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El Mahdiui M, Van Der Bijl P, Abou R, De Lustosa R, Van Der Geest R, Ajmone Marsan N, Delgado V, Bax J. Non-invasive myocardial work: an echocardiographic measure of post-infarct scar on contrast-enhanced cardiac magnetic resonance imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Late gadolinium contrast enhanced cardiac magnetic resonance (LGE CMR) imaging accurately quantifies the extent of fibrosis and transmurality in chronically infarcted left ventricular (LV) segments, and identifies viability. Moreover, CMR characterizes the remote, non-infarcted zone, which is an emerging region of interest following ST-segment elevation myocardial infarction (STEMI). Non-invasive myocardial work is a novel LV function parameter - calculated from speckle-tracking strain echocardiography and sphygmomanometrically-determined blood pressure, which has shown excellent correlation with invasively measured myocardial work.
Purpose
To explore the relation of non-invasively estimated parameters of LV myocardial work to post-infarct scar on LGE CMR, and to compare myocardial work indices between the infarct core and remote zone in STEMI patients who were treated with primary percutaneous coronary intervention (PCI).
Methods
Patients with a STEMI who underwent primary PCI and LGE CMR, in addition to echocardiographic studies where non-invasive myocardial work analysis was feasible, were included. The LV was subdivided into non-infarcted, non-transmural and transmurally infarcted segments. The remote zone was defined as the non-infarcted myocardial segment diametrically opposed to the infarct core, without any evidence of LGE. Myocardial work indices were compared with linear mixed models, ANOVA and Wilcoxon signed rank tests.
Results
53 patients (89% male, age 58±9 years) and 689 segments were analysed. The mean scar burden comprised 14±7% of the total LV mass and 76 (11%) segments showed transmural LGE. The following non-invasive myocardial work indices: myocardial work index (MWI), constructive work (CW) and myocardial work efficiency (MWE) showed a significant inverse relationship with infarct transmurality (p<0.05 for all comparisons) while a positive trend was observed for wasted work (WW) (p=0.086) (Figure 1). The core zone demonstrated lesser MWI (1237±568 vs. 1514±518 mmHg%; p=0.010), CW (1331±627 vs. 1827±537 mmHg%; p<0.001) and MWE (92 (84–98) vs. 98 (95–99) %; p<0.001) as well as greater WW when compared to the remote zone (107 (26–196) vs. 26 (10–90) mmHg%; p=0.001).
Conclusions
In STEMI patients who underwent primary PCI, MWI, CW and MWE were significantly related to the extent of transmural infarction, while WW demonstrated a trend. MWI, CW and MWE were significantly lower, and WW higher, in the core zone compared to the remote zone. Non-invasive myocardial work indices may provide an echocardiographic method for determining post-infarct viability, as well as characterization of the remote zone.
MW and scar transmurality on LGE CMR
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M El Mahdiui
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - P Van Der Bijl
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - R.P De Lustosa
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - R Van Der Geest
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - J.J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
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Van Der Bijl P, Abou R, Goedemans L, Gersh B, Holmes D, Pellikka P, Ajmone Marsan N, Delgado V, Bax J. Progressive left ventricular post-infarction remodelling: impact on outcome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While the presence left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) is known to worsen prognosis, the impact of progressive vs. stable LV remodelling on outcome has not been established.
Purpose
To investigate the impact of progressive LV remodelling on outcome in STEMI patients who were treated with primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy.
Methods
Baseline, 3-, 6- and 12-month echocardiograms were analysed. Early LV remodelling (ER) was defined as a ≥20% increase in LV end-diastolic volume (EDV) during the first 3 months post-STEMI, and mid-term remodelling (MTR) as ≥20% LVEDV change by 6 months. Progressive LV remodelling was defined according to spline curve analyses: ≥0% LVEDV increase by 6 months (i.e. further increase after 3 months) for ER, and ≥20% by 12 months (i.e. an additional increase after 6 months) for MTR. The impact of progressive LV remodelling on outcome was evaluated with a Log rank test.
Results
589 STEMI patients (mean age 61±12 years, 78% male) who demonstrated LV remodelling in the first 6 months post-infarct, were analysed: 408 (69%) ER and 181 (31%) MTR. Progressive LV remodelling occurred in 146 (36%) ER and in 12 (7%) MTR. After a median follow-up of 90 (IQR 64–117) months, 39 (10%) ER were hospitalised for heart failure. 25 (14%) MTR remodellers died after a median follow-up of 86 (IQR 66–112) months. Progressive LV remodelling in ER led to a higher rate of heart failure hospitalisation (P=0.017 vs. non-progressive ER, Fig. 1A) but no mortality difference (P=0.10 vs. non-progressive ER). In contrast, MTR with progressive LV remodelling experienced worse survival (P=0.01 vs. non-progressive MTR, Fig. 1B) but no increase in heart failure hospitalisation (P=0.65 vs. non-progressive MTR).
Conclusions
Progressive LV remodelling causes an increased risk of heart failure in ER post-infarct, vs. higher mortality in MTR. These two patterns of progressive, post-infarct LV remodelling possibly represent different underlying pathophysiological mechanisms: i.e. evolution of true post-infarct remodelling in ER, vs. natural history of established heart failure in MTR.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - B.J Gersh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - D.R Holmes
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - P.A Pellikka
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - J.J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
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Gegenava T, Vollema M, Abou R, Goedemans L, Rosendael A, Kley F, Weger A, Ajmone N, Bax J, Delgado V. P4501Prognostic value of thoracic aorta calcification burden in patients after transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - M Vollema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Rosendael
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - F Kley
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Weger
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - N Ajmone
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Dolci G, Goedemans L, Abou R, Vollema EM, Rossi A, Bax JJ, Delgado V, Ajmone Marsan N. P1761Prognostic impact of left ventricular diastolic dysfunction in severe aortic stenosis patients undergoing surgical valve replacement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Dolci
- University of Verona, Department of Medicine, Section of Cardiology, Verona, Italy
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - E M Vollema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Rossi
- University of Verona, Department of Medicine, Section of Cardiology, Verona, Italy
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Goedemans L, Hoogslag GE, Abou R, Schalij MJ, Ajmone Marsan N, Bax JJ, Delgado V. P4674Acute myocardial infarction in patients with chronic obstructive pulmonary disease: prognostic implications of right ventricular systolic dysfunction determined with speckle tracking echocardiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - G E Hoogslag
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - M J Schalij
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Goedemans L, Abou R, Montero-Cabezas JM, Ajmone Marsan N, Delgado V, Bax JJ. P1890Is chronic obstructive pulmonary disease associated with increased risk of atrial arrhythmias after ST-segment elevation myocardial infarction? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | | | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Gegenava T, Vollema EM, Rosendael A, Abou R, Goedemans L, Kley F, Weger A, Ajmone N, Bax J, Delgado V. P4496Changes in valvulo-arterial impedance after transcatheter aortic valve implantation according to calcification burden of thoracic aorta. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - E M Vollema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Rosendael
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - F Kley
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Weger
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - N Ajmone
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Van Der Bijl P, Abou R, Goedemans L, Gersh BJ, Holmes DR, Ajmone Marsan N, Delgado V, Bax JJ. P3633Different temporal patterns of left ventricular post-infarction remodelling: characteristics and clinical outcome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Van Der Bijl
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - B J Gersh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - D R Holmes
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Van Der Bijl P, Abou R, Goedemans L, Gersh BJ, Holmes DR, Ajmone Marsan N, Delgado V, Bax JJ. P3664Left ventricular post-infarct remodelling: temporal patterns and left ventricular functional evolution. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Van Der Bijl
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - B J Gersh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - D R Holmes
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Prihadi EA, Van Der Bijl P, Dietz M, Abou R, Vollema EM, Marsan NA, Delgado V, Bax JJ. 5322Prognostic value of right ventricular systolic dysfunction by speckle tracking echocardiography beyond conventional echocardiography in significant functional tricuspid regurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E A Prihadi
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - P Van Der Bijl
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - M Dietz
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - E M Vollema
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - N A Marsan
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
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Hensen L, Goossens K, Delgado V, Abou R, Rotmans J, Jukema J, Bax J. P6121Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left ventricular ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Prihadi E, Van Der Bijl P, Gursoy E, Abou R, Vollema E, Hahn R, Stone G, Leon M, Ajmone Marsan N, Delgado V, Bax J. 1285Progression of tricuspid regurgitation over time and outcome: new insights in the natural history. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Montero Cabezas J, Abou R, Schalij M, Ajmone Marsan N, Bax J, Delgado V. P5572Coronary atrial branch occlusion during primary percutaneous coronary intervention in with ST-segment elevation myocardial infarction is not associated with atrial arrhythmias at one-year follow up. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Wijngaarden S, Abou R, Ajmone Marsan N, Bax J, Delgado V. P3552Myxomatous mitral valve disease and phenotyping by left ventricular function per level using 2D speckle strain analyses. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prihadi E, Van Der Bijl P, Gursoy E, Abou R, Vollema E, Hahn R, Stone G, Leon M, Ajmone Marsan N, Delgado V, Bax J. 2000Determinants of progression from none and mild to moderate and severe native tricuspid regurgitation: results from a large-scale echocardiographic study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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