The predictive value of carotid artery strain and strain-rate in assessing the 3-year risk for stroke and acute coronary syndrome in patients with metabolic syndrome

Purpose

The goal of this study is to see if carotid strain and strain rate can predict major cardio-vascular events (MACE) in people who have metabolic syndrome (MS) over a 3-year period of time.

Methods

In this prospective observational research, we enrolled 220 adult MS patients (60.7±7.5 years old, 53% male). Bilateral 2D common carotid carotid artery (CCA) speckle-tracking ultrasound was used to determine the peak circumferential strain (CS) and the peak circumferential strain rate (CSR). Clinical outcomes were assessed throughout a three-year follow-up period.

Results

After a 3-year follow-up period follow-up, 14 (7%) experienced MACE: Eight (4%) suffered an atherothrombotic ischemic stroke, four (2%) had acute coronary syndrome, and two (1%) were hospitalized for heart failure. Univariate regression analysis of the clinical and echocardiographic features of the MS patients found that age, systemic hypertension, diabetes mellitus, and the CCA circumferential strain and strain rate were significantly associated with the risk of MACE. Multivariate logistic regression identified two independent predictors of MACE in patients with MS, namely the CCA-related CS (%) and CSR (1/s), P<0.01. The ROC curve analyses of these independent predictors of MACE indicated appropriate sensitivities and specificities. CS (AUC = 0.806, sensitivity = 82.6%, specificity = 79.2%, P<0.0001); CSR (AUC = 0.779, sensitivity = 82.6%, specificity = 72.4%, P<0.0001). The cut-off values were ≤2.9% for carotid CS and ≤0.35 s–1 for carotid CSR. Using these cut-off values, we obtained Kaplan-Meier survival curves, and these showed that MACE, ischemic stroke, and ACS-free survival was significantly lower among the MS patients with lower carotid CS and CSR (P<0.0001).

Conclusion

Carotid CS and CSR were independent predictors of major cardio- and cerebrovascular events in prospectively monitored MS patients without established cardiovascular disease. Carotid deformation could be valuable as an early prognostic indicator for the cardiovascular risk in this population group.

Funding Acknowledgement

Type of funding sources: None.

Fusion CRT pacing: septal flash significance in super responder patients

Background

LV only CRT pacing is an option that may be considered to maximize response to CRT and at least as an alternative in non-responders to biventricular (BiV) pacing. However, criteria to best titrate therapy on an individual basis are lacking in fusion pacing. On the other hand, septal flash (SF) is a strong predictor of favorable response for patients (pts) with BiV pacing.

Purpose

To analyze the relationship between SF and the response to fusion CRT pacing.

Methods

Consecutive pts with exclusive fusion CRT-P were included. Right atrium/left ventricle leads DDD CRT pacing system were used in all patients. Prospective data were collected at every 6 months follow-up visits: device interrogation, exercise test, echocardiographic parameters. Exercise tests, device reprogramming and medication optimization were performed regular in order to maximize CRT response. Patients were divided in 2 groups: super-responders (SR) and responders (R). SRs were defined those with left ventricular end-systolic volume (LVESV) improvement ≥30% and stable ejection fraction (LVEF) ≥45%.

Results

69 pts with NYHA II–III heart failure and non-ischemic dilated cardiomyopathy were initially included. 5 pts were non responders and excluded (non LBBB, spontaneous QRS <149 ms). Final analyzed group had 64 pts (35 male) aged 60±12 y.o. The mean follow-up was 54±19 months; 22 pts (34%) were SRs. At baseline, SF was found in all SR pts and in 55% of R pts. SF was corrected post CRT in all patients, except one. For this patient (LV lead in a posterior branch of the coronary sinus – CS) the strategy included an upgrade to triple chamber device with a second lead in a lateral branch of the CS and became SR from R. Mitral regurgitation decreased in 38 patients (all SR, 40% R). Interesting, baseline left atrium volume and pulmonary sistolic artery pressure were smaller in SR versus R group, however SF did not corelate with LA volume/diastolic dysfunction.

Conclusions

Septal flash seems to be a strong predictor of super-response in patients with fusion CRT pacing. This finding could improve the selection of candidates for fusion CRT-P, however larger studies are needed to assess SF in this categories of patients.

Funding Acknowledgement

Type of funding sources: None.

LA strain helps identifying the cardioembolic etiology of transient ischemic attacks

Background

Patients who have transient ischemic attacks (TIA) often suffer from asymptomatic and paroxysmal atrial fibrillation (AF). Due to the fact that AF is located in the atria, we sought to determine whether abnormalities in left atrial (LA) structure and function could help identify the cardioembolic cause of TIA in patients with sinus rhythm but with documented episodes of paroxysmal AF.

Methods

The research included 190 individuals with TIA and classified them into two groups based on the presence (group I) or absence (group II) of confirmed paroxysmal AF. The diagnosis of paroxysmal AF was established by an assessment of medical records. To prevent assessing atrial stunning, cardiac ultrasonography was conducted in sinus rhythm at least 14 days following the initiation the TIA.

Results

The results indicated that patients in group I were older, more often female, had a history of stroke or TIA, and had a higher CHA2DS2-VASc score. Additionally, they exhibited increased LA volumes, a decreased LA emptying fraction, and markedly altered LA deformation patterns. Three factors were found as being independently associated with paroxysmal AF using multivariate logistic regression: age, LA reservoir strain, and LA emptying fraction (P<0.0001). The variables had as cut-off values: age >55 years, LA reservoir strain<−17%, and LA emptying fraction <51%.

Conclusion

The current research establishes that LA strains are independently associated with paroxysmal AF in patients with TIA and may aid in determining the cardioembolic origin of these events.

Our findings have considerable clinical implications because, until now, LA 2D-STE was not included in the usual evaluation of TIA patients, but it may be the ideal next step in this regard.

Funding Acknowledgement

Type of funding sources: None.

2D speckle tracking: a diagnostic and prognostic tool of paramount importance

OBJECTIVE

We aimed to conduct a review of the literature relevant to cardiac imaging techniques and summarize the use of different non-invasive imaging modalities in the assessment of ventricular size, function, and mechanics. The current review emphasizes the benefits of speckle tracking imaging (STI), highlighting its use in demonstrating myocardial strain. This robust technique is a recent addition to the existing imaging techniques that are used to assess the myocardium. In terms of effectively determining the left ventricle ejection fraction, it is a comparable technique to cardiac magnetic resonance. The use of STI method for image acquisition relies on semiautomatic identification of the border and deformation of the region of interest, and is also independent of the angle of insonation, thus it increases the inter-and intra-observer reproducibility in contrast to the conventional tissue doppler imaging.

MATERIALS AND METHODS

The databases of PubMed, Scopus, and Embase were thoroughly searched for the following keywords: 2- dimensional/ two-dimensional/ 2-D, speckle/strain tracking, systolic dysfunction, and heart failure. The studies selected described image acquisition techniques and the application of this imaging modality in various clinical settings. The selected journal articles were perused to provide the best possible analysis of STI.

RESULTS

Our comparative analysis demonstrated that the STI, when compared with the conventional echocardiography, is a more sensitive image acquiring technique for detecting subclinical myocardial dysfunction. Based on the analysis it can be stated that the STI can provide valuable information on both regional and global myocardial function, and it can also quantify cardiac synchronicity and rotation. Additionally, it serves as a better prognostic indicator.

CONCLUSIONS

The change in longitudinal strain can serve as an early marker of the left ventricular systolic dysfunction, and therefore, monitoring via STI has both diagnostic and prognostic value in heart failure, ischemic heart disease, valvulopathies, chemotherapy-induced cardiotoxicity, and cardiac resynchronization therapy. Despite the lack of standardization, the method is also effective in assessing the right ventricle and left atrial function and arterial rigidity.