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Kandels J, Metze M, Hagendorff A, Stöbe S. Prognostic Relevance of Global Myocardial Work Index in Patients with Moderate Aortic Valve Stenosis. J Clin Med 2023; 12:7694. [PMID: 38137763 PMCID: PMC10743712 DOI: 10.3390/jcm12247694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was to evaluate the prognostic value of the GWI in patients with moderate AS. METHODS AND RESULTS In this prospective study, 103 patients with moderate AS (mean age 72 ± 10 years; male: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without an aortic valve replacement (AVR). After a median follow-up of 30 ± 5 months, 37 patients (36%) were referred for an AVR. Survival without an AVR was 96% at 12 months and 80% at 30 months (>1951 mmHg%) versus 96% and 68% (≤1951 mmHg%). A GWI ≤ 1951 mmHg% did not predict the need for an AVR (hazard ratio 1.31 (95% CI, 0.63-2.72), p = 0.49). Furthermore, there was no significant correlation between the mean GWI (1644 ± 448 mmHg%) and mean aortic valve pressure gradient (24.2 mmHg ± 6.2, p = 0.615) or effective aortic orifice area (1.24 cm2 ± 0.11, p = 0.678). There was no difference between the AVR and non-AVR groups in the occurrence of clinical symptoms. CONCLUSION In contrast to patients with severe AS, a GWI ≤ 1951 mmHg% did not predict the need for an AVR. Further research is needed to improve the risk stratification in patients with moderate AS.
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Affiliation(s)
- Joscha Kandels
- Correspondence: ; Tel.: +49-341-97-12389; Fax: +49-341-97-12659
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Agha HM, Othman MA, El-Saiedi S, El Zahrae Hassan F, Taher H, El-Sisi A, Sobhy R, AbdelMassih A. Early onset left ventricular remodeling in juvenile systemic lupus erythematosus; Insight from 3-dimensional speckle tracking echocardiography. Lupus 2021; 30:2114-2123. [PMID: 34794349 DOI: 10.1177/09612033211051302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early diagnosis and treatment of myocardial affection in patients with systemic lupus erythematosus (SLE) are crucial. OBJECTIVES To evaluate the ventricular systolic function in juvenile-onset systemic lupus erythematosus (j-SLE) patients by 3-D speckle tracking echocardiography (3D-STE) and to determine the predictors of left ventricular (LV) dysfunction if present. METHODS Twenty-six SLE patients without heart failure and 21 healthy controls were studied by standard echocardiogram and 3D-STE. Conventional parameters included LV ejection fraction (EF), fractional shortening (FS), and mitral annular plane systolic excursion (MAPSE). Global LV strain (GLS) and global area strain (GAS) were obtained by 3D-STE. Medical records, including diagnosis criteria, duration of disease, and SLE disease activity index (SLEDAI) were evaluated. RESULTS The mean age was similar in patients and controls 11.42 vs 11.48 years p = 0.93. The mean duration of the disease was 1.87 ± 1.02 years and SLEDAI ranged from 0 to 9. By conventional and tissue Doppler imaging echocardiography, only MAPSE was significantly lower in SLE patients compared to controls (14.56 vs 18.46 mm, p < 0.001). By 3D speckle tracking echocardiography, GLS and GAS were significantly reduced in SLE patients compared to controls (-15.07 vs -19.9.4%, -34.6% vs -39.7%, respectively, p < 0.001). Multiple linear regression and ROC analyses indicated that the SLEDAI score was the only predictive factor for the left ventricular remodeling. CONCLUSIONS These results indicate that early subclinical LV dysfunction occur in jSLE patients even with normal EF and SLE disease activity might be a potential driver for LV deformation.
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Affiliation(s)
- Hala M Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Mahmoud A Othman
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Sonia El-Saiedi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Fatma El Zahrae Hassan
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Heba Taher
- Department of Pediatrics, Pediatric Rheumatology Unit, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Amal El-Sisi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Rodina Sobhy
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
| | - Antoine AbdelMassih
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, 63527Cairo University, Cairo, Egypt
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Samaan AA, Said K, Aroussy WE, Hassan M, Romeih S, El Sawy A, Fawzy ME, Yacoub M. Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study. Front Cardiovasc Med 2021; 8:674435. [PMID: 34150869 PMCID: PMC8212956 DOI: 10.3389/fcvm.2021.674435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied. Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function. Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated. Results: At baseline, patients had median EF of 57 (range: 45–69) %, LVEDVI of 74 (44–111) ml/m2 and LVESVI of 31 (14–57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (−16.4 vs. −13.8, p < 0.001) and global circumferential strain (GCS) (−17.8 vs. −15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (−17.9 vs. −16.4, p = 0.008) and GCS (−19.4 vs. −17.8 p = 0.03). Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.
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Affiliation(s)
- Amir Anwar Samaan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.,Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Karim Said
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.,Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Wafaa El Aroussy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohammed Hassan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Soha Romeih
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Amr El Sawy
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Mohammed Eid Fawzy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Magdi Yacoub
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt.,Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom
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Shveс DA, Povetkin SV. [Quantitative Assessment of Alterations of Reginal Contractility of the Left Ventricle in Patients With Ischemic Heart Disease]. Kardiologiia 2018:13-22. [PMID: 29870320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND An important aspect of ischemic heart disease (IHD) diagnosis is the assessment of alterations of regional contractility (ARC) of the left ventricle. Speckle tracking imaging is a relatively new diagnostic method used for this purpose. Aim of this study was to identify optimal parameters of left ventricular (LV) deformation by speckle-tracking echocardiography which can differentiate quantitatively degrees of ARC of all left ventricular segments in patients with acute and chronic forms of IHD. MATERIALS AND METHODS We compared parameters of LV longitudinal, radial, and circular deformation in 216 patients with IHD in dependence on the presence of ARC. RESULTS The most sensitive and specific indicator of ARC of LV anterior septal wall was found to be the value of longitudinal systolic deformation of the middle and apical segments (diagnostic thresholds -13.5 % and 14.7 %, respectively). Such indicator for LV inferior wall was value of circular systolic strain (diagnostic threshold for the basal segment -12.9 %, for the middle segment -10.7%).
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Affiliation(s)
- D A Shveс
- Orel region "Orel clinical regional hospital"
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Ye Z, Coutinho T, Pellikka PA, Villarraga HR, Borlaug BA, Kullo IJ. Associations of Alterations in Pulsatile Arterial Load With Left Ventricular Longitudinal Strain. Am J Hypertens 2015; 28:1325-31. [PMID: 25840581 DOI: 10.1093/ajh/hpv039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 02/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increased arterial stiffness leads to increased pulsatile load on the heart. We investigated associations of components of pulsatile load with a measure of left ventricular (LV) systolic function-global longitudinal strain (GLS), in a community-based cohort ascertained based on family history of hypertension. METHODS Arterial tonometry and echocardiography with speckle tracking were performed in 520 adults with normal LV ejection fraction (EF) (age 67±9 years, 70% hypertensive) to quantify measures of pulsatile load (characteristic aortic impedance (Zc), total arterial compliance (TAC), and augmentation index (AI)) and GLS. The associations of log-Zc, log-TAC, and AI with GLS were assessed using sex-specific z-scores for each measure of arterial load. RESULTS In univariable analyses, higher Zc was associated with worse GLS (less negative) and higher TAC and AI were associated with better GLS (all P < 0.001). In a multivariable model including age, sex, heart rate (HR), LVEF, mean arterial load (systemic vascular resistance), and measures of pulsatile load, Zc remained associated with GLS (β = 0.28, P < 0.001), while the associations of TAC and AI were no longer significant (P > 0.5). Additional adjustment for cardiovascular risk factors and history of coronary heart disease and stroke did not attenuate the association of Zc with GLS; Zc, sex, HR, LVEF remained associated with GLS after stepwise elimination (all P < 0.001). CONCLUSIONS Greater proximal aortic stiffness, as manifested by a higher Zc, is independently associated with worse LV longitudinal function.
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Affiliation(s)
- Zi Ye
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Thais Coutinho
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector R Villarraga
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
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Venkatesh BA, Donekal S, Yoneyama K, Wu C, Fernandes VRS, Rosen BD, Shehata ML, McClelland R, Bluemke DA, Lima JAC. Regional myocardial functional patterns: Quantitative tagged magnetic resonance imaging in an adult population free of cardiovascular risk factors: The multi-ethnic study of atherosclerosis (MESA). J Magn Reson Imaging 2014; 42:153-9. [PMID: 25223588 DOI: 10.1002/jmri.24749] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/19/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To characterize the left ventricular (LV) regional deformation patterns and identify normal values of left ventricular strains from tagged magnetic resonance imaging (MRI) in a population with low-risk-factor (LRF) exposure. MATERIALS AND METHODS Tagged CMR on three LV short axis slices was performed in participants of the MESA study who were free of cardiovascular disease at baseline. Images were analyzed by the harmonic phase imaging method to obtain: peak torsion, circumferential (Ecc) and radial (Err) strains, and systolic (SRs) and early-diastolic (SRe) strain rates. An LRF group was created from the overall population based on strict exclusion criteria (n = 129) based on risk factors and events observed over a 10-year follow-up. RESULTS The normative prediction intervals for the averaged peak Ecc (%) and torsion (deg/cm) measures were: in 45-59-year-old women: (-20.8, -13.2) and (2.1, 6.3); 60-84-year-old women: (-20.6, -12.8) and (2.2, 6.9); 45-59-year-old men: (-21.3, -13.5) and (1.9, 5.7); 60-84-year-old men: (-20.5, -12.5) and (1.5, 5.2). In general, African-Americans (Ecc = -15.9, torsion = 3.3) had lower strains as compared to Chinese (Ecc = -17.1, torsion = 3.9), while Caucasians and Hispanics were intermediate and not significantly different. Circumferential shortening increased spatially from the epicardium to the endocardium (-16.9 to -18.2 at the mid-ventricle) and from the base to the apex (-15.1 to -17.5 at the midwall). CONCLUSION The present study provides reference ranges and deformation patterns of deformation values from a large healthy population free of cardiovascular disease at baseline.
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Affiliation(s)
| | | | | | - Colin Wu
- National Institutes of Health, Bethesda, Maryland, USA
| | | | - Boaz D Rosen
- Johns Hopkins University, Baltimore, Maryland, USA
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