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Kovács A, Tokodi M. Refining Echocardiographic Surveillance of Aortic Stenosis Using Machine Learning: Toward Personalized and Sustainable Follow-Up Schemes. JACC Cardiovasc Imaging 2023:S1936-878X(23)00092-X. [PMID: 37038877 DOI: 10.1016/j.jcmg.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Lakatos BK, Ruppert M, Tokodi M, Oláh A, Braun S, Karime C, Ladányi Z, Sayour AA, Barta BA, Merkely B, Radovits T, Kovács A. Myocardial work index: a marker of left ventricular contractility in pressure- or volume overload-induced heart failure. ESC Heart Fail 2021; 8:2220-2231. [PMID: 33754487 PMCID: PMC8120402 DOI: 10.1002/ehf2.13314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022] Open
Abstract
Aims While global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function, it is significantly influenced by loading conditions. We hypothesized that global myocardial work index (GMWI), a novel marker of LV function, may show better correlation with load‐independent markers of LV contractility in rat models of pressure‐induced or volume overload‐induced heart failure. Methods and results Male Wistar rats underwent either transverse aortic constriction (TAC; n = 12) or aortocaval fistula creation (ACF; n = 12), inducing LV pressure or volume overload, respectively. Sham procedures were performed to establish control groups (n = 12/12). Echocardiographic loops were obtained to determine GLS and GMWI. Pressure‐volume analysis with transient occlusion of the inferior caval vein was carried out to calculate preload recruitable stroke work (PRSW), a load‐independent ‘gold‐standard’ parameter of LV contractility. Myocardial samples were collected to assess interstitial and perivascular fibrosis area and also myocardial atrial‐type natriuretic peptide (ANP) and brain‐type natriuretic peptide (BNP) relative mRNA expression. Compared with controls, GLS was substantially lower in the TAC group (−7.0 ± 2.8 vs. −14.5 ± 2.5%; P < 0.001) and was only mildly reduced in the ACF group (−13.2 ± 2.4 vs. −15.4 ± 2.0%, P < 0.05). In contrast with these findings, PRSW and GMWI were comparable with sham in TAC (110 ± 26 vs. 116 ± 68 mmHg; 1687 ± 275 mmHg% vs. 1537 ± 662 mmHg%; both P = NS), while it was found to be significantly reduced in ACF (58 ± 14 vs. 111 ± 40 mmHg; 1328 ± 411 vs. 1934 ± 308 mmHg%, both P < 0.01). In the pooled population, GMWI (r = 0.70; P < 0.001) but not GLS (r = −0.23; P = 0.12) showed a strong correlation with PRSW. GLS correlated with interstitial (r = 0.61; P < 0.001) and perivascular fibrosis area (r = 0.54; P < 0.001), and also with myocardial ANP (r = 0.85; P < 0.001) and BNP relative mRNA expression (r = 0.75; P < 0.001), while GMWI demonstrated no or only marginal correlation with these parameters. Conclusions Being significantly influenced by loading conditions, GLS may not be a reliable marker of LV contractility in heart failure induced by pressure or volume overload. GMWI better reflects contractility in haemodynamic overload states, making it a more robust marker of systolic function, while GLS should be considered as an integrative marker, incorporating systolic function, haemodynamic loading state, and adverse tissue remodelling of the LV.
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Affiliation(s)
- Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Mihály Ruppert
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Szilveszter Braun
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Christian Karime
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Bálint András Barta
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
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Predictors of moderate to severe ischemic mitral regurgitation after myocardial infarction: a cardiac magnetic resonance study. Eur Radiol 2021; 31:5650-5658. [PMID: 33449179 DOI: 10.1007/s00330-020-07658-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/04/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study is to explore the predictors of moderate to severe ischemic mitral regurgitation (IMR) after myocardial infarction with cardiovascular magnetic resonance (CMR). METHODS From January 2016 to September 2018, 109 patients (mean age 60 ± 8 years) with IMR were studied retrospectively. All patients underwent CMR-cine with True-FISP sequence and late gadolinium enhancement (LGE) with a phase-sensitive inversion recovery sequence. The presence of papillary muscle infarction (PMI), global left ventricular (LV) infarcted extent, LV functional parameters, and LV myocardial strain were assessed. Univariate and multivariate analyses were performed to identify factors in the development of moderate to severe IMR. RESULTS Mild IMR was present in 61 patients (56%), and moderate to severe IMR was present in 48 patients (44%). PMI was identified in 22 patients (20.1%); 14 of them (63.63%) showed a moderate or severe IMR. Global LV infarcted extent was increased in patients with moderate to severe IMR (p < 0.001). LV functional parameters of patients with moderate to severe IMR were statistically different from those of the patients with mild IMR (all p < 0.001), except the LV SV index (p = 0.142) and LV CI (p = 0.447). The global longitudinal strain (GLS), regional radial strain (RS), and circumferential strain (CS) of the moderate-to-severe IMR group were significantly decreased compared with those of the mild IMR group (p < 0.05). In multivariable analyses, age (OR = 1.11; p = 0.001), global LV infarct extent (OR = 1.14; p = 0.000), and GLS (OR = 1.31; p = 0.000) were associated with moderate-to-severe chronic IMR. CONCLUSIONS The incidence of PMI was higher in patients with moderate-to-severe IMR. The extent of global LV infarcted extent and GLS were independent predictors of moderate-to-severe IMR. KEY POINTS • Cardiovascular magnetic resonance late gadolinium enhancement and feature-tracking imaging provide reliable information on LV function, myocardial viability, and papillary muscle morphology. • Papillary muscle infarction is not an independent predictor of moderate-to-severe IMR. • The extent of global LV infarction and LV global longitudinal strain were independent predictors of moderate-to-severe chronic IMR.
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