research is needed to improve the risk stratification in patients with moderate AS.
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Affiliation(s)
- Joscha Kandels
- Correspondence: ; Tel.: +49-341-97-12389; Fax: +49-341-97-12659
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6
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Kandels J, Stöbe S, Kogel A, Hepp P, Riepenhof H, Droste JN, Stoeggl T, Marshall RP, Rudolph U, Laufs U, Fikenzer S, Hagendorff A. Effect of maximum exercise on left ventricular deformation and its correlation with cardiopulmonary exercise capacity in competitive athletes. Echo Res Pract 2023; 10:17. [PMID: 37789500 PMCID: PMC10548575 DOI: 10.1186/s44156-023-00029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Global longitudinal strain (GLS) and global myocardial work index (GWI) allow early detection of subclinical changes in left ventricular (LV) systolic function. The aim of the study was to investigate the immediate effects of maximum physical exercise by different exercise testing methods on early post exercise LV deformation parameters in competitive athletes and to analyze their correlation with cardiopulmonary exercise capacity. METHODS To reach maximum physical exercise, cardiopulmonary exercise testing (CPET) was performed by semi-recumbent ergometer in competitive handball players (n = 13) and by treadmill testing in competitive football players (n = 19). Maximum oxygen uptake (VO2max) indexed to body weight (relative VO2max) was measured in all athletes. Transthoracic echocardiography and blood pressure measurements were performed at rest and 5 min after CPET in all athletes. GLS, GWI and their changes before and after CPET (ΔGLS, ΔGWI) were correlated with (relative) VO2max. RESULTS In handball and football players, GLS and GWI did not differ significantly before and after CPET. There were no significant correlations between GLS and relative VO2max, but moderate correlations were found between ΔGWI and relative VO2max in handball (r = 0.631; P = 0.021) and football players (r = 0.592; P = 0.008). Furthermore, handball (46.7 ml/min*kg ± 4.7 ml/min*kg vs. 37.4 ml/min*kg ± 4.2; P = 0.004) and football players (58.3 ml/min*kg ± 3.7 ml/min*kg vs. 49.7 ml/min*kg ± 6.8; P = 0.002) with an increased ΔGWI after CPET showed a significant higher relative VO2max. CONCLUSION Maximum physical exercise has an immediate effect on LV deformation, irrespective of the used testing method. The correlation of relative VO2max with ΔGWI in the early post exercise period, identifies ΔGWI as an echocardiographic parameter for characterizing the current individual training status of athletes.
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Affiliation(s)
- J Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - P Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie Und Plastische Chirurgie, Universitätsklinikum, 04103, Leipzig, Germany
| | - H Riepenhof
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Center for Rehabilitation and Sports Medicine, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - J N Droste
- Center for Rehabilitation and Sports Medicine, BG Klinikum Hamburg, 21033, Hamburg, Germany
- Red Bull Athlete Performance Center, 5303, Salzburg, Austria
| | - T Stoeggl
- Red Bull Athlete Performance Center, 5303, Salzburg, Austria
- Department of Sport and Exercise Science, Universität Salzburg, 5020, Salzburg, Austria
| | - R P Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle, Germany
| | - U Rudolph
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - U Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - S Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Motoi K, Iwano H, Ishizaka S, Nakamura K, Tamaki Y, Aoyagi H, Nakabachi M, Yokoyama S, Nishino H, Murayama M, Kaga S, Anzai T. Paradoxical increase in global longitudinal strain by handgrip exercise despite left ventricular diastolic dysfunction. Echocardiography 2023; 40:810-821. [PMID: 37449835 DOI: 10.1111/echo.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/11/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Although global longitudinal strain (GLS) is recognized as a sensitive marker of intrinsic left ventricular (LV) dysfunction, its afterload dependency has also been pointed. We hypothesized that decrease in GLS during handgrip exercise could be more sensitive marker of intrinsic myocardial dysfunction. METHODS Handgrip exercise-stress echocardiography was performed in 90 cardiovascular disease patients with preserved LV ejection fraction. LV diastolic function was graded according to the guidelines. Diastolic wall stress (DWS) and ratio of left atrial (LA) volume index to late-diastolic mitral annular velocity (LAVI/a') were measured at rest as LV stiffness. As well, LA strains were measured to assess LA function. GLS was expressed as absolute value and significant changes in GLS by handgrip exercise was defined as changes over prespecified mean absolute test-retest variability (2.65%). RESULTS While mean value of GLS did not change by the exercise, substantial patients showed significant changes in GLS: decreased (group I, n = 28), unchanged (group II, n = 34), and increased (group III, n = 28). Unexpectedly, patients in group I did not show any clinical and echocardiographic characteristics, while those in group III were characterized by elevated natriuretic peptide levels, blunted heart rate response to handgrip exercise, and advanced LV diastolic dysfunction. Multivariable analyses revealed that DWS, left atrial booster strain, and grade II or more diastolic dysfunction determined the increase in GLS even after adjustment for elevated natriuretic peptides and the changes in heart rate by the exercise. CONCLUSION In contrast to our hypothesis, paradoxical increase in GLS by handgrip exercise could be associated with advanced LV diastolic dysfunction in cardiovascular patients with preserved LV ejection fraction. Our findings suggest that HG exercise for heart failure patients does not enhance the afterload straightforward, resulting in variable changes of GLS according to the individual conditions.
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Affiliation(s)
- Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Division of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Nakamura
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoji Tamaki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Aoyagi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Nakabachi
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Keating S, Eberhard J, Friederich J, Wess G. Systolic function in dogs with pulmonic stenosis of different severities and the effect of balloon valvuloplasty. J Vet Cardiol 2023; 46:40-54. [PMID: 37058905 DOI: 10.1016/j.jvc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION/OBJECTIVES Pulmonic stenosis (PS) is one of the most common congenital heart diseases in dogs leading to right ventricular (RV) pressure overload, myocardial remodeling, and potential RV dysfunction. Our objectives were to investigate the extent of RV systolic dysfunction in canine PS and to examine the immediate influence of balloon valvuloplasty (BV) on systolic function. ANIMALS, MATERIALS AND METHODS This prospective study evaluated 72 dogs with PS and 86 healthy dogs. Echocardiographic parameters of systolic function included normalized tricuspid annular plane systolic excursion (N-TAPSE), normalized systolic myocardial tissue Doppler velocity of the lateral tricuspid annulus (N-RVFW-S'), fractional area change, and speckle-tracking longitudinal endocardial RV strain. Forty-four dogs underwent BV and were re-examined after surgery. RESULTS Systolic function at the basal segment of the RV was significantly lower in the PS group when compared to healthy dogs (mean N-TAPSE 4.29 ± standard deviation 1.18 mm/kg0.285 vs. 5.60 ± 1.29 mm/kg0.285; median N-RVFW-S' 5.28 [lower-upper 25% quantile 4.35-6.43 cm/s/kg0.186] vs. 7.82 [6.73-8.79 cm/s/kg0.186]; all P<0.001). Global longitudinal RV endocardial strain showed no significant difference between the two groups (-28.50 ± 6.23% vs. 28.61 ± 4.64%; P=0.886), but segmental strain analyses revealed basal hypo- and potential compensatory hyperkinesis of the apical RVFW. Furthermore, BV affected most parameters of systolic function, but not the segmental strain values and N-TAPSE. CONCLUSIONS Right ventricular basal longitudinal systolic function is decreased in dogs with PS in comparison to a healthy cohort. Regional and global function does not necessarily coincide.
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miR-146a-5p, miR-223-3p and miR-142-3p as Potential Predictors of Major Adverse Cardiac Events in Young Patients with Acute ST Elevation Myocardial Infarction-Added Value over Left Ventricular Myocardial Work Indices. Diagnostics (Basel) 2022; 12:diagnostics12081946. [PMID: 36010296 PMCID: PMC9406722 DOI: 10.3390/diagnostics12081946] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Acute ST elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide despite continuous advances in diagnostic, prognostic and therapeutic methods. Myocardial work (MW) indices and miRNAs have both emerged as potential prognostic markers in acute coronary syndromes in recent years. In this study we aim to assess the prognostic role of myocardial work indices and of a group of miRNAs in young patients with STEMI. We enrolled 50 young patients (<55 years) with STEMI who underwent primary PCI and 10 healthy age-matched controls. We performed standard 2D and 3D echocardiography; we also calculated left ventricular global longitudinal strain (GLS) and the derived myocardial work indices. Using RT-PCR we determined the plasmatic levels of six miRNAs: miR-223-3p, miR-142-3p, miR-146a-5p, miR-125a-5p, miR-486-5p and miR-155-5p. We assessed the occurrence of major adverse cardiac events (MACE) at up to one year after STEMI. Out of 50 patients, 18% experienced MACE at the one-year follow-up. In a Cox univariate logistic regression analysis, myocardial work indices were all significantly associated with MACE. The ROC analysis showed that GWI, GCW and GWE as a group have a better predictive value for MACE than each separately (AUC 0.951, p = 0.000). Patients with higher miRNAs values at baseline (miR-223-3p, miR-142-3p and miR-146a-5p) appear to have a higher probability of developing adverse events at 12 months of follow-up. ROC curves outlined for each variable confirmed their good predictive value (AUC = 0.832, p = 0.002 for miR-223-3p; AUC = 0.732, p = 0.031 for miR-142-3p and AUC = 0.848, p = 0.001 for miR-146a-5p); the group of three miRNAs also proved to have a better predictive value for MACE together than separately (AUC = 0.862). Moreover, adding each of the miRNAs (miR-233, miR-142-3p and miR-146a-5p) or all together over the myocardial work indices in the regression models improved their prognostic value. In conclusion, both myocardial work indices (GWI, GCW and GWE) and three miRNAs (miR-223-3p, miR-142-3p and miR-146a-5p) have the potential to be used as prognostic markers for adverse events after acute myocardial infarction. The combination of miRNAs and MW indices (measured at baseline) rather than each separately has very good predictive value for MACE in young STEMI patients (C-statistic 0.977).
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Purwowiyoto SL, Halomoan R. Highlighting the role of global longitudinal strain assessment in valvular heart disease. Egypt Heart J 2022; 74:46. [PMID: 35639183 PMCID: PMC9156579 DOI: 10.1186/s43044-022-00283-9] [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: 05/07/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Echocardiography has been the choice for imaging modality for valvular heart disease. It is less invasive, widely available, and allows valvular structure visualization. Echocardiographic assessment often also determines the management. Left ventricular ejection fraction is the most commonly used indicator during echocardiography assessment. It shows signs of left ventricular dysfunction in patients with valve disease. However, most of the time, the ongoing process of cardiac damage may already occur even with preserved cardiac function; further deteriorated ejection fraction will show irreversible cardiac damage. There is a need for a more advanced diagnostic tool to detect early cardiac dysfunction, to prevent further damage.
Main body
Advanced echocardiography imaging using strain imaging allows a physician to evaluate cardiac function more precisely. A more sensitive parameter than left ventricular ejection fraction, global longitudinal strain, can evaluate subclinical myocardial dysfunction before the symptoms occur by evaluating complex cardiac mechanisms. Global longitudinal strain evaluation provides the chance for physicians to determine the intervention needed to prevent further deterioration and permanent cardiac dysfunction. Global longitudinal strain is proven to be beneficial in many types of valvular heart diseases, especially in mitral and aortic valve diseases. It has an excellent diagnostic and prognostic value for patients with valve disease. This review aims to present the superiority of global longitudinal strain compared to left ventricular ejection fraction in assessing cardiac function in patients with valvular heart disease. Clinical usage of global longitudinal strain in several valvular heart diseases is also presented in this review.
Conclusions
The superiority of global longitudinal strain to left ventricular ejection fraction relies on the mechanism where other strains would compensate for the deterioration of longitudinal strain, which is more vulnerable to damage, so the cardiac function is preserved. Therefore, examination of longitudinal strain would give the physician early signs of cardiac function impairment, and prompt management can be conducted.
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Timóteo AT, Branco LM, Galrinho A, Rio P, Sousa L, Ferreira RC. Impact of repaired aortic coarctation in left ventricular myocardial work. Rev Port Cardiol 2022; 41:299-307. [DOI: 10.1016/j.repc.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/19/2020] [Accepted: 02/04/2021] [Indexed: 10/19/2022] Open
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Left ventricular longitudinal strain variations assessed by speckle-tracking echocardiography after a passive leg raising maneuver in patients with acute circulatory failure to predict fluid responsiveness: A prospective, observational study. PLoS One 2021; 16:e0257737. [PMID: 34591884 PMCID: PMC8483378 DOI: 10.1371/journal.pone.0257737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background An association was reported between the left ventricular longitudinal strain (LV-LS) and preload. LV-LS reflects the left cardiac function curve as it is the ratio of shortening over diastolic dimension. The aim of this study was to determine the sensitivity and specificity of LV-LS variations after a passive leg raising (PLR) maneuver to predict fluid responsiveness in intensive care unit (ICU) patients with acute circulatory failure (ACF). Methods Patients with ACF were prospectively included. Preload-dependency was defined as a velocity time integral (VTI) variation greater than 10% between baseline (T0) and PLR (T1), distinguishing the preload-dependent (PLD+) group and the preload-independent (PLD-) group. A 7-cycles, 4-chamber echocardiography loop was registered at T0 and T1, and strain analysis was performed off-line by a blind clinician. A general linear model for repeated measures was used to compare the LV-LS variation (T0 to T1) between the two groups. Results From June 2018 to August 2019, 60 patients (PLD+ = 33, PLD- = 27) were consecutively enrolled. The VTI variations after PLR were +21% (±8) in the PLD+ group and -1% (±7) in the PLD- group (p<0.01). Mean baseline LV-LS was -11.3% (±4.2) in the PLD+ group and -13.0% (±4.2) in the PLD- group (p = 0.12). LV-LS increased in the whole population after PLR +16.0% (±4.0) (p = 0.04). The LV-LS variations after PLR were +19.0% (±31) (p = 0.05) in the PLD+ group and +11.0% (±38) (p = 0.25) in the PLD- group, with no significant difference between the two groups (p = 0.08). The area under the curve for the LV-LS variations between T0 and T1 was 0.63 [0.48–0.77]. Conclusion Our study confirms that LV-LS is load-dependent; however, the variations in LV-LS after PLR is not a discriminating criterion to predict fluid responsiveness of ICU patients with ACF in this cohort.
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Tokodi M, Oláh A, Fábián A, Lakatos BK, Hizoh I, Ruppert M, Sayour AA, Barta BA, Kiss O, Sydó N, Csulak E, Ladányi Z, Merkely B, Kovács A, Radovits T. Novel insights into the athlete's heart: is myocardial work the new champion of systolic function? Eur Heart J Cardiovasc Imaging 2021; 23:188-197. [PMID: 34432004 PMCID: PMC8788018 DOI: 10.1093/ehjci/jeab162] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 01/09/2023] Open
Abstract
Aims We sought to investigate the correlation between speckle-tracking echocardiography (STE)-derived myocardial work (MW) and invasively measured contractility in a rat model of athlete's heart. We also assessed MW in elite athletes and explored its association with cardiopulmonary exercise test (CPET)-derived aerobic capacity. Methods and results Sixteen rats underwent a 12-week swim training program and were compared to controls (n = 16). STE was performed to assess global longitudinal strain (GLS), which was followed by invasive pressure-volume analysis to measure contractility [slope of end-systolic pressure–volume relationship (ESPVR)]. Global MW index (GMWI) was calculated from GLS curves and left ventricular (LV) pressure recordings. In the human investigations, 20 elite swimmers and 20 healthy sedentary controls were enrolled. GMWI was calculated through the simultaneous evaluation of GLS and non-invasively approximated LV pressure curves at rest. All subjects underwent CPET to determine peak oxygen uptake (VO2/kg). Exercised rats exhibited higher values of GLS, GMWI, and ESPVR than controls (−20.9 ± 1.7 vs. −17.6 ± 1.9%, 2745 ± 280 vs. 2119 ± 272 mmHg·%, 3.72 ± 0.72 vs. 2.61 ± 0.40 mmHg/μL, all PExercise < 0.001). GMWI correlated robustly with ESPVR (r = 0.764, P < 0.001). In humans, regular exercise training was associated with decreased GLS (−17.6 ± 1.5 vs. −18.8 ± 0.9%, PExercise = 0.002) but increased values of GMWI at rest (1899 ± 136 vs. 1755 ± 234 mmHg·%, PExercise = 0.025). GMWI exhibited a positive correlation with VO2/kg (r = 0.527, P < 0.001). Conclusions GMWI precisely reflected LV contractility in a rat model of exercise-induced LV hypertrophy and captured the supernormal systolic performance in human athletes even at rest. Our findings endorse the utilization of MW analysis in the evaluation of the athlete’s heart.
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Affiliation(s)
- Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - István Hizoh
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Mihály Ruppert
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Bálint András Barta
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
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Butcher SC, Lustosa RP, Abou R, Marsan NA, Bax JJ, Delgado V. Prognostic implications of left ventricular myocardial work index in patients with ST-segment elevation myocardial infarction and reduced left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2021; 23:699-707. [PMID: 33993227 DOI: 10.1093/ehjci/jeab096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/27/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS This study aimed to determine whether lower values of left ventricular (LV) global work index (GWI) at baseline were associated with a reduction in LV functional recovery and poorer long-term prognosis in patients with reduced LV ejection fraction (LVEF ≤40%) following ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS A total of 197 individuals (62 ± 12 years, 75% male) with STEMI treated with primary percutaneous coronary intervention and reduced LVEF were evaluated. All patients were followed up for the occurrence of all-cause mortality and the presence of LVEF normalization at 6 months (LVEF ≥50%). The median LVEF was 36% (interquartile range 32-38) and the mean value of LV GWI was 1041 ± 404 mmHg% at baseline. At 6-month follow-up, 41% of patients had normalized LVEF. On multivariable logistic regression, higher values of LV GWI were independently associated with LVEF normalization at 6 months of follow-up (odds ratio 1.32 per 250 mmHg%, P = 0.038). Over a median follow-up of 112 months, 40 patients (20%) died. LV GWI <750 mmHg% was independently associated with all-cause mortality (HR 3.85, P < 0.001) and was incremental to LV global longitudinal strain (P = 0.039) and LVEF (P < 0.001). CONCLUSION In individuals with an LVEF ≤40% following STEMI, higher values of LV GWI were associated with a greater probability of LVEF normalization at 6-month follow-up. In addition, lower values of LV GWI were independently associated with increased all-cause mortality at long-term follow-up, providing incremental prognostic value over LVEF and minor incremental prognostic value over LV global longitudinal strain.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth WA 6000, Australia
| | - Rodolfo P Lustosa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Rachid Abou
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Einarsen E, Hjertaas JJ, Gu H, Matre K, Chowienczyk PJ, Gerdts E, Chambers JB, Saeed S. Impact of arterio-ventricular interaction on first-phase ejection fraction in aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 22:650-657. [PMID: 32793965 PMCID: PMC8110316 DOI: 10.1093/ehjci/jeaa154] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/30/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS First-phase ejection fraction (EF1), the EF at the time to peak aortic jet velocity, has been proposed as a novel marker of peak systolic function in aortic stenosis (AS). This study aimed to explore the association of myocardial contractility and arterial load with EF1 in AS patients. METHODS AND RESULTS Data from a prospective, cross-sectional study of 114 patients with mild, moderate, and severe AS with preserved left ventricular EF (>50%) were analysed. EF1 was measured as the volume change from end-diastole to the time that corresponded to peak aortic jet velocity. Myocardial contractility was assessed by strain rate measured by speckle tracking echocardiography. Arterial stiffness was assessed by central pulse pressure/stroke volume index ratio (PP/SVi). The total study population included 48% women, median age was 73 years, and mean peak aortic jet velocity was 3.47 m/s. In univariable linear regression analyses, lower EF1 was associated with higher age, higher peak aortic jet velocity, lower global EF, lower global longitudinal strain, lower strain rate, and higher PP/SVi. There was no significant association between EF1 and heart rate or sex. In multivariable linear regression analysis, EF1 was associated with lower strain rate and higher PP/SVi, independent of AS severity. Replacing PP/SVi by valvular impedance did not change the results. CONCLUSION In patients with AS, reduced myocardial contractility and increased arterial load were associated with lower EF1 independent of the severity of valve stenosis.
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Affiliation(s)
- Eigir Einarsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Corresponding author. Tel: +47 98096917. E-mail:
| | | | - Haotian Gu
- British Heart Foundation Centre, King’s College London, London, UK
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John B Chambers
- Cardiothoracic Centre, Guy’s and St Thomas’ Hospital, London, UK
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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de Abreu CB, Muzzi RAL, de Oliveira LED, Schulien T, Coelho MDR, Alves LA, Hirsch C, Dorneles EMS, Pinto AMBG, Barreto MSO, Muzzi LAL, Nogueira RB. Systolic dysfunction by two-dimensional speckle tracking echocardiography in dogs with parvoviral enteritis. J Vet Cardiol 2021; 34:93-104. [PMID: 33631657 DOI: 10.1016/j.jvc.2021.01.006] [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: 08/30/2019] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION/OBJECTIVES Parvoviral enteritis (PVE) can cause either primary or secondary myocardial injury; the latter is associated with systemic inflammatory response syndrome and sepsis. Strain (St) and strain rate (SR) are relatively new speckle tracking echocardiographic (STE) variables used to assess myocardial function and are less influenced by preload and volume status than are conventional variables. The aim of this study was to evaluate systolic function in dogs with PVE using two-dimensional STE. ANIMALS Forty-five client-owned dogs were included. MATERIALS AND METHODS Dogs were classified into four groups: healthy (n = 9), PVE-mild (n = 15), PVE-severe (n = 13) and PVE-died (n = 8). Left ventricular global and segmental myocardial St and SR were assessed in radial, circumferential and longitudinal axes in the right parasternal transverse and apical 4-chamber views. In the circumferential and longitudinal axes, the value of each segment was determined separately at the endocardial and epicardial levels. RESULTS Compared to healthy animals, all dogs with PVE showed significantly impaired St and SR values, mainly for PVE-severe and PVE-died groups. Moreover, the lowest SR value was observed in the circumferential axis at the mid-septal epicardial segment in the PVE-died group. For this variable, a cut-off value of 0.95 s-1 demonstrated 100% sensitivity and specificity for distinguishing between PVE-severe and PVE-died groups. CONCLUSIONS In the present study, all dogs with PVE developed systolic dysfunction, which was more severe in non-survivors. Assessment of St and SR in dogs with PVE might be clinically useful for evaluating haemodynamic status and developing suitable therapeutic strategies to improve prognosis.
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Affiliation(s)
- C B de Abreu
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil.
| | - R A L Muzzi
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - L E D de Oliveira
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - T Schulien
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - M de R Coelho
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - L A Alves
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - C Hirsch
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - E M S Dorneles
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - A M B G Pinto
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - M S O Barreto
- Department of Veterinary Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - L A L Muzzi
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
| | - R B Nogueira
- Department of Veterinary Medicine, Federal University of Lavras, Lavras, 37200-900, Brazil
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Karande A. Role of strain imaging for guiding management of valvular heart disease: Current status. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Miki T, Yamano T, Yamano M, Nakamura T, Takamatsu K, Ma C, Wakana N, Nakanishi N, Zen K, Shiraishi H, Shirayama T, Matoba S. Favorable changes of left ventricular function in the circumferential direction following transcatheter atrial septal defect closure: a strain imaging study. Int J Cardiovasc Imaging 2020; 37:903-912. [PMID: 33047179 DOI: 10.1007/s10554-020-02064-4] [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: 06/12/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
To clarify the impact on left ventricular (LV) function of percutaneous atrial septal defect (ASD) closure in adult patients. Echocardiograms of 46 patients (52 ± 18 years) who underwent ASD closure with a significant left-to-right shunt obtained before and 1 month after the procedure were retrospectively analyzed. Functional parameters were obtained by 2-dimensional speckle-tracking imaging. Global longitudinal strain and strain rate at early diastole (SRe) was calculated from the three standard apical views, while circumferential and radial parameters were calculated from basal, middle, and apical LV short-axis views. Along with a diminished right ventricular (RV) volume, the LV volume and ejection fraction increased (end-diastolic volume: 61 ± 12 to 76 ± 15 mL, p < 0.001; and 63% ± 4 to 64% ± 4% p = 0.03; respectively). Both global strain and SRe was augmented only in the circumferential direction (- 16.2% ± 2.9% to - 19.8% ± 2.8%; and 1.07 ± 0.29 to 1.34 ± 0.28 s-1, both p < 0.001). Augmentation of circumferential SRe correlated with both the changes in and the pre-procedural value of diastolic LV eccentricity index (r = - 0.57, p < 0.001; and r = 0.37, p = 0.01; respectively), a morphological parameter of RV volume overload. Following ASD closure in adults, both LV systolic and diastolic function could favorably change in the circumferential direction, and the degree of diastolic functional change is associated with RV volume overload, i.e., severity of ventricular interdependence.
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Affiliation(s)
- Tomonori Miki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Chao Ma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Noriyuki Wakana
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Ruppert M, Lakatos BK, Braun S, Tokodi M, Karime C, Oláh A, Sayour AA, Hizoh I, Barta BA, Merkely B, Kovács A, Radovits T. Longitudinal Strain Reflects Ventriculoarterial Coupling Rather Than Mere Contractility in Rat Models of Hemodynamic Overload–Induced Heart Failure. J Am Soc Echocardiogr 2020; 33:1264-1275.e4. [DOI: 10.1016/j.echo.2020.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
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Zieleskiewicz L, Claret PG, Muller L, de La Coussaye JE, Lefrant JY, Schuster I, Roger C, Bobbia X. Global longitudinal strain changes during hemorrhagic shock: An experimental study. Turk J Emerg Med 2020; 20:97-104. [PMID: 32832728 PMCID: PMC7416855 DOI: 10.4103/2452-2473.290066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Global longitudinal strain (GLS) appears sensitive and reproducible to identify left ventricular systolic dysfunction. The main objective was to analyze the GLS changes in an anesthetized-piglet model of controlled hemorrhagic shock (HS). The secondary objective was to evaluate if GLS changes was different depending on the expansion fluid treatment with or without norepinephrine. METHODS Eighteen anesthetized and ventilated piglets were bled until the mean arterial pressure reached 40 mmHg. Controlled hemorrhage was maintained for 30 min before randomizing the piglets to three resuscitation groups: control group, LR group (resuscitated with lactated ringer), and NA group (resuscitated with lactated ringer and norepinephrine). RESULTS There was no difference in the baseline hemodynamic, biological, and ultrasound data among the three groups. During the hemorrhagic phase, the GLS increased significantly from 25 mL/kg of depletion. During the resuscitation phase, the GLS decreased significantly from 20 mL/kg of fluid administration. There was no difference in GLS variation among the groups during the hemorrhagic, maintenance, and resuscitation phases. CONCLUSION In our HS model, GLS increased with hemorrhage and decreased during resuscitation, showing its preload dependence.
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Affiliation(s)
- Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care, North Hospital, APHM, Aix Marseille Univ., INSERM, INRA, C2VN, Marseille, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Laurent Muller
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Iris Schuster
- Department of Sports Medicine and Cardiology (CEMAPS 30), Nîmes University Hospital and PhyMedExp, INSERM U1046, CNRS UMR9214, Montpellier University, Montpellier, France
| | - Claire Roger
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Critical Care, Montpellier University, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.,Faculty of Medicine, Montpellier-Nimes University,EA 2992, Nîmes, France
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21
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Giao DM, Wang Y, Rojas R, Takaba K, Badathala A, Spaulding KA, Soon G, Zhang Y, Wang VY, Haraldsson H, Liu J, Saloner D, Guccione JM, Ge L, Wallace AW, Ratcliffe MB. Left ventricular geometry during unloading and the end-systolic pressure volume relationship: Measurement with a modified real-time MRI-based method in normal sheep. PLoS One 2020; 15:e0234896. [PMID: 32569290 PMCID: PMC7307770 DOI: 10.1371/journal.pone.0234896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/04/2020] [Indexed: 01/08/2023] Open
Abstract
The left ventricular (LV) end-systolic (ES) pressure volume relationship (ESPVR) is the cornerstone of systolic LV function analysis. We describe a 2D real-time (RT) MRI-based method (RTPVR) with separate software tools for 1) semi-automatic level set-based shape prior method (LSSPM) of the LV, 2) generation of synchronized pressure area loops and 3) calculation of the ESPVR. We used the RTPVR method to measure ventricular geometry, ES pressure area relationship (ESPAR) and ESPVR during vena cava occlusion (VCO) in normal sheep. 14 adult sheep were anesthetized and underwent measurement of LV systolic function. Ten of the 14 sheep underwent RTMRI and eight of the 14 underwent measurement with conductance catheter; 4 had both RTMRI and conductance measurements. 2D cross sectional RTMRI were performed at apex, mid-ventricle and base levels during separate VCOs. The Dice similarity coefficient was used to compare LSSPM and manual image segmentation and thus determine LSSPM accuracy. LV cross-sectional area, major and minor axis length, axis ratio, major axis orientation angle and ESPAR were measured at each LV level. ESPVR was calculated with a trapezoidal rule. The Dice similarity coefficient between LSSPM and manual segmentation by two readers was 87.31±2.51% and 88.13±3.43%. All cross sections became more elliptical during VCO. The major axis orientation shifted during VCO but remained in the septo-lateral direction. LV chamber obliteration at the apical level occurred during VCO in 7 of 10 sheep that underwent RTMRI. ESPAR was non-linear at all levels. Finally, ESPVR was non-linear because of apical collapse. ESPVR measured by conductance catheter (EES,Index = 2.23±0.66 mmHg/ml/m2) and RT (EES,Index = 2.31±0.31 mmHg/ml/m2) was not significantly different. LSSPM segmentation of 2D RT MRI images is accurate and allows calculation of LV geometry, ESPAR and ESPVR during VCO. In the future, RTPVR will facilitate determination of regional systolic material parameters underlying ESPVR.
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Affiliation(s)
- Duc M. Giao
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yan Wang
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Renan Rojas
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kiyoaki Takaba
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Anusha Badathala
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kimberly A. Spaulding
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Gilbert Soon
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Vicky Y. Wang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Henrik Haraldsson
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Jing Liu
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - David Saloner
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Julius M. Guccione
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Liang Ge
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Arthur W. Wallace
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Anesthesia, University of California, San Francisco, CA, United States of America
| | - Mark B. Ratcliffe
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
- * E-mail:
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22
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Clinical and Research Tools for the Study of Cardiovascular Effects of Cancer Therapy. J Cardiovasc Transl Res 2020; 13:417-430. [PMID: 32472498 DOI: 10.1007/s12265-020-10030-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
The expansion of cancer therapeutics has paved the way for improved cancer-related outcomes. Cardiotoxicity from cancer therapy occurs in a small but significant subset of patients, is often poorly understood, and contributes to adverse outcomes at all stages of cancer treatment. Given the often-idiopathic occurrence of cardiotoxicity, novel strategies are needed for risk-stratification and early identification of cancer patients experiencing cardiotoxicity. Clinical and research tools extending from imaging to blood-based biomarkers and pluripotent stem cells are being explored as methods to study the cardiovascular impact of various cancer treatments. Here we provide an overview of tools currently available for evaluation of cardiotoxicity and highlight novel techniques in development aimed at understanding underlying pathophysiologic mechanisms.
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23
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D'Souza R, Wang Y, Calderon-Anyosa RJC, Montero AE, Banerjee MM, Ekhomu O, Matsubara D, Mercer-Rosa L, Agger P, Sato T, Banerjee A. Decreased right ventricular longitudinal strain in children with hypoplastic left heart syndrome during staged repair and follow-up: does it have implications in clinically stable patients? Int J Cardiovasc Imaging 2020; 36:1667-1677. [PMID: 32363447 DOI: 10.1007/s10554-020-01870-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/24/2020] [Indexed: 12/01/2022]
Abstract
The principal aim of this study was to evaluate changes in systolic function in the single right ventricle (SRV), during progression of the same patient through the three stages of surgical repair for hypoplastic left heart syndrome and during a 5-year follow-up. We hypothesize that, SRV global longitudinal strain (GLS) will be low during 3 stages of repair even in stable patients. We retrospectively evaluated 140 echocardiograms in 20 patients with HLHS (ages 0-11.3 years), before and after 3 stages of surgical palliation. Five-year follow-up data were available in all 20 patients. Controls with structurally normal hearts and in the same age group were used for comparison. We utilized speckle-tracking imaging for assessment of SRV segmental and global longitudinal and circumferential strains, from previously acquired 4-chamber and mid-cavity short-axis views prior to and within 1-3 months of each surgical stage. Longitudinal strain (LS) remained low through all 3 stages of repair and during follow-up. The pre-Fontan stage demonstrated significant interstage improvement compared to the post-Glenn stage despite similar volume status. Global LS was (- 15.6 ± 4.5% after Fontan surgery and remained similar (- 15.32 ± 3.2%) 5 years later. The SRV also showed increased dominance of circumferential strain compared to the normal RV, where the longitudinal deformation was dominant. In SRV, longitudinal strain may be a useful clinical index for evaluating both segmental and global function in an objective manner. Due to lack of significant clinical deterioration over a 10-year period, we speculate that a "lower-than-normal" longitudinal strain may be used as an objective measure of SRV function in clinically stable patients, particularly after the Fontan operation. Compensatory mechanisms where the longitudinal pattern of contraction switches to a more circumferential pattern, may play a role in asymptomatic patients with HLHS.
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Affiliation(s)
- Roshan D'Souza
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Yan Wang
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Renzo J C Calderon-Anyosa
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Andrea E Montero
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Maalika M Banerjee
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Tufts University School of Medicine, Boston, MA, 02116, USA
| | - Omoni Ekhomu
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Daisuke Matsubara
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Peter Agger
- Dept. of Pediatrics and Adolescent Medicine and Dept. of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tomoyuki Sato
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Anirban Banerjee
- Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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24
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Abstract
Echocardiographic strain imaging allows new insight into a complex cardiac mechanics and enables more precise evaluation of cardiac function. Hence, it has been shown to have clinical utility in a variety of valvular heart diseases. In particular, global longitudinal strain has been shown to be more sensitive to detect systolic dysfunction than left ventricular ejection fraction. In patients with valvular heart diseases, it provides both diagnostic and prognostic information in addition to standard echocardiographic and clinical parameters. In this review, we summarize current clinical application of strain echocardiography in patients with valvular heart diseases and discuss pathophysiological mechanisms that lead to respective findings in specific diseases.
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25
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Dynamic changes in cardiac function before and early postdelivery in women with severe preeclampsia. J Hypertens 2020; 38:1367-1374. [DOI: 10.1097/hjh.0000000000002406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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26
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Mirea O, Vallecilla C, Claus P, Rademakers F, D’hooge J. Experimental validation of the prestretch-strain relationship as a non-invasive index of left ventricular myocardial contractility. PLoS One 2020; 15:e0228027. [PMID: 32101554 PMCID: PMC7043779 DOI: 10.1371/journal.pone.0228027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background The slope of the relationship between segmental PreS and total systolic shortening (S) has been proposed as a non-invasive index of left ventricular contractility. The aim of this study was to correlate this novel parameter to invasive gold standard measurements of contractility and to investigate how it is influenced by afterload. Methods In domestic pigs, afterload was increased by either balloon inflation in the aorta or by administration of phenylephrine while contractility was increased by dobutamine infusion. During all interventions, left ventricular pressure-volume measurements and trans-diaphragmatic two-dimensional echocardiographic images were acquired. The PreS-S slope was constructed from 18 segmental strain curves obtained by speckle tracking analysis and compared to the slope of the end systolic PV relationship (Emax) and the pre-load recruitable stroke work (PRSW). Results Sixteen datasets of increased contractility and afterload were analyzed. During dobutamine infusion, the LV volumes decreased (p<0.05) while ejection fraction increased (p<0.05). Emax, PRSW and the slope of the intra-ventricular PreS-S relation increased significantly during dobutamine infusion. Afterload increase led to increase in systolic blood pressure (105±16mmHg vs. 138±25mmHg; p<0.01) and decrease of LV stroke volume and ejection fraction (p<0.01). The PreS-S slope was not influenced by loading conditions in concordance with the PRSW findings. The absolute values of the PreS-S slope did not correlate with Emax or PRSW. However, the change of the PreS-S slope in relation with different interventions demonstrated good correlation with changes in PRSW or Emax, (r = 0.66, p<0.05 and r = 0.69, p<0.05). Conclusions The slope of the PreS-S relationship is sensitive to changes in inotropy and is less load-dependent than conventional non-invasive parameters of left ventricular function. The magnitude of the change of this slope correlates well with changes in invasive contractility measurements making it an attractive parameter to assess contractile reserve or contractile changes during longitudinal follow-up of patients.
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Affiliation(s)
- Oana Mirea
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- * E-mail:
| | - Carolina Vallecilla
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
| | - Frank Rademakers
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
| | - Jan D’hooge
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
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27
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Niu P, Li L, Yin Z, Du J, Tan W, Huo Y. Speckle tracking echocardiography could detect the difference of pressure overload-induced myocardial remodelling between young and adult rats. J R Soc Interface 2020; 17:20190808. [PMID: 32093537 DOI: 10.1098/rsif.2019.0808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The assessment by speckle tracking echocardiography (STE) provides useful information on regional and global left ventricular (LV) functions. The aim of the study is to investigate if STE-based strain analysis could detect the difference of pressure overload-induced myocardial remodelling between young and adult rats. Physiological, haemodynamic, histological measurements were performed post-operatively in young and adult rats with transverse aortic constriction (TAC) as well as the age-matched shams. Two-way ANOVA was used to detect the statistical difference of various measured parameters. Pressure overload decreased the ejection fraction, fractional shortening, dp/dtmax and |dp/dtmin|, but increased the LV end-diastolic (ED) pressure in adult rat hearts for nine weeks after TAC operation than those in young rat hearts. Pressure overload also resulted in different changes of peak strain and strain rate in the free wall, but similar changes in the interventricular septum of young and adult rat hearts. The changes in myocardial remodelling were confirmed by the histological analysis including the increased apoptosis rate of myocytes and collagen area ratio in the free wall of adult rat hearts of LV hypertrophy when compared with the young. Pressure overload alters myocardial components in different degrees between young and adult animals. STE-based strain analysis could detect the subtle difference of pressure overload-induced myocardial remodelling between young and adult rats.
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Affiliation(s)
- Pei Niu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China
| | - Li Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China
| | - Zhongjie Yin
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China
| | - Jie Du
- Beijing Anzhen Hospital Capital Medical University, Beijing, People's Republic of China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, People's Republic of China.,Shenzhen Graduate School, Peking University, Shenzhen, Guangdong, People's Republic of China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, People's Republic of China.,Institute of Mechanobiology and Medical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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28
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Dalla K, Bech-Hanssen O, Ricksten SE. General anesthesia and positive pressure ventilation suppress left and right ventricular myocardial shortening in patients without myocardial disease - a strain echocardiography study. Cardiovasc Ultrasound 2019; 17:16. [PMID: 31400770 PMCID: PMC6689330 DOI: 10.1186/s12947-019-0165-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/28/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Myocardial deformation imaging using speckle-tracking echocardiography to assess global longitudinal strain (GLS) is today considered a more sensitive measure of left ventricular (LV) systolic function than ejection fraction. General anesthesia and positive pressure ventilation (PPV) are known to change the right ventricular (RV) and LV loading conditions. However, little is known about the effects of anesthesia and PPV on RV free wall and LV GLS. We studied the influence of general anesthesia and PPV on RV and LV longitudinal strain in patients without myocardial disease. METHODS Twenty-one patients scheduled for non-cardiac surgery were included. The baseline examination was performed on the un-premedicated patients within 60 min of anesthesia. The second examination was performed 10-15 min after induction of anesthesia (propofol, remifentanil), intubation and start of PPV. The examinations included apical four-, two- and three-chamber projections, mitral and aortic Doppler flow velocities and tissue Doppler velocities of tricuspid and mitral annulus. LV end-systolic elastance (Ees) and aortic elastance were determined (Ea). RESULTS General anesthesia and PPV reduced the mean arterial blood pressure (- 29%, p < 0.0019), stroke volume index (- 13%, p < 0.001) and cardiac index (- 23%, p < 0.001). RV end-diastolic area index and LV end-diastolic volume index decreased significantly, while systemic vascular resistance was not significantly affected. Ees decreased significantly with the induction of anaesthesia (- 23%, p = 0.002), while there was a trend for a decrease in Ea (p = 0.053). The ventriculo-arterial coupling, Ea/Ees, was not significantly affected by the anesthetics and PPV. The LV GLS decreased from - 19.1 ± 2.3% to - 17.3 ± 2.9% (p < 0.001) and RV free wall strain decreased from - 26.5 ± 3.9% to - 24.1 ± 4.2% (p = 0.001). One patient (5%) had at baseline a LV GLS > - 16% compared with 6 patients (28%) during general anesthesia and PPV. Three patients (14%) had a RV free wall strain > - 24% compared to 8 patients (38%) during general anesthesia and PPV. CONCLUSIONS General anesthesia and PPV reduces systolic LV and RV function to levels considered indicating dysfunction in a substantial proportion of patients without myocardial disease.
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Affiliation(s)
- Keti Dalla
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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29
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Boucek KA, DeCampli WM. Commentary: Who doesn't have abnormal myocardial strain? J Thorac Cardiovasc Surg 2019; 158:520-522. [DOI: 10.1016/j.jtcvs.2019.03.022] [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: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
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30
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Boonhoh W, Kijtawornrat A, Sawangkoon S. Comparative effects of amiodarone and dronedarone treatments on cardiac function in a rabbit model. Vet World 2019; 12:345-351. [PMID: 31040580 PMCID: PMC6460874 DOI: 10.14202/vetworld.2019.345-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022] Open
Abstract
AIM The objective of the study was to compare the effects of amiodarone (AM) and dronedarone (DR) on heart rate variability (HRV) and cardiac contractility in a rabbit model. MATERIALS AND METHODS A total of 16 male New Zealand white rabbits were divided into two groups, treated either with AM or DR at incremental dosages of 50 mg/kg/day (AM50 and DR50) and 100 mg/kg/day (AM100 and DR100), orally administrated for 7 days. At the end of each period, electrocardiograms were recorded during consciousness and analyzed using the short-term time and frequency domains of HRV. Standard echocardiography and speckle-tracking echocardiography were studied during immobilization with xylazine and ketamine. RESULTS The results showed that AM100 and DR100 significantly decreased heart rate, total power, low-frequency component, and low-to-high frequency ratio compared with baselines. Most echocardiogram parameters revealed no significant difference from baselines, except for the global circumferential plane strain rate and time to peak standard deviation of strain, which had statistical significances after treating with AM. CONCLUSION Both AM and DR possess negative chronotropy and reduce HRV, which may be explained by their sympathetic suppression and calcium channel blocking activities. Theoretically, both antiarrhythmic drugs may also possess negative inotropy, but only AM is shown to have a negative inotropic effect and reduces cardiac dyssynchrony in this model.
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Affiliation(s)
- Worakan Boonhoh
- Department of Physiology, Animal Physiology Program, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
- Research Clusters: Research Study and Testing of Drug’s Effect Related to Cardiovascular System in Laboratory Animal, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Suwanakiet Sawangkoon
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
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31
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Katbeh A, Ondrus T, Barbato E, Galderisi M, Trimarco B, Van Camp G, Vanderheyden M, Penicka M. Imaging of Myocardial Fibrosis and Its Functional Correlates in Aortic Stenosis: A Review and Clinical Potential. Cardiology 2018; 141:141-149. [PMID: 30517934 DOI: 10.1159/000493164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/15/2018] [Indexed: 11/19/2022]
Abstract
Patients with severe aortic stenosis (AS) show progressive fibrotic changes in the myocardium, which may impair cardiac function and patient outcomes even after successful aortic valve replacement. Detection of patients who need an early operation remains a diagnostic challenge as myocardial functional changes may be subtle. In recent years, speckle tracking echocardiography (STE) and cardiac magnetic resonance mapping have been shown to provide complementary information for the assessment of left ventricular mechanics and identification of subtle damage by focal or diffuse myocardial fibrosis, respectively. Little is known, however, about how focal and diffuse myocardial fibrosis occurring in severe AS are related to measurable functional changes by echocardiography and to which extent both parameters have prognostic and diagnostic value. The aims of this review are to discuss the occurrence of focal and diffuse myocardial fibrosis in patients with severe AS and to explore their relation with myocardial function, determined by STE, as well as the prognostic and diagnostic potential of both parameters.
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Affiliation(s)
- Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Tomas Ondrus
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium,
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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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Grapsa J. Left Ventricular Ejection Fraction and Global Longitudinal Strain. J Am Coll Cardiol 2018; 72:1065-1066. [DOI: 10.1016/j.jacc.2018.05.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/15/2018] [Accepted: 05/20/2018] [Indexed: 11/24/2022]
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Hensel KO, Roskopf M, Abellan Schneyder F, Heusch A. Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope - a blinded prospective speckle tracking head-up tilt-table challenge study. BMC Cardiovasc Disord 2018; 18:87. [PMID: 29739317 PMCID: PMC5941376 DOI: 10.1186/s12872-018-0826-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
Background Data on left ventricular (LV) function in patients with neurocardiogenic syncope (NS) is conflicting in adults and lacking in children. The aim of this study was to analyze LV myocardial performance in children with NS at rest and during head-up tilt-table (HUTT) testing. Methods This is the first study to combine HUTT and speckle-tracking echocardiography (STE) in children with NS. 43 consecutive normotensive pediatric patients with NS (mean age 13.9 ± 2.6 years, 51% female) and 41 sex- and age-matched healthy controls were included in the study. The study groups consisted of 21 patients with a positive HUTT reaction (HUTT+) and 22 with a negative HUTT reaction (HUTT-). STE was used to analyze peak systolic LV myocardial strain and strain rate. Results Conventional echocardiographic parameters were similar in all analyzed groups. When compared to healthy controls, children with NS had depressed levels of circumferential strain rate (p = 0.032) and significantly depressed longitudinal strain rate (p < 0.001) at rest. Interestingly, during HUTT testing LV global strain and strain rate were similar in both groups. LV strain rate was lowest in HUTT+ followed by HUTT- and control subjects both at rest and during HUTT. Conclusions Resting LV longitudinal strain rate is attenuated in children with NS, especially in those with a positive HUTT response. This is further evidence that NS patients feature altered cardiac mechanics rendering them prone to vasovagal perturbations that can ultimately result in collapse. Trial registration Witten/Herdecke University ethics committee clinical study number: UWH-73-2014.
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Affiliation(s)
- Kai O Hensel
- HELIOS University Medical Center Wuppertal, Children's Hospital, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany. .,University of Cambridge, Addenbrooke's Hospital, Department of Paediatrics, Cambridge, UK.
| | - Markus Roskopf
- HELIOS University Medical Center Wuppertal, Children's Hospital, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany
| | - Francisca Abellan Schneyder
- HELIOS University Medical Center Wuppertal, Children's Hospital, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany
| | - Andreas Heusch
- HELIOS University Medical Center Wuppertal, Children's Hospital, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Heusnerstr. 40, D-42283, Wuppertal, Germany
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Chowdhury SM, Butts RJ, Taylor CL, Bandisode VM, Chessa KS, Hlavacek AM, Nutting A, Shirali GS, Baker GH. Longitudinal measures of deformation are associated with a composite measure of contractility derived from pressure-volume loop analysis in children. Eur Heart J Cardiovasc Imaging 2018; 19:562-568. [PMID: 29053805 PMCID: PMC5909637 DOI: 10.1093/ehjci/jex167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/13/2022] Open
Abstract
Aims The relationship between echocardiographic measures of left ventricular (LV) systolic function and reference-standard measures have not been assessed in children. The objective of this study was to assess the validity of echocardiographic indices of LV systolic function via direct comparison to a novel composite measure of contractility derived from pressure-volume loop (PVL) analysis. Methods and results Children with normal loading conditions undergoing routine left heart catheterization were prospectively enrolled. PVLs were obtained via conductance catheters. A composite invasive composite contractility index (ICCI) was developed using data reduction strategies to combine four measures of contractility derived from PVL analysis. Echocardiograms were performed immediately after PVL analysis under the same anesthetic conditions. Conventional and speckle-tracking echocardiographic measures of systolic function were measured. Of 24 patients, 18 patients were heart transplant recipients, 6 patients had a small patent ductus arteriosus or small coronary fistula. Mean age was 9.1 ± 5.6 years. Upon multivariable regression, longitudinal strain was associated with ICCI (β = -0.54, P = 0.02) while controlling for indices of preload, afterload, heart rate, and LV mass under baseline conditions. Ejection fraction and shortening fraction were associated with LV mass and load indices, but not contractility. Conclusion Speckle-tracking derived longitudinal strain is associated ICCI in children with normal loading conditions. Longitudinal measures of deformation appear to accurately assess LV contractility in children.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Karen S Chessa
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Anthony M Hlavacek
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Arni Nutting
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Girish S Shirali
- The Ward Family Heart Center, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - G Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
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Nafati C, Gardette M, Leone M, Reydellet L, Blasco V, Lannelongue A, Sayagh F, Wiramus S, Antonini F, Albanèse J, Zieleskiewicz L. Use of speckle-tracking strain in preload-dependent patients, need for cautious interpretation! Ann Intensive Care 2018; 8:29. [PMID: 29468335 PMCID: PMC5821613 DOI: 10.1186/s13613-018-0376-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In critical patients, left ventricular ejection fraction and fractional shortening are used to reflect left ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deformation occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the peri-operative period where preload constantly varies. Our objective, in this prospective single-center observational study, was to evaluate the effect of fluid resuscitation on two-dimensional-strain echocardiography measurements in preload-dependent critically ill patients. We included 49 patients with preload dependence attested by an increase of at least 10% in the left ventricular outflow track velocity-time integral measured by echocardiography during a passive leg raising maneuver. Echocardiography was performed before fluid resuscitation (echocardiography 1) and after preload independency achievement (echocardiography 2). RESULTS Two-dimensional-strain echocardiography was feasible in 40 (82%) among the 49 patients. With preload dependence correction, the absolute value of global longitudinal strain and systolic strain rate was significantly increased from, respectively, - 13.3 ± 3.5 to - 18.4% ± 4.5 (p < 0.01) and - 1.11 s-1 ± 0.29 to - 1.55 s-1 ± 0.55 (p < 0.001). The fluid resuscitation affects GLS and SSR in preload-dependent patients, with a shift, for GLS, from pathological to normal values. CONCLUSION In critically ill patients, the assessment of the systolic function by two-dimensional-strain echocardiography needs prior evaluation of preload dependency, in order to adequately interpret this variable. Future studies should assess the ability of global longitudinal strain to guide fluid management in the critically ill patients.
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Affiliation(s)
- C Nafati
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France. .,Service d'anesthésie et de réanimation, CHU de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - M Gardette
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France.,Centre d'Investigation Clinique, Aix-Marseille University, AP-HM, 14901, Marseille, France
| | - L Reydellet
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - V Blasco
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - A Lannelongue
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - F Sayagh
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - S Wiramus
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France
| | - J Albanèse
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Marseille, la Timone Hospital, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, North Hospital, Marseille, France
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Fredholm M, Jörgensen K, Houltz E, Ricksten SE. Load-dependence of myocardial deformation variables - a clinical strain-echocardiographic study. Acta Anaesthesiol Scand 2017; 61:1155-1165. [PMID: 28804896 DOI: 10.1111/aas.12954] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/08/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effects of left ventricular (LV) loading on myocardial deformation variables are not well-studied in the clinical setting. In the present study, we evaluated the effects of isolated changes in preload, afterload and heart rate on LV longitudinal strain, systolic (SR-S) and early diastolic strain rate (SR-E) in post-cardiac surgery patients. METHODS Twenty-one patients were studied early after cardiac surgery. Longitudinal myocardial strain and SR were analysed off-line using 2-D speckle echocardiography. The experimental protocol consisted of three consecutive interventions: (1) preload was increased by passive leg elevation, (2) afterload was increased by an infusion of phenylephrine to increase arterial blood pressure by 10-15% and (3) heart rate was increased 10% and 20% by atrial pacing. During both the preload and afterload challenges heart rate was kept constant by atrial pacing. Central venous pressure was kept constant during pacing by infusion of hetastarch/albumin. RESULTS The increase in preload increased LV strain, SR-S and SR-E by 20%, 11% and 17%, respectively. The phenylephrine-induced increase in afterload, did not affect LV strain, SR-S or SR-E. LV strain was not affected while SR-S and SR-E increased by pacing-induced heart rate increase. CONCLUSION After cardiac surgery, systolic and early diastolic strain rate are dependent on both preload and heart rate, while neither of these variables was afterload-dependent. LV strain was preload-dependent but not affected by atrial pacing. When evaluating the direct effects of various pharmacological or other interventions on myocardial contractility and relaxation, preload and heart rate must be controlled.
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Affiliation(s)
- M. Fredholm
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - K. Jörgensen
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - E. Houltz
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
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Kirkham A, Shave R, Bland K, Bovard J, Eves N, Gelmon K, McKenzie D, Virani S, Stöhr E, Warburton D, Campbell K. Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT. Int J Cardiol 2017; 245:263-270. [DOI: 10.1016/j.ijcard.2017.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/23/2017] [Accepted: 07/12/2017] [Indexed: 01/16/2023]
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Differences in myocardial strain between pectus excavatum patients and healthy subjects assessed by cardiac MRI: a pilot study. Eur Radiol 2017; 28:1276-1284. [DOI: 10.1007/s00330-017-5042-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022]
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Chungsomprasong P, Hamilton R, Luining W, Fatah M, Yoo SJ, Grosse-Wortmann L. Left Ventricular Function in Children and Adolescents With Arrhythmogenic Right Ventricular Cardiomyopathy. Am J Cardiol 2017; 119:778-784. [PMID: 28040191 DOI: 10.1016/j.amjcard.2016.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to determine if left ventricular (LV) contractility is reduced in children with arrhythmogenic right ventricular cardiomyopathy (ARVC). For this retrospective study, children and adolescents undergoing a workup for ARVC were characterized according to the revised Task Force Criteria (rTFC). LV strain, rotation, and torsion were measured by feature-tracking cardiovascular magnetic resonance imaging (CMR). Of 142 pediatric patients, 41% had no, 23% possible, 20% borderline, and 16% definite ARVC. LV ejection fraction (EF) did not differ between rTFC categories. Patients in higher rTFC categories had lower right ventricular (RV) EF z-scores (Z-), higher Z-RV end-diastolic volumes (EDVs) and larger Z-LVEDVs (p <0.001, p = 0.002 and 0.013, respectively). LV global circumferential strain was lower in higher rTFC categories (p = 0.018). Z-LVEDV correlated with Z-RVEDV, and Z-LVEF correlated with Z-RVEF (r = 0.69 and r = 0.55, both p <0.001). Z-LVEF and Z-RVEF correlated with LV global circumferential strain (r = 0.48 and r = 0.46, both p <0.001). Forty-eight patients (34%) underwent follow-up CMR investigations after a mean of 3.2 ± 1.9 (0.4 to 8.4) years. A decrease of Z-LVEF over time correlated with that of Z-RVEF (r = 0.35), and Z-LVEDV increase correlated with Z-RVEDV increase (r = 0.57). In conclusion, LV myocardial dysfunction is present in young patients with suspected ARVC. Progressive LV dysfunction assessed by conventional CMR and feature-tracking and enlargement over time parallel adverse remodeling of the RV.
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Dahle GO, Salminen PR, Moen CA, Eliassen F, Nygreen E, Kytö V, Saukko P, Haaverstad R, Matre K, Grong K. Carvedilol-Enriched Cold Oxygenated Blood Cardioplegia Improves Left Ventricular Diastolic Function After Weaning From Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2016; 30:859-68. [PMID: 27521963 DOI: 10.1053/j.jvca.2016.03.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To investigate whether adding carvedilol, a nonselective β- and selective α1-receptor blocking agent with antioxidant properties, to oxygenated blood cardioplegia improves myocardial function after weaning from bypass. DESIGN A randomized controlled study. SETTING A university laboratory. PARTICIPANTS Twenty anesthetized pigs, Norwegian Landrace. INTERVENTIONS On cardiopulmonary bypass, cardiac arrest was induced with cold (12°C), oxygenated blood cardioplegia, enriched with carvedilol or vehicle, and repeated every 20 minutes. After 100 minutes, the heart was reperfused and weaned. MEASUREMENTS AND MAIN RESULTS Left ventricular function was evaluated with pressure-volume loops, local myocardial systolic strain, and strain rate from Speckle tracking analysis and multilayer short-axis tissue Doppler Imaging. In the carvedilol group, the load-independent logarithmic end-diastolic pressure volume relationship, β, decreased from 1 to 3 hours of reperfusion and was low, 0.028±0.004 v 0.042±0.007 (p<0.05) in controls at 3 hours, demonstrating improved left ventricular compliance. The diastolic relaxation constant τ was decreased, 28.9±0.6 ms v 34.6±1.3 ms (pg<0.035), and dP/dtmin was more negative,-1,462±145 mmHg/s v-1,105±105 mmHg/s (pg = 0.024), for carvedilol v control group. The systolic variables, preload recruitable stroke work and end-systolic pressure-volume relationship, did not differ between groups, neither did left ventricular systolic strain and strain rate. Myocardial oxidative stress, measured as tissue levels of malondialdehyde, was reduced by carvedilol, 0.19±0.01 compared to 0.24±0.01 nmol/mg (p = 0.004) in controls. CONCLUSIONS Carvedilol added to blood cardioplegia improved diastolic cardiac function and reduced oxidative stress during the first 3 hours after reperfusion in a porcine model, with 100 minutes of cardioplegic arrest.
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Affiliation(s)
- Geir Olav Dahle
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;; Department of Clinical Science, University of Bergen, Bergen, Norway;.
| | - Pirjo-Riitta Salminen
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;; Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Finn Eliassen
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Else Nygreen
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ville Kytö
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland;; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Pekka Saukko
- Department of Pathology and Forensic Medicine, University of Turku, Turku, Finland
| | - Rune Haaverstad
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ketil Grong
- Department of Clinical Science, University of Bergen, Bergen, Norway
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