Left ventricular myocardial strain gradient using a novel multi-layer transthoracic echocardiography technique positively correlates with severity of aortic stenosis

2016 ◽  
Vol 221 ◽  
pp. 218-226 ◽  
Author(s):  
Koya Ozawa ◽  
Nobusada Funabashi ◽  
Yoshio Kobayashi
Keyword(s):  
Aortic Stenosis ◽  
Strain Gradient ◽  
Transthoracic Echocardiography ◽  
Myocardial Strain ◽  
Left Ventricular

scholarly journals Deficient Myocardial Organization and Pathological Fibrosis in Fetal Aortic Stenosis—Association of Prenatal Ultrasound with Postmortem Histology

2021 ◽  
Vol 8 (10) ◽  
pp. 121
Author(s):  
Fleur Zwanenburg ◽  
Marco C. DeRuiter ◽  
Lambertus J. Wisse ◽  
Conny J. van Munsteren ◽  
Margot M. Bartelings ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Structural Damage ◽  
Fetal Echocardiography ◽  
Pregnancy Termination ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Fetal Ultrasound ◽  
Chamber View ◽  
Potential Biomarker

In fetal aortic stenosis (AS), it remains challenging to predict left ventricular development over the course of pregnancy. Myocardial organization, differentiation and fibrosis could be potential biomarkers relevant for biventricular outcome. We present four cases of fetal AS with varying degrees of severity and associate myocardial deformation on fetal ultrasound with postmortem histopathological characteristics. During routine fetal echocardiography, speckle tracking recordings of the cardiac four-chamber view were performed to assess myocardial strain as parameter for myocardial deformation. After pregnancy termination, postmortem cardiac specimens were examined using immunohistochemical labeling (IHC) of key markers for myocardial organization, differentiation and fibrosis and compared to normal fetal hearts. Two cases with critical AS presented extremely decreased left ventricular (LV) strain on fetal ultrasound. IHC showed overt endocardial fibro-elastosis, which correlated with pathological fibrosis patterns in the myocardium and extremely disturbed cardiomyocyte organization. The LV in severe AS showed mildly reduced myocardial strain and less severe disorganization of the cardiomyocytes. In conclusion, the degree of reduction in myocardial deformation corresponded with high extent to the amount of pathological fibrosis patterns and cardiomyocyte disorganization. Myocardial deformation on fetal ultrasound seems to hold promise as a potential biomarker for left ventricular structural damage in AS.

scholarly journals Non-invasive estimation of myocardial work in aortic stenosis from modelling approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.P Owashi ◽  
A Hubert ◽  
E Galli ◽  
E Donal ◽  
A.I Hernandez ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Patient Specific ◽  
Pressure Curve ◽  
Aortic Valve Area ◽  
Myocardial Performance ◽  
Non Invasive ◽  
Model Based ◽  
Global Correlation

Abstract Background The noninvasive assessment of myocardial work by pressure-strain loops (PSL) analysis is a recently introduced tool to estimate myocardial performance. PSL analysis cannot be applied to patients having an obstacle to LV ejection, as in the case of aortic stenosis (AS), because of the difficulty to estimate left ventricular (LV) pressure. The purpose of this work is to propose a non-invasive model-based estimation of the left ventricular pressure curve in AS patients in order to evaluate myocardial work indices. Methods Twelve patients with moderate-to-severe AS underwent cardiac catheterization to acquire the LV pressure (Pexp-LV). All patients underwent a standard trans-thoracic echocardiography to extract regional myocardial strain curves and estimate the aortic valve area (AVA). Systolic and diastolic arterial pressures were also measured. The proposed cardiovascular system (CVS) model is composed of four main coupled sub-models simulating: i) cardiac electrical activities, ii) cardiac cavity, iii) the systemic and pulmonary circulation, and iv) cardiac valves (Figure 1, upper panel). A 2-step parameter identification strategy, based evolutionary algorithms, was implemented to learn LV parameters from Pexp-LV and to estimate patient-specific model-based LV pressure curves (Pmodel-LV) starting from parameters obtained from non-invasive hemodynamics. Global myocardial constructive work (GCW) and myocardial wasted work (GWW) were calculated using Pexp-LV and Pmodel-LV. Results A close match was observed between Pexp-LV and Pmodel-LV, with a mean total relative error of 12.27% (range 5.9% to 17.40%). When considering GCW and GWW, global correlation was equal to 0.92 (p<0.0001). In BA analysis, mean bias was −2.9 mmHg.%, which corresponds to relative bias equal to 0.11% with respect to the mean value of work indices (Figure 1, lower panel). Conclusions A model-based approach can be used to estimate LV pressure and myocardial work indices in patients with AS, and be provide a promising tool for the assessment of myocardial performance in patients with AS Funding Acknowledgement Type of funding source: None

scholarly journals Poster Session 2The imaging examination and quality assessmentP520Benefit of early basic transthoracic echocardiography (TTE) in emergency patients performed by physicians with low to intermediate TTE experienceP521Appropriateness criteria in echocardiography. A contemporary necessity in clinical practiceP522Interobserver variability in 2d transthoracic echocardiography impact of scanning and reading on total variability results from the STAAB cohort study quality controlP5233D printing for personalised planning of catheter-based left atrial appendage occlusionP524Central obesity: an independent role or synergistic effect to metabolic syndrome on right atrial structure?P525Dynamics of left ventricular volumes and mortality in patients with early and late effect of cardiac resynchronization therapyP526Variability of thoracic aortic diameters according to gender, age and body surface area. Time to forget absolute cut-off values?P527The association of left ventricular outflow tract velocity time integral to all-cause mortality in elderly patients with heart failureP528Left ventricular myocardial performance and atrioventricular coupling in patients with primary arterial hypertensionP529Interest of a combinatory approach based on traditional left ventricular dyssynchrony parameters and cardiac work estimated by pressure-strain loop curves for the prediction of cardiac resynchronizatP530The evaluation of cardiac performance by pressure-strain loops: a useful tool for the identification of cardiac resynchronization therapy respondersP531Left ventricle cardiac function by 2D-speckle tracking echocardiography in diabetes mellitus population: sub-clinical systolic disfunction studyP532Biphasic tissue doppler mitral annular isovolumic contraction velocities are associated with left ventricular function, isovolumic relaxation, and pulmonary wedge pressure in heart failure patientsP533Abnormal left atrial volumes and strains are associated with increased arterial stiffnes in patients with cryptogenic stroke: a novel pathophysiological pathP534Detection of coronary microvascular disease using two-dimensional speckle-tracking echocardiographyP535Predictive value of a bi-dimensional transthoracic echocardiographic sign of " binary image" to identify the anomalous origin of the left circumflex coronary artery from the right coronary sinusP536Systematic review and meta-analysis of screening for coronary artery disease in asymptomatic diabetic patientsP537Noninvasive screening test for diagnosis of nonobstructive coronary artery disease using echocardiographic criteriaP538Early echocardiography after primary angioplasty, important role in predicting left ventricular remodelingP539Prognostic impact of low-flow severe aortic stenosis in Japanese patients undergoing transcatheter aortic valve implantation: the ocean-tavi registryP540Left ventricular outflow tract geometry and its impact on aortic valve area calculations in aortic stenosis using 3D transoesophageal echocardiography and 2D transthoracic echocardiographyP541Impaired left atrial myocardial deformation predicts postoperative atrial fibrillation after aortic valve replacement in patients with aortic stenosisP542Ejection fraction-velocity ratio in predicting symptoms in severe aortic stenosisP543Incremental value of transesophageal echocardiography in conjunction with transthoracic echocardiography in the assessment of aortic stenosis severity

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii88-ii94 ◽  
Author(s):  
M. Brand ◽  
A. Stefanidis ◽  
C. Morbach ◽  
YT. Fan ◽  
D R A Elremisy ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transthoracic Echocardiography ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Artery Disease

scholarly journals P307 Trajectories of Myocardial Strain Across the Spectrum of Aortic Stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Alfuhied ◽  
M Alfarih ◽  
P Kumar M ◽  
G Captur ◽  
P Nihoyannopoulos
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
P Value ◽  
Global Circumferential Strain ◽  
Significant Difference

Abstract Introduction Optimal timing of intervention in aortic stenosis (AS) is key. Left ventricular deformation parameters are sensitive markers of myocardial wellbeing in AS, but data is sparse so strain does not currently feature in the clinical decision-making process governing timing of AS intervention. We explore the trajectory of myocardial strain in AS of varying severity to potentially identify the most sensitive periods for valve intervention. Methods 50 patients from across the spectrum of isolated AS were prospectively recruited: mild AS n = 10; moderate AS n = 10; and severe AS n = 30 of which n = 10 in each of 3 ejection fraction (EF) groups: EF > 50%, EF = 40-49% and EF < 35%. Longitudinal, circumferential, and radial strain were measured by speckle tracking echocardiography (STE) using TomTec software. Results Strain parameters and EF were not significantly different between mild and moderate AS groups but almost all parameters (except for global circumferential strain (GCS)) showed significant deterioration with progression to severe AS, even in spite of preserved EF (>50%; Table1). In patients with severe AS, strain parameters showed no significant differences between hearts with EF > 50% and EF 40-49%, but they continued to deteriorate significantly (p < 0.05) as hearts transitioned from 40-49% to <35% (Figure 1, a&b). Conclusion The heart can maintain its deformation and global systolic function throughout mild and moderate AS but strain deteriorates significantly in severe AS, irrespective of EF. Tracking the precise timings of strain deterioration in severe AS could help refine optimal timings of AS intervention. LVEF and strain in varying AS severity Left ventricle ejection fraction and strain values in varying severity of AS Mild (n = 10) Moderate (n = 10) Severe (n = 10) P-value Mean (SD) Mean (SD) Mean (SD) EF (%) 65.4 (6.1) 65.8 (9.0) 60.4 (3.6)*§ 0.15 GLS (%) -14.2 (2.1) -13.6 (2.3) -11.8 (2.9)* 0.09 GCS (%) -30.3 (9.1) -31.0 (11.4) -26.5 (8.2) 0.55 GRS (%) 55.9 (15.5) 52.6 (24.0) 35.9 (13.5)*§ 0.05 EF: ejection fraction; GLS: global longitudinal strain; GCS: global circumferential strain; GRS: global radial strain; SD: standard deviation. Severe (n = 10): Severe AS with preserved EF >50%. P-value: ANOVA-single factor; comparison in-between groups was performed using unpaired t-test (parametric) and Mann Whitney test (non-parametric). *significant difference P < 0.05 mild vs severe. §significant difference P < 0.05 moderate vs severe. Abstract P307 Figure.

Abstract 4700: Changes in Left Ventricular Myocardial Strain after Aortic Valve Replacement: Comprehensive 2-Dimensional Speckle Tracking Strain Imaging Assessment

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Victoria Delgado ◽  
Laurens F Tops ◽  
Rutger J van Bommel ◽  
Frank van der Kley ◽  
Robert J Klautz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Strain Rate ◽  
Speckle Tracking ◽  
Severe Aortic Stenosis ◽  
Myocardial Strain ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Lv Dysfunction

Background: In patients with severe aortic stenosis and preserved left ventricular (LV) ejection fraction (EF), the presence of subtle left ventricular (LV) dysfunction may be misdiagnosed by the standard methods. Two-dimensional speckle tracking strain imaging enables multidirectional assessment of LV myocardial strain. Objectives: To evaluate the presence of subtle LV dysfunction in patients with severe aortic stenosis by using 2-dimensional speckle tracking imaging and the recovery of myocardial function after aortic valve replacement (AVR). Methods: Changes in radial, circumferential and longitudinal strain/strain rate of the LV were evaluated by using 2-dimensional speckle tracking imaging in 100 severe aortic stenosis patients after AVR. Radial and circumferential strain/strain rate were assessed at mid ventricular short axis level of the LV. Longitudinal strain/strain rate were evaluated at the conventional 2-, 4-chambers and long-axis apical views of the LV. These LV functional parameters were compared to conventional LVEF. Results: After AVR (median follow-up 5.3 months), the aortic valve area significantly increased (from 0.8 ± 0.2 cm 2 to 1.6 ± 0.5 cm 2 , p<0.001) together with a significant decrease in the maximal transaortic pressure gradient (from 72 ± 21 mmHg to 22 ± 9 mmHg, p<0.001). In addition, a significant regression of LV mass index was observed (from 154 ± 48 g/m 2 to 132 ± 44 g/m 2 , p<0.001). The LVEF remained unchanged at follow-up whereas a significant improvement of LV longitudinal and circumferential shortening was observed (Table ). Conclusions: In severe aortic stenosis patients, impaired LV longitudinal and circumferential shortening exist although preserved LVEF. After AVR, myocardial strain improves significantly in these two directions. Two-dimensional speckle tracking strain imaging enables an early detection of these subtle changes in LV performance. Changes in LV mechanics after AVR

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