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Gouda P, Liu Y, Butler J, Del Prato S, Ibrahim NE, Lam CSP, Marwick T, Rosenstock J, Tang W, Zannad F, Januzzi J, Ezekowitz J. Relationship between NT-proBNP, echocardiographic abnormalities and functional status in patients with subclinical siabetic cardiomyopathy. Cardiovasc Diabetol 2024; 23:281. [PMID: 39095808 PMCID: PMC11297788 DOI: 10.1186/s12933-024-02378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Persons with diabetes are at risk for developing a cardiomyopathy through several pathophysiological mechanisms independent of traditional risk factors for heart failure. Among those with diabetic cardiomyopathy (DbCM), the relationship between natriuretic peptides, cardiac structural abnormalities and functional capacity is largely unknown. METHODS In this prespecified subgroup analysis of the Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) trial, 685 participants with asymptomatic DbCM underwent baseline echocardiography data, laboratory investigations, and functional assessments. Participants were stratified by N-terminal pro-B type natriuretic peptide (NT-proBNP) quartiles, and correlation with echocardiographic and functional parameters were assessed using Spearman correlation test. RESULTS The median NT-proBNP was 71 (Q1, Q3: 33, 135) ng/L. No association was observed between NT-proBNP concentrations and echocardiographic parameters of either diastolic or systolic dysfunction including global longitudinal strain, left ventricular ejection fraction, left ventricular mass index, left atrial volume index, E/E', or right ventricular systolic pressure. In contrast, NT-proBNP was significantly correlated with overall Kansas City Cardiomyopathy Questionnaire score (rho = - 0.10; p = 0.007), the Physical Activity Scale in the Elderly (rho = - 0.12; p = 0.004), duration of cardiopulmonary exercise testing (rho = - 0.28; p < 0.001), peak VO2 (rho = - 0.26; p < 0.001), and ratio of minute ventilation/carbon dioxide production (rho = 0.12; p = 0.002). After adjustment for known confounders, the correlation with Physical Activity Scale in the Elderly and overall Kansas City Cardiomyopathy Questionnaire score was no longer significant. CONCLUSION Among patients with subclinical DbCM, elevated NT-proBNP concentrations are associated with worse health status, lower activity levels, and reduced functional capacity, but not with cardiac structural abnormalities. These findings suggest that regardless of cardiac structural abnormalities, biomarker concentrations reflect important deterioration in functional capacity in affected individuals. TRIAL REGISTRATION ARISE-HF, NCT04083339 Date Registered August 23, 2019.
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Affiliation(s)
- Pishoy Gouda
- University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Yuxi Liu
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Stefano Del Prato
- Interdisciplinary Research Center "Health Science" , Sant'Anna School of Advanced Studies, Pisa, Italy
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Nasrien E Ibrahim
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Thomas Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Menzies Institute for Health Research, Hobart, Australia
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Julio Rosenstock
- Dallas Diabetes Research Center, Dallas, TX, USA
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Wilson Tang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Faiez Zannad
- Inserm CIC and CHRU, Université de Lorraine, Nancy, France
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - James Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA, USA
- Canadian VIGOUR Centre, Edmonton, AB, Canada
| | - Justin Ezekowitz
- University of Alberta, Edmonton, AB, Canada.
- University of Mississippi, Jackson, MS, USA.
- Canadian VIGOUR Centre, Edmonton, AB, Canada.
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Daios S, Anastasiou V, Bazmpani MA, Angelopoulou SM, Karamitsos T, Zegkos T, Didagelos M, Savopoulos C, Ziakas A, Kamperidis V. Moving from left ventricular ejection fraction to deformation imaging in mitral valve regurgitation. Curr Probl Cardiol 2024; 49:102432. [PMID: 38309543 DOI: 10.1016/j.cpcardiol.2024.102432] [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: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
The increasing prevalence of valvular heart diseases, specifically mitral regurgitation (MR), underscores the need for a careful and timely approach to intervention. Severe MR, whether primary or secondary, when left untreated leads to adverse outcomes, emphasizing the critical role of a timely surgical or transcatheter intervention. While left ventricular ejection fraction (LVEF) remains the guideline-recommended measure for assessing left ventricle damage, emerging evidence raises concerns regarding its reliability in MR due to its volume-dependent nature. This review summarizes the existing literature on the role of LVEF and deformation imaging techniques, emphasizing the latter's potential in providing a more accurate evaluation of intrinsic myocardial function. Moreover, it advocates the need for an integrated approach that combines traditional with emerging measures, aiming to optimize the management of patients with MR. It attempts to highlight the need for future research to validate the clinical application of deformation imaging techniques through large-scale studies.
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Affiliation(s)
- Stylianos Daios
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Vasileios Anastasiou
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Maria-Anna Bazmpani
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Stella-Maria Angelopoulou
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Thomas Zegkos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Matthaios Didagelos
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Christos Savopoulos
- First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Antonios Ziakas
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, Thessaloniki 54636, Greece.
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3
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Rao RA, Varghese SS, Ansari F, Rao A, Meng E, El-Diasty M. The Role of Natriuretic Peptides in Predicting Adverse Outcomes After Cardiac Surgery: An Updated Systematic Review. Am J Cardiol 2024; 210:16-36. [PMID: 37884264 DOI: 10.1016/j.amjcard.2023.09.101] [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: 07/29/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
The increasing global burden of cardiovascular disease, particularly, in the aging population, has led to an increase in high-risk cardiac surgical procedures. The current preoperative risk stratification scores, such as the European System for Cardiac Operative Risk Evaluation and the Society for Thoracic Surgeons score, have limitations in their predictive accuracy and tend to underestimate the mortality risk in higher-risk populations. This systematic review aimed to evaluate the utility of natriuretic peptides, brain natriuretic peptide (BNP) and its precursor prohormone (N-terminal prohormone BNP), as predictive biomarkers for adverse outcomes after cardiac surgery. A comprehensive search strategy was performed, and 63 studies involving 40,667 patients who underwent major cardiac operations were included for data extraction. Preoperative levels of BNP and N-terminal prohormone BNP seemed to be associated with an increased risk of short- and long-term mortality, postoperative heart failure, kidney injury, and length of intensive care unit stay. However, their predictive value for postoperative arrhythmias and myocardial infarction was less established. Our findings suggest that natriuretic peptides may play an important role in risk prediction in patients who underwent cardiac surgery. The addition of these biomarkers to the existing clinical risk stratification strategies may enhance their predictive accuracy. However, this needs to be endorsed by data derived from wide-scale clinical trials.
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Affiliation(s)
- Reddi Ashwin Rao
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | | | - Farzan Ansari
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Aditya Rao
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Eric Meng
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Mohammad El-Diasty
- Harrington Heart and Vascular Institute, Cardiac Surgery Department, University Hospitals, Cleveland, Ohio.
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4
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Ueyama H, Kuno T, Takagi H, Krishnamoorthy P, Prandi FR, Palazzuoli A, Sharma SK, Kini A, Lerakis S. Prognostic value of left ventricular global longitudinal strain in mitral regurgitation: a systematic review. Heart Fail Rev 2023; 28:465-483. [PMID: 35900680 DOI: 10.1007/s10741-022-10265-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
Conventional echocardiographic assessment may overestimate the left ventricular (LV) function in mitral regurgitation (MR). LV global longitudinal strain (GLS) is more sensitive marker to detect subclinical LV dysfunction. Multiple studies have investigated the prognostic value of LV-GLS in MR to examine its potential to determine the timing and indication of intervention. This systematic review aimed to assess the prognostic value of LV-GLS in patients with mitral regurgitation (MR) to define its clinical applicability. PUBMED and EMBASE were queried through July 2021 to identify studies investigating the prognostic value of LV-GLS in MR. A total of 24 observational studies with 5267 patients were identified. Sixteen studies investigated for primary MR, 7 studies for secondary MR, and 1 study for both. Most studies included patients who underwent intervention. There was significant heterogeneity in patient population, intervention status, follow-up period, LV-GLS cutoff value, outcomes, and statistical methods among the studies. Meta-analysis was not performed considering the significant variability. With exception to 1 study, all studies demonstrated significant association between impaired LV-GLS and worse clinical and echocardiographic outcomes in primary MR. Prognostic value of LV-GLS in secondary MR was less certain due to inconsistent findings and limited reporting. LV-GLS is a promising parameter of prognostication in primary MR and can be considered as alternative to determine the timing of intervention. However, the optimal cutoff value remains unclear. The prognostic value of LV-GLS in secondary MR is less clear. Further large-scale prospective study is warranted before its routine clinical application.
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Affiliation(s)
- Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.,Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Toshiki Kuno
- Department of Cardiology, Montefiore Medical Center, Albert Einstein Medical College, New York, NY, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Francesca Romana Prandi
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Throacic and Vascular, Department S. Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Samin K Sharma
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Annapoorna Kini
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Stamatios Lerakis
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA.
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5
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Ajmone Marsan N, Delgado V, Shah DJ, Pellikka P, Bax JJ, Treibel T, Cavalcante JL. Valvular heart disease: shifting the focus to the myocardium. Eur Heart J 2023; 44:28-40. [PMID: 36167923 PMCID: PMC9805407 DOI: 10.1093/eurheartj/ehac504] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/12/2022] [Accepted: 08/26/2022] [Indexed: 01/05/2023] Open
Abstract
Adverse cardiac remodelling is the main determinant of patient prognosis in degenerative valvular heart disease (VHD). However, to give an indication for valvular intervention, current guidelines include parameters of cardiac chamber dilatation or function which are subject to variability, do not directly reflect myocardial structural changes, and, more importantly, seem to be not sensitive enough in depicting early signs of myocardial dysfunction before irreversible myocardial damage has occurred. To avoid irreversible myocardial dysfunction, novel biomarkers are advocated to help refining indications for intervention and risk stratification. Advanced echocardiographic modalities, including strain analysis, and magnetic resonance imaging have shown to be promising in providing new tools to depict the important switch from adaptive to maladaptive myocardial changes in response to severe VHD. This review, therefore, summarizes the current available evidence on the role of these new imaging biomarkers in degenerative VHD, aiming at shifting the clinical perspective from a valve-centred to a myocardium-focused approach for patient management and therapeutic decision-making.
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Affiliation(s)
- Nina Ajmone Marsan
- Department of Cardiology, Leiden Univesity Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden Univesity Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Cardiology, Germans Trias i Pujol Hospital, Carretera de Canyet s/n. 08916 Badalona, Barcelona, Spain
| | - Dipan J Shah
- Division of Cardiovascular Imaging, Weill Cornell Medical College, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Patricia Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden Univesity Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Thomas Treibel
- Department of Cardiology, Barts Heart Centre and University College London, West Smithfield, London EC1A 7BE, UK
| | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute at Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
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6
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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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7
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Lehtola H, Piuhola J, Niemelä M, Tauriainen T, Junttila J, Mäkikallio T, Juvonen T, Biancari F. B-type natriuretic peptide ability to predict mortality after transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown) 2022; 23:e18-e20. [PMID: 34261080 PMCID: PMC8654270 DOI: 10.2459/jcm.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/14/2021] [Accepted: 06/19/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Heidi Lehtola
- Department of Internal Medicine, Oulu University Hospital, Oulu
| | - Jarkko Piuhola
- Department of Internal Medicine, Oulu University Hospital, Oulu
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu
| | - Tuomas Tauriainen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki
| | - Juhani Junttila
- Department of Internal Medicine, Oulu University Hospital, Oulu
| | | | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki
- Research Unit of Surgery, Anesthesia and Critical Care, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki
- Research Unit of Surgery, Anesthesia and Critical Care, Faculty of Medicine, University of Oulu, Oulu, Finland
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8
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Moura B, Aimo A, Al-Mohammad A, Flammer A, Barberis V, Bayes-Genis A, Brunner-La Rocca HP, Fontes-Carvalho R, Grapsa J, Hülsmann M, Ibrahim N, Knackstedt C, Januzzi JL, Lapinskas T, Sarrias A, Matskeplishvili S, Meijers WC, Messroghli D, Mueller C, Pavo N, Simonavičius J, Teske AJ, van Kimmenade R, Seferovic P, Coats AJS, Emdin M, Richards AM. Integration of imaging and circulating biomarkers in heart failure: a consensus document by the Biomarkers and Imaging Study Groups of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:1577-1596. [PMID: 34482622 DOI: 10.1002/ejhf.2339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/28/2021] [Accepted: 08/29/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating biomarkers and imaging techniques provide independent and complementary information to guide management of heart failure (HF). This consensus document by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) presents current evidence-based indications relevant to integration of imaging techniques and biomarkers in HF. The document first focuses on application of circulating biomarkers together with imaging findings, in the broad domains of screening, diagnosis, risk stratification, guidance of treatment and monitoring, and then discusses specific challenging settings. In each section we crystallize clinically relevant recommendations and identify directions for future research. The target readership of this document includes cardiologists, internal medicine specialists and other clinicians dealing with HF patients.
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Affiliation(s)
- Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - Abdallah Al-Mohammad
- Medical School, University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar de Vila Nova Gaia/Espinho, Espinho, Portugal
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, UK
| | - Martin Hülsmann
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nasrien Ibrahim
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tomas Lapinskas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Axel Sarrias
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Noemi Pavo
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Justas Simonavičius
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
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9
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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10
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Pastore MC, Mandoli GE, Dokollari A, Bisleri G, D'Ascenzi F, Santoro C, Miglioranza MH, Focardi M, Cavigli L, Patti G, Valente S, Mondillo S, Cameli M. Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention? Heart Fail Rev 2021; 27:1247-1260. [PMID: 33829389 PMCID: PMC9197800 DOI: 10.1007/s10741-021-10100-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
Thanks to the improvement in mitral regurgitation (MR) diagnostic and therapeutic management, with the introduction of minimally invasive techniques which have considerably reduced the individual surgical risk, the optimization of the timing for MR “open” or percutaneous surgical treatment has become a main concern which has highly raised scientific interest. In fact, the current indications for intervention in MR, especially in asymptomatic patients, rely on echocardiographic criteria with high severity cut-offs that are fulfilled only when not only mitral valve apparatus but also the cardiac chambers’ structure and function are severely impaired, which results in poor benefits for post-operative clinical outcome. This led to the need of new indices to redefine the optimal surgical timing in these patients. Speckle tracking echocardiography provides early markers of cardiac dysfunction due to subtle myocardial impairment; therefore, it could offer pivotal information in this setting. In fact, left ventricular and left atrial strains have already shown evidence about their usefulness in recognizing MR impact not only on symptoms and quality of life but also on cardiovascular events and new-onset atrial fibrillation in these patients. Moreover, right ventricular strain could be used to identify those patients with advanced cardiac damage and different grades of right ventricular dysfunction, which entails higher risks for cardiac surgery that could overweigh surgical benefits. This review aims to describe the importance of reconsidering the timing of intervention in MR and to analyze the potential additive value of speckle tracking echocardiography in this clinical setting.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy. .,Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | | | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Giuseppe Patti
- Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
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11
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Modaragamage Dona AC, Afoke J, Punjabi PP, Kanaganayagam GS. Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review. J Card Surg 2021; 36:2458-2466. [PMID: 33783012 DOI: 10.1111/jocs.15521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients. METHODS Following PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included "mitral regurgitation," "mitral valve insufficiency," "global longitudinal strain," "deformation," "LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D-STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery. Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed. RESULTS Baseline GLS is an independent predictor of postoperative outcomes, ranging from -17.9 to -21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long-term survival rates were seen in patients who underwent early surgery. CONCLUSION GLS shows sensitivity in predicting long-term postoperative outcomes. Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.
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Affiliation(s)
| | - Jonathan Afoke
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gajen S Kanaganayagam
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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12
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Misfeld M, Borger MA. Commentary: More insights into the resect versus respect debate: Will we ever have a winner? J Thorac Cardiovasc Surg 2021; 164:1500-1501. [PMID: 33867125 DOI: 10.1016/j.jtcvs.2021.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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13
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Saijo Y, Isaza N, Conic JZ, Desai MY, Johnston D, Roselli EE, Grimm RA, Svensson LG, Kapadia S, Obuchowski NA, Griffin BP, Popović ZB. Left Ventricular Longitudinal Strain in Characterization and Outcome Assessment of Mixed Aortic Valve Disease Phenotypes. JACC Cardiovasc Imaging 2021; 14:1324-1334. [PMID: 33744141 DOI: 10.1016/j.jcmg.2021.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aims of this study were to characterize the interplay between mixed aortic valve disease (MAVD) phenotypes (defined by concomitant severities of aortic stenosis and aortic regurgitation) and left ventricular global longitudinal strain (LV-GLS), and to assess the prognostic utility of LV-GLS in MAVD. BACKGROUND Little is known about the way LV-GLS separates MAVD phenotypes and if it is associated with their outcomes. METHODS This observational cohort study evaluated 783 consecutive adult patients with left ventricular ejection fraction ≥50% and MAVD, which was defined as coexisting with at least moderate aortic stenosis and at least moderate aortic regurgitation. We measured the conventional echocardiographic variables and average LV-GLS from apical long, 2- and 4-chamber views. The primary endpoint was all-cause mortality. RESULTS Mean age of patients was 69 ± 15 years, and 58% were male. Mean LV-GLS was -14.7 ± 2.9%. In total, 458 patients (59%) underwent aortic valve replacement at a median period of 50 days (25th to 75th percentile range: 6 to 560 days). During a median follow-up period of 5.6 years (25th to 75th percentile range: 1.8 to 9.4 years), 391 patients (50%) died. When stratified patients into tertiles according to LV-GLS values, patients with worse LV-GLS had worse outcomes (p < 0.001). LV-GLS was independently associated with mortality (hazard ratio: 1.09; 95% confidential intervals: 1.04 to 1.14; p < 0.001), with the relationship between LV-GLS and mortality being linear. CONCLUSIONS LV-GLS is associated with all-cause mortality. LV-GLS may be useful for risk stratification in patients with MAVD.
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Affiliation(s)
- Yoshihito Saijo
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicolas Isaza
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Julijana Z Conic
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Douglas Johnston
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Richard A Grimm
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nancy A Obuchowski
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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14
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 545] [Impact Index Per Article: 181.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 782] [Impact Index Per Article: 260.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 345] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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17
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Workup and Management of Primary Mitral Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Canessa M, Thamman R, Americo C, Soca G, Dayan V. Global Longitudinal Strain Predicts Survival and Left Ventricular Function After Mitral Valve Surgery: A Meta-analysis. Semin Thorac Cardiovasc Surg 2020; 33:337-342. [PMID: 32971244 DOI: 10.1053/j.semtcvs.2020.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023]
Abstract
The timing for surgical treatment in patients with primary organic severe mitral valve regurgitation and preserved left ventricular ejection fraction (LVEF) systolic is a challenge since it depends upon LV end systolic dimension and LVEF which may be late markers of LV dysfunction. Echocardiography is the most important tool in the diagnosis of mechanisms, etiology, severity, and hemodynamic consequences of mitral regurgitation. The global longitudinal strain (GLS), a new and sensitive method for the detection of LV dysfunction, might be a useful method for the evaluation of preclinical systolic dysfunction. Nevertheless, its role for predicting postoperative outcomes is not well established. A meta-analysis was performed to address the role of GLS in patients with severe mitral regurgitation and preserved LVEF who underwent mitral surgery. We included studies that compared outcomes according to preoperative GLS in regard to survival and postoperative LV function. We included 2358 patients enrolled in 8 studies. Patients with reduced GLS% had worse long term survival after mitral valve surgery (hazard ratio = 1.13, 95% confidence interval [CI]: 1.02-1.26). Patients with preoperatively reduced GLS% had lower LVEF after surgery (mean difference [MD] = -5.06%, 95% CI: -8.97-1.16%) and additionally, patients who presented postoperative LVEF dysfunction had worse preoperative GLS (MD = 4.33, 95% CI: 3.89-4.76). In patients with primary mitral regurgitation, preoperative GLS is a predictor for long term survival and postoperative LVEF. It is a useful parameter to be included when considering early surgery in patients with severe mitral regurgitation and normal LVEF.
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Affiliation(s)
- Martin Canessa
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Ritu Thamman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlos Americo
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Gerardo Soca
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Victor Dayan
- National Institute of Cardiac Surgery, Montevideo, Uruguay; Centro Cardiovascular Universitario, Montevideo, Uruguay.
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Prognostic Utility of Left Ventricular Global Longitudinal Strain in Surgery for Primary Mitral Regurgitation: A Systematic Review. JACC Cardiovasc Imaging 2020; 13:1838-1840. [PMID: 32563661 DOI: 10.1016/j.jcmg.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/24/2022]
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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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22
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Flint N, Raschpichler M, Rader F, Shmueli H, Siegel RJ. Asymptomatic Degenerative Mitral Regurgitation. JAMA Cardiol 2020; 5:346-355. [DOI: 10.1001/jamacardio.2019.5466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matthias Raschpichler
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- University Clinic of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hezzy Shmueli
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert J. Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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23
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Carabello BA. Timing of Surgery for Primary MR. JACC Cardiovasc Imaging 2020; 13:586-588. [DOI: 10.1016/j.jcmg.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
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Bijvoet GP, Teske AJ, Chamuleau SAJ, Hart EA, Jansen R, Schaap J. Global longitudinal strain to predict left ventricular dysfunction in asymptomatic patients with severe mitral valve regurgitation: literature review. Neth Heart J 2020; 28:63-72. [PMID: 31410717 PMCID: PMC6977936 DOI: 10.1007/s12471-019-01318-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The optimal treatment strategy for asymptomatic patients with severe mitral valve regurgitation (MR) and preserved left ventricular (LV) function is challenging. This manuscript reviews the available literature on the value of left ventricular global longitudinal strain (LV-GLS) in predicting LV dysfunction after mitral valve surgery in these patients and discusses its current place in the treatment strategy. Studies were identified from Cochrane Library, SCOPUS, PubMed and Web of Science up to February 2018. The domain used was MR. The determinant was LV-GLS; other methods of deformation imaging were excluded. The examined outcome was LV dysfunction after surgery. A total of 144 articles were retrieved, of which 11 publications met the inclusion criteria, including a total of 2415 patients. Ten studies showed a significant correlation between preoperative LV-GLS and LV dysfunction postoperatively; one study reported a negative correlation. These studies suggest that LV-GLS is a predictor of LV dysfunction after surgery in asymptomatic patients with chronic MR. Hence, incorporation of LV-GLS for clinical decision-making in these patients might be of additional value. Further research is needed to confirm the role of LV-GLS in postoperative patients, and additionally in asymptomatic MR patients during a 'watchful waiting' strategy.
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Affiliation(s)
- G P Bijvoet
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - A J Teske
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E A Hart
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Jansen
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Schaap
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
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Hiemstra YL, Tomsic A, van Wijngaarden SE, Palmen M, Klautz RJ, Bax JJ, Delgado V, Ajmone Marsan N. Prognostic Value of Global Longitudinal Strain and Etiology After Surgery for Primary Mitral Regurgitation. JACC Cardiovasc Imaging 2020; 13:577-585. [DOI: 10.1016/j.jcmg.2019.03.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
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Fava AM, Meredith D, Desai MY. Clinical Applications of Echo Strain Imaging: a Current Appraisal. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:50. [PMID: 31473859 DOI: 10.1007/s11936-019-0761-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making. RECENT FINDINGS Strain has been proposed as a sensitive tool in detecting early ventricular dysfunction. Left ventricular global longitudinal strain (LV-GLS) detects subtle changes in myocardial function, often not quantifiable by ejection fraction alone. Thus, LV-GLS provides the opportunity for early decision-making, and the implementation of more effective treatments, improving outcomes in a variety of diseases such as valvular heart diseases, cardio-oncology, ischemic heart disease, cardiomyopathies, heart transplantation, and pericardial diseases and cardiomyopathies. Strain is a promising tool for the early detection of myocardial dysfunction in patients with preserved left ventricular ejection fraction and can prognosticate long-term outcomes.
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Affiliation(s)
- Agostina M Fava
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Dane Meredith
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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Utilidad del “speckle tracking” en pacientes no oncológicos. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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28
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Kvisvik B, Aagaard EN, Mørkrid L, Røsjø H, Lyngbakken M, Smedsrud MK, Eek C, Bendz B, Haugaa KH, Edvardsen T, Gravning J. Mechanical dispersion as a marker of left ventricular dysfunction and prognosis in stable coronary artery disease. Int J Cardiovasc Imaging 2019; 35:1265-1275. [DOI: 10.1007/s10554-019-01583-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/13/2019] [Indexed: 10/26/2022]
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Jeffrey RR, Hamburger RF, Gooden-Ebanks J, Petersen JW. Speckle Tracking Echocardiography Identifies Impaired Longitudinal Strain as a Common Deficit in Various Cardiac Diseases. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Antoine C, Mantovani F, Benfari G, Mankad SV, Maalouf JF, Michelena HI, Enriquez-Sarano M. Pathophysiology of Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging 2018; 11:e005971. [DOI: 10.1161/circimaging.116.005971] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Clemence Antoine
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Francesca Mantovani
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Giovanni Benfari
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Sunil V. Mankad
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Joseph F. Maalouf
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Hector I. Michelena
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
| | - Maurice Enriquez-Sarano
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN (C.A., F.M., G.B., S.V.M., J.F.M., H.I.M., M.E.-S.); and Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy (F.M.)
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31
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Outcomes in Degenerative Mitral Regurgitation: Current State-of-the Art and Future Directions. Prog Cardiovasc Dis 2017; 60:370-385. [DOI: 10.1016/j.pcad.2017.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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32
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Mentias A, Desai MY. Markers of increased risk in primary mitral regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:338. [PMID: 28861435 DOI: 10.21037/atm.2017.04.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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34
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Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Chronic Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction. JACC Cardiovasc Imaging 2017. [PMID: 28624411 DOI: 10.1016/j.jcmg.2017.02.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to examine the prognostic utility of left ventricular (LV) global longitudinal strain (GLS) in asymptomatic patients with ≥III+ aortic regurgitation (AR), an indexed LV end-systolic dimension of <2.5 cm/m2, and preserved left ventricular ejection fraction (LVEF). BACKGROUND Management of asymptomatic patients with severe chronic AR and preserved LVEF is challenging and is typically based on LV dimensions. METHODS We studied 1,063 such patients (age 53 ± 16 years; 77% men) seen between 2003 and 2010 (excluding those with symptoms, obstructive coronary artery disease, acute AR/dissection, aortic/mitral stenosis, more than moderate mitral regurgitation, and previous cardiac surgery). Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Average resting LV-GLS was measured offline on 2-, 3-, and 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, Pennsylvania). RESULTS Mean STS score, LVEF, LV-GLS, and right ventricular systolic pressure were 4.4 ± 5.0%, 57.0 ± 4.0%, -19.5 ± 0.2%, and 31.0 ± 9.0 mm Hg, respectively. In total, 671 patients (63%) underwent aortic valve surgery at a median of 42 days after the initial evaluation. At 6.8 ± 3.0 years, 146 patients (14%) had died. On multivariable Cox survival analysis, LV-GLS (hazard ratio [HR]: 1.11), STS score (HR: 1.51), indexed LV end-systolic dimension (HR: 0.50), right ventricular systolic pressure (HR: 1.33), and aortic valve surgery (HR: 0.35) were associated with longer term mortality (all p < 0.001). Sequential addition of LV-GLS and aortic valve surgery improved the C-statistic for longer term mortality for the clinical model (STS score + right ventricular systolic pressure + indexed LV end-systolic dimension) from 0.61 (95% confidence interval [CI]: 0.51 to 0.72) to 0.67 (95% CI: 0.54 to 0.87) and to 0.77 (95% CI: 0.63 to 0.90), respectively (p < 0.001 for both). A significantly higher proportion (log-rank p = 0.01) of patients with LV-GLS worse than median (-19.5%) died versus those with an LV-GLS better than median (86 of 513 [17%] vs. 60 of 550 [11%]). The risk of death at 5 years significantly increased with an LV-GLS of worse than -19%. CONCLUSIONS In asymptomatic patients with ≥III+ chronic AR and preserved LVEF, worsening LV-GLS was associated with longer term mortality, providing incremental prognostic value and improved reclassification.
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Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G. Cardiac surgery 2016 reviewed. Clin Res Cardiol 2017; 106:851-867. [PMID: 28396989 DOI: 10.1007/s00392-017-1113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 01/09/2023]
Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Yasin Essa
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Khalil Jacoub
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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Apostolidou E, Maslow AD, Poppas A. Primary mitral valve regurgitation: Update and review. Glob Cardiol Sci Pract 2017; 2017:e201703. [PMID: 31139637 PMCID: PMC6516795 DOI: 10.21542/gcsp.2017.3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of “watchful waiting” versus “early surgical intervention” for severe, asymptomatic, primary mitral regurgitation are addressed.
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Affiliation(s)
| | - Andrew D Maslow
- Section of Cardiac Anesthesia, Rhode Island and Miriam Hospital, Providence, RI, USA
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