The Relationship Between EF and Strain Permits a More Accurate Assessment of LV Systolic Function

Introduction: Left ventricular noncompaction (LVNC) is a rare form of cardiomyopathy in children, characterized by abnormal endocardial myofiber arrangement. This may result in an altered pattern of LV rotation depicted by a “roller pump” like motion and described as rigid body rotation (RBR). This pattern, is characterized by the apex and the base rotating in the same direction. Hypothesis: To describe the LV rotational patterns in children with LVNC using speckle tracking echocardiography and detect the relationship between the different rotational patterns and measures of LV systolic function. Methods: We prospectively studied 19 children (age 0.9 to 17.8 years) with LVNC and compared them with age-matched controls. Apical and basal rotations, peak twist and peak torsion were analyzed as indices of systolic function. Peak apical recoil rate was measured as an index of diastolic function. Results: Children with LVNC had significantly lower apical rotation (6.26°± 3.09°, 8.59°± 2.19° p=0.01) than controls. In 7 out of 19 (36.8%) patients a pattern of RBR was detected. Twelve patients exhibited the typical “wringing” motion of the LV, where the apex rotated counterclockwise and the base clockwise. Patients with LVNC and RBR had significantly lower ejection fraction than patients with LVNC without RBR (49.1 ± 9.2% vs 60.3 ± 10.2%, p<0.05). There were no significant differences in the remainder of the systolic and diastolic indices between LVNC patients and controls. Conclusions: Children with LVNC can exhibit an abnormal LV rotational pattern characterized by RBR that is associated with impaired systolic function.

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Coexistence of Cardiomyopathy and Chronic Liver Disease in Non-Moderate Drinkers

Journal of Nepal Medical Association ◽

10.31729/jnma.552 ◽

2013 ◽

Vol 52 (189) ◽

pp. 217-223 ◽

Cited By ~ 2

Author(s):

Mani Prasad Gautam ◽

Usha Ghimire ◽

Gangapatnam Subramanyam ◽

Sogunuru Guruprasad

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Heart Muscle ◽

Systolic Function ◽

Chronic Liver ◽

Muscle Disease ◽

Moderate Drinking ◽

Echo Features ◽

Lv Systolic Function ◽

The Relationship

Introduction: The dose-response relationship suggests a toxic effect of alcohol on heart and liver and the possibility of a correlation between alcohol-induced liver and heart disease. The present study was aimed to look into the relationship between chronic liver and heart muscle disease among the non-moderate drinkers in our context.Methods: An observational study on non-moderate chronic drinkers was carried out. Clinical evaluation along with detail sonographic study of heart and liver was conducted.Results: Fifty-eight percent had echocardiographic features consistent with heart muscle disease, either as a dilated cardiomyopathy, categorized by the presence of echo features of impaired LV systolic function and dilated left ventricle or as a possible cardiomyopathy categorized by the presence of any of these two echo features. Similarly, 56 of the total recruits showed ultrasonographic evidence of chronic liver disease as cirrhosis or early cirrhosis. Approximately, 86% of these 56 non-moderate drinkers with chronic liver disease also had echocardiographic features of heart muscle disease and 83% of the 58 non-moderate drinkers showing echo features of heart muscle disease had ultrasonographic features of chronic liver disease.Conclusions:Our study showed a strongly positive relationship on the coexistence of chronic liver disease and cardiomyopathy among the non-moderate drinkers. Non-moderate drinkers with chronic liver disease have a high likelihood of having a concurrent clinical or sub-clinical heart muscle disease and vice versa.Keywords: alcohol; chronic liver disease; heart muscle disease; non-moderate drinking.

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The Relationship between QRS duration and LV systolic function in Paced Patients

Korean Circulation Journal ◽

10.4070/kcj.2001.31.3.327 ◽

2001 ◽

Vol 31 (3) ◽

pp. 327 ◽

Cited By ~ 1

Author(s):

M Y Lee ◽

T H Rho ◽

K D You ◽

G W Moon ◽

E J Cho ◽

...

Keyword(s):

Systolic Function ◽

Qrs Duration ◽

Lv Systolic Function ◽

The Relationship

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Acute coronary syndromes in chronic kidney disease patients: the good, the bad or the ugly?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1514 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Saleiro ◽

D De Campos ◽

J Lopes ◽

R Teixeira ◽

J.P Sousa ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Function ◽

Lv Function ◽

Angiotensin Ii Antagonist ◽

All Cause Mortality ◽

Group A ◽

Lv Ejection Fraction ◽

Group B ◽

Lv Systolic Function

Abstract Background Patients with chronic kidney disease (CKD) are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, current aggressiveness of therapeutic strategies may minimize the course of the disease. Aim To assess the prognostic impact of optimized medical treatment in a CKD population with acute coronary syndrome (ACS). Methods 355 ACS patients admitted to a single coronary care with CKD who were discharged from hospital were included. Those with end-stage renal disease were excluded. Three groups were created based on the KDIGO classification: Group A (Stage 3A, eGFR [estimated glomerular filtration rate] 45–59mL/min/1.73 m2) N=190; Group B (Stage 3B, eGFR 30–44mL/min/1.73 m2) N=113; and Group C (Stage 3B, eGFR 15–29mL/min/1.73 m2) N=52. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The median of follow-up was 32 (IQ 15–70) months. Results Groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, left ventricular (LV) systolic function, peak troponin, multivessel disease, treatment option (PCI, CABG or OMT) and medical therapy at discharge. More advance renal failure patients had a higher prevalence of diabetes mellitus (DM), a lower haemoglobin, a higher NT-proBNP and were less likely to receive ACE inhibitors/angiotensin II antagonist at discharge. 170 patients met the primary outcome. Kaplan-Meyer curves showed decreased survival with worse renal function (Group A 68% vs Group B 57% vs Group C 37%, Log Rank P=0.006 – Figure 1). After adjustment for age, DM, haemoglobin, NT-proBNP, LV systolic function and ACE inhibitors/angiotensin II antagonist at discharge, eGFR was not associated with increased death (HR 1.00, 95% CI 0.98–1.01). In this model, only age (HR 1.04, 95% CI 1.01–1.07), haemoglobin (HR 0.86, 95% CI 0.979–0.94), Nt-proBNP (HR 1.00, 95% CI 1.00–1.00) and impaired LV function (LV ejection fraction 40–49%: HR 2.95, 95% CI 1.89–4.81; LV ejection fraction <40%: HR 2.15, 95% CI 1.44–3.21) remained associated with the outcome. Conclusion The worse outcome attributed to CKD after an ACS seems to be related not the eGFR itself but to associated comorbidities such as age, anaemia, fluid overload and impaired LV function. The fact that some of these comorbidities may be altered by intensive therapy indicates that CKD patients should also be candidates to optimized medical treatment. Funding Acknowledgement Type of funding source: None

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Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02174-7 ◽

2021 ◽

Author(s):

Philippe C. Wouters ◽

Geert E. Leenders ◽

Maarten J. Cramer ◽

Mathias Meine ◽

Frits W. Prinzen ◽

...

Keyword(s):

Systolic Function ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Lv Function ◽

Peak Strain ◽

Cardiac Resynchronisation ◽

Reverse Remodelling ◽

Resynchronisation Therapy ◽

Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm9041043 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1043 ◽

Cited By ~ 2

Author(s):

Pei-Hsun Sung ◽

Yi-Chen Li ◽

Mel S. Lee ◽

Hao-Yi Hsiao ◽

Ming-Chun Ma ◽

...

Keyword(s):

Systolic Function ◽

Coronary Intervention ◽

Left Ventricular ◽

Diffuse Coronary Artery Disease ◽

Cd34 Cells ◽

Group 2 ◽

Artery Disease ◽

One Year ◽

Lv Systolic Function ◽

Group 1

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

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Does fusion contribute to the improvement of LV systolic function of heart failure patients when pacing the LV with varying AV delays?

Journal of Cardiac Failure ◽

10.1016/s1071-9164(99)91488-4 ◽

1999 ◽

Vol 5 (3) ◽

pp. 39

Author(s):

Angelo Auricchio ◽

Jiang Ding ◽

Yinghong Yu ◽

Andrew Kramer ◽

Rod Salo ◽

...

Keyword(s):

Heart Failure ◽

Systolic Function ◽

Heart Failure Patients ◽

Lv Systolic Function

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Abstract 90: Bendavia (MTP-131), a Novel Mitochondria-Targeting Peptide, Improves ADP-Stimulated Mitochondrial Respiration in Cardiomyocytes Isolated From Dogs with Chronic Heart failure

Circulation Research ◽

10.1161/res.115.suppl_1.90 ◽

2014 ◽

Vol 115 (suppl_1) ◽

Author(s):

Hani Sabbah ◽

Ramesh C Gupta ◽

Sharad Rastogi ◽

Paula Mohyi ◽

Kristina Szekely

Keyword(s):

Heart Failure ◽

Mitochondrial Respiration ◽

Systolic Function ◽

Atp Synthesis ◽

Vehicle Control ◽

Electrode System ◽

Lv Function ◽

Targeting Peptide ◽

Lv Systolic Function ◽

Mitochondria Targeting

Background: Mitochondria (MITO) of failed human hearts and hearts of dogs with experimental heart failure (HF) manifest structural and functional abnormalities characterized by hyperplasia and reduced organelle size and reduced respiration. These abnormalities lead to reduced ATP synthesis that adversely impacts LV function. We previously showed that chronic therapy (3 months) with Bendavia (MTP-131), a novel mitochondria-targeting peptide, improves LV systolic function in dogs with heart failure (HF), reverses MITO abnormalities and normalizes mitochondria ATP synthesis in myocardium from Bendavia-treated HF dogs. In the present study we examined the direct effects of Bendavia on mitochondria ADP-stimulated state 3 respiration in freshly isolated cardiomyocytes from dogs with advanced chronic HF. Methods: Cardiomyocytes were isolated from LV free wall of 3 untreated dogs with HF produced by intracoronary microembolizations (LV ejection fraction <30%). A standard collagenase-based enzymatic process was used for isolation that yielded ~70% viable rod-shaped cardiomyocytes that excluded trypan blue. Equal aliquotes of cardiomyocytes were incubated in 0, 0.01, 0.10, 1.0 and 10 μM concentration of Bendavia for one hour at 37°C. At the end of incubation, ADP-stimulated state-3 respiration was measured using a Clark electrode system and quatified in nAtom Oxygen/min/mg protein. Results: State-3 respiration in the absence of Bendavia (Vehicle-Control) was 248±9 nAtom Oxygen/min/mg protein. Compared to vehicle-control, incubation of failing cardiomyocytes with Bendavia significantly increased state-3 respiration to 303±33 at 0.01 μM, p<0.05; 405±39 at 0.10 μM, p<0.05; 371±28 at 1.0 μM, p<0.05; and 346±29 at 10.0 μM, p<0.05. Conclusions: Results of this study indicate that the effects of Bendavia on mitochondrial respiration in cardiomyocytes is direct and not a consequence of improved global LV structure or function. Furthermore, the results indicate that the improvement in mitochondrial respiration after treatment with Bendavia can occur early after initiation of therapy (within one hour) and is dose-dependent up to concentrations of 0.10 μM.

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Abstract 14432: Myocardial Work in Stage I and II Hypertensive Patients

Circulation ◽

10.1161/circ.142.suppl_3.14432 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Akshar Jaglan ◽

Sarah Roemer ◽

Ana C Perez Moreno ◽

Bijoy K Khandheria

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Deformation Analysis ◽

Hypertensive Patients ◽

Reduced Ejection Fraction ◽

Work Index ◽

Significant Difference ◽

Global Work ◽

Lv Systolic Function

Introduction: Myocardial work is a novel parameter that can be used in a clinic setting to assess left ventricular (LV) pressures and deformation. This study sought to distinguish patterns of global myocardial work index in hypertensive vs. non-hypertensive patients. Methods: Fifty (25 male, mean age 60±14 years) hypertensive patients and 15 (7 male, mean age 38±12 years) control patients underwent transthoracic echocardiography at rest. Hypertensive patients were divided into stage 1 (26 patients) and stage 2 (24 patients) based on the 2017 American College of Cardiology guidelines. We excluded patients with suboptimal image quality for myocardial deformation analysis, reduced ejection fraction (EF), valvular heart disease, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were estimated from LV pressure strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using a noninvasive brachial artery cuff. Results: Global longitudinal strain (GLS) and EF were preserved between the two groups with no statistically significant difference whereas there was a statistically significant difference in the GWI (p<0.01), GCW (p=0.03), GWW (p<0.01), and GWE (p=0.03) (Figure and Table). Conclusions: Myocardial work gives us a closer look at the relationship between LV pressure and contractility in settings of increased load dependency whereas LVEF and GLS cannot. We show how myocardial work is an advanced assessment of LV systolic function in hypertensive patients.

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Impact of the Severity of Mitral Stenosis on the LV Systolic function as assessed by 2D Strain using Speckle tracking

QJM ◽

10.1093/qjmed/hcab090.025 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Adel ◽

Tarek K Mosa ◽

Ahmed Yehia ◽

Ahmed Shawqi

Keyword(s):

Heart Disease ◽

Ejection Fraction ◽

Healthy Volunteers ◽

Rheumatic Heart Disease ◽

Mitral Stenosis ◽

Speckle Tracking ◽

Systolic Function ◽

University Hospitals ◽

Lv Systolic Function ◽

Rheumatic Heart

Abstract Background Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries and mitral stenosis is the most common valve affection of rheumatic heart disease worldwide.The left ventricular ejection fraction is the most widely used index of contractile function, but due to the visual component, assessment of endocardial excursion is subjective leading to inter-observer variability.Speckle-tracking echocardiography is an imaging technique developed as a method to objectively quantify myocardial function and analyzes cardiac motion and deformation by tracking naturally occurring speckle patterns in the myocardium. Objective To evaluate the effect of the severity of mitral stenosis on LV systolic function as assessed by speckle tracking. Patients and Methods This study was a case-control study involving 80 individuals which included 60 patients having mitral stenosis who presented to the outpatient clinics of Ain Shams University Hospitals and 20 healthy volunteers, The patients suffering from mitral stenosis were subdivided into 3 sub-groups: GROUP(1) 20 Patients having severe mitral stenosis (MV Area less than 1 cm²) GROUP (2) 20 Patients having moderate mitral stenosis (MV Area more than 1 cm² and less than 1.5 cm²) GROUP(3) 20 Patients having mild mitral stenosis (MV Area more than 1.5 cm²) A Control group involved 20 healthy volunteers recruited from health care workers in Ain Shams University hospitals. Results Study included 60 patients,16 males (26.7%) and 44 females (73.3%), with mean age of 41.30 ± 8.64 years. Patients living in rural Areas were 34 (57.7%) while those in urban areas were 26 (43.3%).Which was significant.There was no significant difference between gender or habitat and the severity of mitral Stenosis.There was a strong significance between the duration of the disease and its severity. The more the duration of mitral Stenosis, the more severe the mitral stenosis.A strong positive relation was noticed between the severity of mitral stenosis and both RVSP and LA diameter, while a strong negative relation between severity of mitral stenosis and GLPS. GLPS was affected in severe mitral stenosis only. Conclusion Subtle LV systolic dysfunction is present in large number of patients with severe mitral stenosis even in patients with normal ejection fraction by conventional 2D echocardiography.There was a significant relationship between the duration of mitral stenosis and its severity. The longer the duration of mitral stenosis, the more severe the mitral stenosis.Speckle tracking echocardiography (STE) can play a great role in identification of higher risk subgroups in whom earlier and more aggressive intervention could have a significant impact on their prognosis.

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